Background: In response to the nationwide need for improved care of patients at end of life,
our medical school implemented approximately 20 hours of mandatory coursework on the
care of dying patients for all students, with satisfactory completion required for graduation.
Objective: We now report a long-term evaluation of this coursework.
Design/subjects/measurements: A 74-item questionnaire concerning attainment of palliative
care and other medical school course objectives, postgraduate practice encounters with patients
at end of life, and postgraduate behaviors in palliative care was mailed to all students
who graduated from our medical school in 2000, 2001, and 2002. Responses were graded by a
Likert-type scale. Additionally, the Association of American Medical Colleges Medical School
Graduation Questionnaire (AAMC/GQ) reports for all schools and for our medical school
were queried for data regarding palliative care.
Results: The return rate of the questionnaire was 54%. The respondents perceived the training
to be valuable and effective. They displayed good postgraduate palliative care practices
such as choosing to use opiates other than meperidine for pain in the end-of-life setting. Fiftythree
percent of the respondents reported that dying patients were often or frequently under
their care since graduation. Despite evidence for the efficacy of the training, the respondents
perceived that preparedness in certain palliative care domains was somewhat below preparedness
in benchmark medical school competencies such as assessment/management of hypertension
and diabetes. The AAMC/GQ surveys indicated that for the years 2000–2002, at
least 20% more of our graduates perceived that their training in pain management and palliative
care was adequate than did all other medical students graduating nationwide.
Conclusions: The evaluation provides support for the conclusion that mandatory training
in palliative and end-of-life care is effective, perceived to be valuable, and contributes to good
palliative and end-of-life care practices in our graduates. Furthermore, the training meets a
significant demand in our graduates' clinical practice: end-of-life care. However, expanded
medical school emphasis and curriculum hours are still needed for palliative care topics, because
preparedness in palliative care skills was perceived to be inferior to benchmark medical skills. To our knowledge, this is the first report of a rigorous summative evaluation of
the efficacy of required coursework in palliative and end-of-life care in a U.S. medical school
curriculum.
