Teaching palliative care and end-of-life issues: a core curriculum for surgical residents.

Abstract

Most surgical training programs have no curriculum to teach palliative care. Programs designed for nonsurgical specialties often do not meet the unique needs of surgeons. With 80-hour workweek limitations on in-hospital teaching, new methods are needed to efficiently teach surgical residents about these problems. A pilot curriculum in palliative surgical care designed for residents was presented in three 1-hour sessions. Sessions included group discussion, role-playing exercises, and instruction in advanced clinical decision making. Residents completed pretest, posttest, and 3-month follow-up surveys designed to measure the program's success. Forty-seven general surgery residents from Brown University participated. Most residents (94%) had "discussed palliative care with a patient or patient's family" in the past. Initially, 57% of residents felt "comfortable speaking to patients and patients' families about end-of-life issues," whereas at posttest and at 3-month intervals, 80% and 84%, respectively, felt comfortable (P < .01). Few residents at pretest (9%) thought that they had "received adequate training in palliation during residency," but at posttest and at 3-month follow-up, 86% and 84% of residents agreed with this statement (P < .01). All residents believed that "managing end-of-life issues is a valuable skill for surgeons." Ninety-two percent of residents at 3-month follow-up "had been able to use the information learned in clinical practice." With a reasonable time commitment, surgical residents are capable of learning about palliative and end-of-life care. Surgical residents think that understanding palliative care is a useful part of their training, a sentiment that is still evident 3 months later.