Sage Journals: Discover world-class research

Abstract

Background:

The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice.

Objective:

This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains.

Methods:

An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort).

Results:

65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well.

Conclusions:

Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents’ short-term comprehension and increased the number of palliative consults.

Keywords

education palliative medicine hospice care residency GME internal medicine

Get full access to this article

View all access options for this article.

References

Aparicio

. The importance of palliative care in chronic disease management. UBCMJ. 2019;11(1):7–8.

Weissman

Mullan

Ambuel

Von Gunten

End-of-life care curriculum reform: outcomes and impact in a follow-up study of internal medicine residency programs. J Palliat Med. 2002;5(4):497–506.

National Institute on Aging. What are palliative care and hospice care? 2017. Accessed on March 23, 2020. https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care#hospice

Thiel

Harden

Brazier

Marks

Smith

. Evaluation tools for interdisciplinary palliative care learning experiences: a literature review. J Palliat Med. 2019. doi:10.1089/jpm.2019.0394

Lori

Biondo

, et al. Neurology resident learning in an end-of-life/palliative care course. J Palliat Med. 2007;10(1):178–181.

Von Gunten

Twaddle

Preodor

Johnson Neely

Martinez

Lyons

. Evidence of improved knowledge and skills after an elective rotation in a hospice and palliative care program for internal medicine residents. Am J Hosp Palliat Me. 2005;22(3):195–203.

Olden

Quill

Bordley

Ladwig

. Evaluation of a required palliative care rotation for internal medicine residents. J Palliat Med. 2009;12(2):150–154.

Vergo

Sachs

MacMartin

Kirkland

Cullinan

Stephens

. Acceptability and impact of a required palliative care rotation with prerotation and postrotation observed simulated clinical experience during internal medicine residency training on primary palliative communication skills. J Palliat Med. 2017;20(5):542–547.

Karlen

Cruz

Leigh

. Resident-led palliative care education project. J Palliat Med. 2016;19(4):428–436.

10.

Ferrell

. Overview of domains of variable relevant to end-of-life care. J Palliat Med. 2005;8(suppl 1):S22–S29.

11.

Lazenby

Ercolano

Schulman-Green

McCorkle

. Validity of the end-of-life professional caregiver survey to assess for multidisciplinary educational needs. J Palliat Med. 2012;15(4):427–431.

12.

Molin

Gallay

Gautier

, et al. PALLIA-10, a screening tool to identify patients needing palliative care referral in comprehensive cancer centers: a prospective multicentric study (PREPA-10). Cancer Med. 2019;8(6):2950–2961.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.17 MB