Psychiatry Resident Education in Palliative Care: Opportunities, Desired Training, and Outcomes of a Targeted Educational Intervention

Abstract

Objectives To assess the educational offerings provided to psychiatry residents in palliative care as well as their concomitant interest in learning more about this subspecialty. To measure the pre- and post-levels of competence, concern, and knowledge exhibited by psychiatry residents when completing a formalized clinical rotation in hospice and palliative care, with additional comparisons to family and internal medicine residents completing the same clinical rotation. Methods Fifty-two Psychiatry Program Directors and 98 psychiatry residents completed an online survey assessing the current course offerings and level of interest in palliative care. Thirty psychiatry residents were additionally evaluated before and after completion of a clinical rotation in hospice and palliative care. Results Few programs offered any formalized training in palliative care, although nearly all psychiatry residents reported interest in this area. A clinical rotation in palliative care significantly increased psychiatry residents’ competence and knowledge while simultaneously decreasing their concerns about practice in this area; most were at levels comparable to family and internal medicine residents completing the same rotation. Psychiatry residents’ knowledge of pain assessment, pain management, and generalized non-pain management were also enhanced during the rotation. Conclusions Results indicate that training opportunities in palliative care are lacking for psychiatry residents in the United States although residents report strong interest in this area. This study finds psychiatry residents can benefit as much as other disciplines from receiving palliative care training. The need to offer such training within psychiatry residencies is highlighted and the welcoming of psychiatrists into palliative care is suggested.

Treatment approaches of palliative medicine specialists for depression in the palliative care setting: findings from a qualitative, in-depth interview study

“…Psychiatry and psychology are implicated in this respect 28–30. To serve in these roles, psychiatrists and psychologists would benefit from training in palliative and EOL care,28 31 and psychiatrists would benefit from having a more equitable balance of psychotherapeutic and pharmacotherapeutic focus in their training 32. There is evidence that treatment guidelines and education strategies by themselves are ineffective in improving the management of depression,33 34 and the integration of psychiatrists and psychologists into palliative care teams may be argued as a superior service model,29 30 which can allow continuing mental health education and assist teams in maintaining a sense of self-sufficiency while being adequately supported.…”

End-of-Life Care and Psychiatry: Current Trends and Future Directions in India

“…Palliative care psychiatry is a specialized area, focussing not just on advanced, progressive, life-limiting illnesses but also has a function to perform in severe psychiatric illnesses such as schizophrenia and bipolar disorders (Irwin and Montross, 2011[16]).…”

Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

“…Irwin et al (2011) present data from a survey of general psychiatry training directors and residents, indicating that, with respect to palliative care psychiatry, formal learning opportunities within general residency programs are lacking, despite a high degree of interest among trainees. Further, they showed that a clinical rotation in palliative care (including supervised clinical activities in a community-based hospice program, communication training, and didactic instruction in palliative care) was associated with significant gains in competence and knowledge, as well as significant decreases in concerns about practicing in the palliative care setting [42]. …”

“…As mentioned, trainees have indicated a strong interest in learning about how to apply their new skills in psychiatry to the care of seriously-ill patients [42], and the task of developing effective learning opportunities will fall to those psychiatrists and training programs that recognize the value that psychiatric expertise can add to palliative care. Hospice and Palliative Medicine fellowship programs will need to find a way to accept fellows from every discipline that sponsors this valuable subspecialty, including psychiatry and neurology.…”