An Educational Intervention To Improve Resident Comfort with Communication at the End of Life

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Abstract
Background: Approximately 20% of deaths in the United States occur in the intensive care unit (ICU). Physician trainees lack the practical communication skills required for end-of-life care, including establishing patient preferences, participating in shared decision making, discussing prognosis, and delivering bad news. Utilizing facilitated, case-based, peer interactions, we sought to assess the feasibility and impact of a novel resident curriculum in end-of-life education. Methods: The study took place at each of the three University of California, San Francisco (UCSF) teaching hospitals, and involved all internal medicine residents at UCSF. The curriculum consisted of two one-hour lunch conference sessions and six one-hour morning reports. A pre- and post-intervention electronic survey was administered. Results and discussion: The teaching sessions offered in this study were well-attended and well-received by residents. Our curriculum impacted resident reports of comfort with specific topics in end-of-life care, including discussions of code status and comfort care. Furthermore, we found that this curriculum, although brief, demonstrated a small impact on resident reports of self-efficacy for communication. Our findings demonstrate the feasibility of incorporating end-of-life communication skills training into an existing internal medicine resident curriculum.

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