Article Text

  1. S. F. Green,
  2. K. Deep,
  3. J. F. Wilson,
  4. C. H. Griffith
  1. University of Kentucky, Lexington, KY


Purpose Residents are frequently confronted with end-of-life (EOL) communication issues in multiple practice settings. Medical education in the area of EOL communication, like many skills, tends to be that of "see one, do one, teach one. " This study was designed to assess residents' self-perceived skill, comfort, and satisfaction with outcomes related to these discussions within the current training paradigm. We also sought to determine the aspects of EOL discussions that cause residents the most difficulty in order to plan for future educational interventions.

Methods We administered an anonymous survey in September 2005 to current internal medicine and medicine-pediatrics residents and physicians who had completed our residency in June 2005. Residents were asked to rate their skill, comfort level, and satisfaction with outcome of discussions concerning the three EOL issues of code status, futile care, and withdrawal of care on a 5-point Likert scale (low = 1; high = 5). Responses rated 4 or 5 were coded as "skilled " or "comfortable. " Residents were also asked in an open-ended question to identify the most challenging aspect of EOL situations.

Results Our response rate was 64%. Residents felt skilled (64%) and comfortable (69%) with code status and less so for futile care (44% skilled, 48% comfortable) and withdrawal of care (46% skilled, 51% comfortable). Regarding code status, nearly 70% of residents felt that they achieved a satisfactory result often or always. This percentage was much lower regarding futile care (< 45%) and withdrawal of care (51% often, zero always). Greater than 50% of residents identified communicating with family as the most challenging aspect of EOL situations.

Conclusions Residents do not perceive themselves to be highly skilled in EOL discussions concerning futile care or withdrawal of care. Their relatively low levels of satisfaction with outcomes may reflect their low comfort level with discussing these issues. A more structured educational component that focuses on improving communication skills and addressing family fears, concerns, and conflicts may improve residents' comfort and satisfaction with EOL discussions.

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