Abstract
Background
: House officers frequently lack basic competency in end-of-life care. Few studies have evaluated educational interventions deliberately utilizing physicians' learning strategies, particularly in the context of a concomitant effort at modification of practice patterns.
Study design
: Prospective controlled trial utilizing preintervention and postintervention cross-sectional surveys.
Participants
: Internal medicine residents at a university hospital in their first, second, and third years of training.
Survey
: A 25-item survey modified from previously published instruments.
Intervention
: Residents in the intervention group utilized an experiential learning intervention (integrated, end-of-life clinical pathway: PEACE Tool). The control group delivered care in a standard fashion.
Data analysis
: Survey item and test responses were tabulated and pair-wise comparisons between group means evaluated statistically using two-sample t tests.
Results
: Fifty-four internal medicine residents (n = 24, first-year; n = 17, second-year; and n = 13, third-year) completed the survey. Preintervention mean scores on a 16-item knowledge scale were 7.4 (46% correct) for first-year, 8.1 (51%) for second-year, and 9.2 (58%) for third-year residents. Eighteen first-year residents participated in the intervention phase (8 in the intervention, 10 in the control). Mean overall knowledge scores were 46% higher in the intervention group compared to the control group (11.8 versus 8.1 p < 0.001).
Conclusions
: A time-effective, practice-based strategy led to a significant improvement in knowledge of end-of-life care. Prior to implementation of this strategy competency in end-of-life care was suboptimal among internal medicine residents, in spite of desirable attitudes. Factual knowledge improved slightly with standard, preintervention training and experience.
Get full access to this article
View all access options for this article.