Are Internal Medicine Residents Meeting the Bar? Comparing Resident Knowledge and Self-Efficacy to Published Palliative Care Competencies

Abstract

Background:

There is a need for improved primary palliative care (PC) education and resident comfort with providing end-of-life care.

Objective:

Utilize a new instrument derived from published PC competencies to assess baseline Internal Medicine (IM) resident knowledge and self-efficacy in PC to identify educational gaps and create new PC curricula.

Design:

We created a 2-part instrument including a Knowledge Test (KT) and a Self-Efficacy Inventory (SEI) addressing 18 PC resident competencies across 5 domains: Pain and Symptom Management (PSM), Communication (COMM), Psychosocial, Spiritual, and Cultural Aspects of Care (PSC), Terminal Care and Bereavement (TCB), and Palliative Care Principles and Practice (PCPP).

Setting/Subjects:

The instrument was emailed to IM residents at our institution during academic years 2015-2016 and 2016-2017.

Measurements:

Basic descriptive statistics were performed for the KT and SEI. Mean Rank Analysis and One-way ANOVA were utilized for the KT and SEI, respectively. Congruence was calculated between knowledge and self-efficacy.

Results:

The mean score on the KT was 73% (range 33-80%). There was no significant difference in knowledge among post-graduate year cohorts. Self-efficacy scores were lower for interns overall and in PCPP, TCB, and COMM domains. Knowledge was concordant with self-efficacy in 42% of participants, higher than self-efficacy in 10% of participants, and lower than self-efficacy in 48% of participants.

Conclusions:

For approximately half of respondents, high self-efficacy in PC did not correlate with high PC knowledge. A more focused curriculum is needed to help IM residents facilitate mastery of PC competencies by graduation.

Keywords

palliative care education internal medicine palliative care competencies resident knowledge resident comfort end-of-life care resident education needs assessment

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References

Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The National Academies Press; 2015. https://doi.org/10.17226/18748.

Lupu

Quigley

Mehfoud

Salsberg

. The Growing demand for hospice and palliative medicine physicians: will the supply keep up? J Pain Symptom Manage. 2018;55(4):1216–1223. doi:10.1016/j.jpainsymman.2018.01.011

Kamal

Bull

Wolf

, et al. Characterizing the hospice and palliative care workforce in the U.S.: clinician demographics and professional responsibilities. J Pain Symptom Manage. 2016;51(3):597–603. doi:10.1016/j.jpainsymman.2015.10.016

Curtis

Kross

Stapleton

. The Importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). J Am Med Assoc. 2020;323(18):1771–1772. doi:10.1001/jama.2020.4894

Arya

Buchman

Gagnon

Downar

. Pandemic palliative care: beyond ventilators and saving lives. Can Med Assoc J. 2020;192(15):E400–E404. doi:10.1503/cmaj.200465

Edwards

Nam

. Palliative care exposure in internal medicine residency education: a survey of ACGME internal medicine program directors. Am J Hosp Palliat Med. 2018;35(1):41–44. doi:10.1177/1049909116687986

Case

Orrange

Weissman

. Palliative medicine physician education in the United States: a historical review. J Palliat Med. 2013;16(3):230–236. doi:10.1089/jpm.2012.0436

Luthy

Cedraschi

Pautex

Rentsch

Piguet

Allaz

. Difficulties of residents in training in end-of-life care. A qualitative study. Palliat Med. 2009;23(1):59–65. doi:10.1177/0269216308098796

Kawaguchi

Mirza

Nissim

Ridley

. Internal medicine residents’ beliefs, attitudes, and experiences relating to palliative care: a qualitative study. Am J Hosp Palliat Med. 2017;34(4):366–372. doi:10.1177/1049909116628799

10.

Lester

Daroowalla

Harisingani

, et al. Evaluation of housestaff knowledge and perception of competence in palliative symptom management. J Palliat Med. 2011;14(2):139–145. doi:10.1089/jpm.2010.0305

11.

Schaefer

Chittenden

Sullivan

, et al. Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents. Acad Med. 2014;89(7):1024–1031. doi:10.1097/ACM.0000000000000271

12.

Moyer

Morrison

Encandela

Kennedy

Ellman

. A New competency-based instrument to assess resident knowledge and self-efficacy in primary palliative care. Am J Hosp Palliat Med. 2020;37(2):117–122. doi:10.1177/1049909119855612

13.

Artino

. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ. 2012;1(2):76–85. doi:10.1007/s40037-012-0012-5

14.

Edgar

McLean

Hogan

Hamstra

Holmboe

. The Milestones Guidebook. Accreditation Council for Graduate Medical Education (ACGME); 2020. Accessed December 19, 2020. https://www.acgme.org/Portals/0/MilestonesGuidebook.pdf

15.

Fischer

Gozansky

Kutner

Chomiak

Kramer

Palliative care education: an intervention to improve medical residents’ knowledge and attitudes. J Palliat Med. 2003;6(3):391–399. doi:10.1089/109662103322144709

16.

Kruger

Dunning

Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121–1134. doi:10.1037/0022-3514.77.6.1121

17.

Krajc

. Are the unskilled really that unaware? Understanding seemingly biased self-assessments. (November 1, 2008). CERGE-EI Working Paper Series No. 373. SSRN: https://ssrn.com/abstract=1483793 or http://dx.doi.org/10.2139/ssrn.1483793

18.

von Gunten

Mullan

Nelesen

, et al. Primary care residents improve knowledge, skills, attitudes, and practice after a clinical curriculum with a hospice. Am J Hosp Palliat Med. 2017;34(8):713–720. doi:10.1177/1049909116655767

19.

Bapat

Ellman

Morrison

. Assessing resident palliative care education: lessons learned for curriculum mapping in graduate medical education. MedEdPublish. 2018. doi:10.15694/mep.2018.0000259.1

20.

Schmit

Meyer

Duff

Dai

Zou

. Perspectives on death and dying: a study of resident comfort with end-of-life care. BMC Med Educ. 2016;16. doi:10.1186/s12909-016-0819-6

21.

Batt-Rawden

Chisolm

Anton

Flickinger

. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88(8):1171–1177. doi:10.1097/ACM.0b013e318299f3e3

22.

Morrison

Shapiro

Harthill

. Resident doctors’ understanding of their roles as clinical teachers. Med Educ. 2005;39(2):137–144. doi:10.1111/j.1365-2929.2004.02063.x

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