The status of medical education in end-of-life care

Abstract

OBJECTIVE:To assess the status of medical education in endof-life care and identify opportunities for improvement.DESIGN: Telephone survey. SETTING: U.S. academic medical centers.PARTICIPANTS: National probability sample of 1,455 students, 296 residents, and 287 faculty (response rates 62%, 56%, and 41%, respectively) affiliated with a random sample of 62 accredited U.S. medical schools. MEASUREMENTS AND MAIN RESULTS:Measurements assessed attitudes, quantity and quality of education, preparation to provide or teach care, and perceived value of care for dying patients. Ninety percent or more of respondents held positive views about physicians' responsibility and ability to help dying patients. However, fewer than 18% of students and residents received formal end-of-life care education, 39% of students reported being unprepared to address patients' fears, and nearly half felt unprepared to manage their feelings about patients' deaths or help bereaved families. More than 40% of residents felt unprepared to teach end-of-life care. More than 40% of respondents reported that dying patients were not considered good teaching cases, and that meeting psychosocial needs of dying patients was not considered a core competency. Forty-nine percent of students had told patients about the existence of a life-threatening illness, but only half received feedback from residents or attendings; nearly all residents had talked with patients about wishes for end-of-life care, and 33% received no feedback.CONCLUSIONS: Students and residents in the United States feel unprepared to provide, and faculty and residents unprepared to teach, many key components of good care for the dying. Current educational practices and institutional culture in U.S. medical schools do not support adequate end-of-life care, and attention to both curricular and cultural change are needed to improve end-of-life care education. T he emerging field of hospice and palliative medicine has experienced tremendous growth in recent years, fueled by deepening public and professional awareness of deficiencies in clinical care of patients at the end of life, 1±5 recognition of the emotional, ethical, and economic costs of inadequate or overly aggressive care for the dying, 6±8 and a vision, rooted in the hospice movement, of the potential for skillful and compassionate end-of-life care for dying patients and their families. 9,10 Attention to the need for physician education in end-of-life care has generated numerous initiatives to improve education and training at all levels. 11±16 Researchers and educators have noted, however, that without attention to the informal or``hidden'' curriculum Ð that is, the values, attitudes, beliefs and behaviors that constitute the culture of medicine Ð reforms of the formal curriculum are unlikely to succeed. 17,18 Understanding and addressing the influences of peers, role models, and norms and practices related to end-of-life care are necessary for curricular change to translate into improved skills, attitudes, and practices in caring ...

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