How do junior doctors in the UK learn to provide end of life care: a qualitative evaluation of postgraduate education

Abstract

BackgroundThe fundamental importance of good end of life care has been well documented however recent national publications have high-lighted inadequacies in training in this area. For many patients dying in the UK today care is provided in hospital and the number of inpatient deaths is forecast to climb significantly in future. The demands of providing medical care for these patients by junior doctors will continue to rise. However, there is currently only limited research on training for doctors in this setting.MethodsA qualitative study using semi-structured interviews of trainees working in general medicine analysed utilising a grounded theory approach.ResultsEleven medical trainees from nine different medical schools participated. They had worked in fifteen different UK hospitals in the course of their careers. All of the doctors interviewed felt generally confident in managing a dying patient. This had developed at postgraduate level and increased when working in certain key specialties. Emerging themes fell into five main categories: perceived ability in clinical management, different learning opportunities experienced, the impact of variations in approach to end of life care, the role of the specialist palliative care team and suggestions for improvements to training. All participants felt further teaching would be beneficial.ConclusionsThis study identified key areas where training could be improved. This included small changes in everyday practice to shift the emphasis for trainees to education. There also needs to be focus on end of life care in the curriculum, formal teaching programmes and assessment of junior doctors. The specialist palliative care team played a vital role in training as well as service provision. For those working in this specialty, every clinical encounter provides an opportunity for education. Specifically targeting junior doctors will not only improve patient care today but empower the consultants of the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0039-6) contains supplementary material, which is available to authorized users.

Care of the dying: a qualitative exploration of Foundation Year doctors’ experiences

“…Despite recommendations that a senior clinician is involved in recognising dying, the EOLCA identified that for a quarter of patients (24%) this did not happen . The data highlight the importance of senior support for FYs in this regard, which is echoed elsewhere for juniors further along in their training . Where senior clinicians remain actively involved in the care of the dying, better care is provided by the whole team, who are supported in this.…”

“…Models exist but are variably implemented . The palliative care team was identified as an important source of support, which is reinforced elsewhere . Clinical, practical and emotional support for all doctors caring for dying patients has been identified by the British Medical Association as important .…”

“…5 The data highlight the importance of senior support for FYs in this regard, which is echoed elsewhere for juniors further along in their training. 12 Where senior clinicians remain actively involved in the care of the dying, better care is provided by the whole team, who are supported in this. Where seniors 'abdicate', then decision making and care is left to the most inexperienced and poorly supported member of the team.…”

“…9,10,25 The palliative care team was identified as an important source of support, which is reinforced elsewhere. 12,14 Clinical, practical and emotional support for all doctors caring for dying patients has been identified by the British Medical Association as important. 11 Therefore it is crucial that this support is also provided for the most junior, least experienced doctors, the FYs.…”

Education and Training: Perceived educational impact, ­challenges and opportunities of hospice placements for foundation year doctors: a qualitative study

“…6,7,8 They have described 'being left' to cope, fearful that their lack of experience could make things worse for patients. 9 Palliative care is often learnt on the job, with little formal teaching. 10 F1s can find communication about end-of-life decisions and recognition of the dying phase challenging and can also lack knowledge of cancer care and symptoms.…”