Death pronouncements: using the teachable moment in end-of-life care residency training.

Abstract

Performing death pronouncement and communicating effectively with gathered family is an important skill relevant to end-of-life care. Often it is a responsibility of first-year residents who lack proper training or emotional preparation for the task. Residents' tension about this task presents an opportunity to positively effect their emotions and build skills for providing end of life care in the future. This paper describes a death pronouncement workshop including its objectives specific to Accreditation Council on Graduate Medical Education (ACGME) competencies, its format and its evolution over 8 years. Multiple media and methods are used in the 90-minute workshop for first-year family practice residents including poetry, prose, and narratives on doing death pronouncements by senior residents; reviews and discussion of protocols for death pronouncement, autopsy, and organ donation; and a role-play of a death pronouncement with the opportunity for reflection. Residents consistently provide high ratings for the overall value of workshop. The death pronouncement workshop serves to prepare residents emotionally to deal with dying patients and provides them the skills to effectively and compassionately communicate with those patients' families while addressing all six ACGME core competencies.