A program to strengthen first year residents' proficiency in leading end-of-life discussions



PubMed - indexed for MEDLINE


Williams DM, Fisicaro T, Veloski JJ, Berg D


Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. donnamw78@gmail.com


Development and evaluation of a program to strengthen first year residents' proficiency in leading end-of-life discussions


Am J Hosp Palliat Care.2011 Aug;28(5):328-34. Epub 2010 Dec 13




Multiple interventions have been developed to teach and improve internal medicine residents' end-of-life communication skills, but have not been easily adaptable to other institutions. The purpose of this study was to develop and evaluate a program to enhance physicians' end-of-life communication with families of dying patients using a format that could be incorporated into an existing curriculum for first-year internal medicine residents.


An end-of-life educational program was developed and evaluated in the context of educating first-year residents at an urban academic medical center during the 2008-2009 academic year. The program consisted of three sessions including an interactive workshop flanked by pre- and post-workshop evaluations in simulated encounter and clinical vignette formats. Simulated encounters were recorded on video and residents' performances were rated by two independent observers using a 23 point checklist.


Complete data were available for 24 (73%) of 33 residents who participated in the program. The residents' checklist scores increased significantly from a mean of 48.1 at baseline to 73.9 at follow-up. The increase in the scores on the clinical vignettes was also statistically significant, but of lesser magnitude.


A short, focused intervention can have significant impact on residents' communication skills in the setting of an end-of-life objective structured clinical examination (OSCE).