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End-of-Life Training in US Internal Medicine Residency Programs: A National Study

Cegelka, Derek S
http://rave.ohiolink.edu/etdc/view?acc_num=toledo1461679801

Abstract Details

2016, Doctor of Philosophy, University of Toledo, Health Education.
Purpose: The purpose of this study was to survey the directors of internal medicine residency programs in the United States to determine the current status of end-of-life care education for internal medicine residents. Methods: The study featured a cross-sectional design with total population sampling. All 403 internal medicine residency directors in the United States were surveyed using a 4-wave data collection method to ensure an optimum return rate. The response rate was 52.4% (211/403). Results: Residency directors reported very high outcome expectations regarding the potential positive outcomes of providing residents with formal training in end-of-life skills. More than 90% of directors believed that the quality of care for patients at the end-of-life phase would increase if their residents were taught specific knowledge and skills related to end-of-life care. Although directors believed in the potential benefits of providing end-of-life training to their residents, nearly 1 in 4 programs (24%) reported not having a formal end-of-life curriculum in place. Another 39% had recently decided to implement an end-of-life curriculum or had implemented a curriculum in the last 3 years. Thus, 63% of residency programs either did not have a formal end-of-life curriculum in place or just recently implemented one. Only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Most programs reported spending nine or less hours of instructional time during residency on multiple end-of-life topical areas such as socio-cultural issues (71%), patient care (56%), professionalism (54%), ethical issues (50%), and communication (46%). The majority of residency directors reported that their programs do not formally evaluate residents’ competence in end-of-life topical areas such as socio-cultural issues (77%), patient care (60%), and ethical issues (55%). The most common method used to evaluate residents’ skill competence in caring for patients at end-of-life was verbal feedback by attending physicians and preceptors. The three most prevalent teaching techniques used to teach end-of-life topics were hospital rounds, classroom/conference style teaching, and teaching by preceptors during outpatient clinics. The most common barriers to increasing and/or improving end-of-life education were lack of time in the teaching schedule (46%), lack of faculty members certified in Hospice and Palliative Medicine (26%), and lack of rotation sites/lack of preceptors with needed experience (15%). Conclusion: Internal medicine physicians play an important role in treating patients with life-threatening illnesses, including those at the end-of-life stage. It is important that internal medicine residents are well educated in providing excellent care and communication to such patients. Although there has been progress over the years in end-of-life training of US physicians, internal medicine residency programs still need improvement in this area.
Timothy Jordan, PhD (Committee Chair)
Jiunn-Jye Sheu, PhD (Committee Member)
Joseph Dake, PhD (Committee Member)
Ragheb Assaly, M.D. (Committee Member)
177 p.
Curricula; Education; Gerontology; Medicine
Internal Medicine; End-of-Life; Medical Education; Internal Medicine Residency; Internal Medicine Director; Graduate Medical Education

Recommended Citations

Citations

  • Cegelka, D. S. (2016). End-of-Life Training in US Internal Medicine Residency Programs: A National Study [Doctoral dissertation, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1461679801

    APA Style (7th edition)

  • Cegelka, Derek. End-of-Life Training in US Internal Medicine Residency Programs: A National Study. 2016. University of Toledo, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=toledo1461679801.

    MLA Style (8th edition)

  • Cegelka, Derek. "End-of-Life Training in US Internal Medicine Residency Programs: A National Study." Doctoral dissertation, University of Toledo, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1461679801

    Chicago Manual of Style (17th edition)

toledo1461679801
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This open access ETD is published by University of Toledo and OhioLINK.