Critical Illness Versus End-of-Life Conversations:A Novel Curriculum for Enhancing Resident Physician Communication Skills.

Abstract

End-of-life (EOL) discussions are of utmost importance to emergency medicine physicians, and residency programs vary in their training on this subject, despite being an Accreditation Council for Graduate Medical Education requirement. The primary objective of this work was to improve resident familiarity by delivering bad news to patients and/or families in time of critical illness and/or EOL discussions. The secondary objective was exposure to interpreting living wills and physician orders for life-sustaining treatment, which previous data from our department indicated that residents are generally unfamiliar with. During two yearly sessions, emergency medicine residents received training on EOL discussions. Each session included a seminar on how to approach the delivery of difficult news to patients and families and how to engage them in conversation. Before and after each seminar, participants were asked to complete an online survey regarding experience, current comfort with EOL discussions, and demographics. While there was a minor increase in self-reported confidence in EOL conversations among first- and second-year residents after training sessions, third-year residents did not see this benefit. There was no statistically significant presession to postsession change in comfort level for any postgraduate year. Only in presurveys was there a statistically significant increase in overall confidence as residency year increased both in delivering the news that a loved one has died (P < 0.001) and in discussing the withdrawal of care (P = 0.01). While no specific questions showed significant improvement in postcurriculum, general participant feedback indicated that these sessions were meaningful and beneficial additions to their residency curriculum. Our novel curriculum increased self-reported confidence in discussing EOL issues, especially among first- and second-year emergency medicine resident physicians. Training and experience with EOL conversations not only helps residents but ultimately benefits patients and their families.