Introduction: Most medical schools are remiss in preparing physicians in end-of-life communication
skills. As a result, many residents are uncomfortable with approaching the patient,
have not developed the skills required to discuss the patients' wishes, and avoid endof-
life conversations.
Objective: To evaluate an educational intervention focused on teaching residents skills to
discuss advance directives.
Methods: Medicine Residents attended a morning report consisting of both didactic training
and participation in a role-play exercise. Charts of inpatients were audited ten days prior
to and five days subsequent to the intervention to ascertain if there was a documented donot-
resuscitate (DNR) discussion.
Results: Seventy-nine records of patients assigned to eight physicians who attended the intervention
and who were responsible for patients before and after the intervention were reviewed.
Of the patients assigned to these residents before the intervention, 32% had a documented
DNR discussion. Thirty-four (34%) of the physicians had discussions after the
intervention, demonstrating only minimal improvement.
Conclusions: A single intervention may be inadequate to affect physician practices related
to DNR discussions. Physicians may need more interactive, experiential learning opportunities
and related supervision over the course of their training in order to improve these communication
skills. A chart review that only records if a DNR discussion was documented in
the medical record may not be the best tool to evaluate the success of this educational intervention.
Improvement in attitudes and knowledge were not able to be measured.
