Palliative care education: an intervention to improve medical residents' knowledge and attitudes.

Abstract

Medical care at the end of life remains poor. One approach to improving end-of-life care is through education of medical trainees. However, evidence regarding the structure of an ideal educational intervention is sparse. To test an innovative curriculum designed to improve medical resident knowledge and decrease anxiety surrounding end-of-life care. Quasiexperimental study of medical trainees in a large academic internal medicine residency. Attitudes and knowledge were measured at baseline and at completion of a 1-month clinical ward rotation for both control (n = 40) and intervention groups (n = 30) using the Collett-Lester Death Anxiety Scale (C-LDAS), the Semantic Differential Scale (SDS), and a 16-question knowledge-based test. Residents in the intervention group completed four 1-hour sessions focused on end-of-life issues. Baseline anxiety levels were high while knowledge scores were poor. Linear regression modeling demonstrated that pretest scores were the strongest predictor of post-test scores for all three measures. Additional significant predictors for the knowledge test were prior palliative care experience and year of training (p = 0.02), while prior palliative care experience alone contributed to the SDS model (p = 0.06). No significant improvements on the SDS, C-LDAS, or knowledge test occurred after the curriculum intervention. Our classroom intervention had no significant effect on residents' attitudes towards or knowledge of end-of-life care. The fact that prior palliative care experience affects baseline scores provides a strong argument for continued research for an effective curriculum for end-of-life education, perhaps focusing on clinical rather than didactic experiences in palliative care.