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Paulsen K, Wu DS, Mehta AK. Primary Palliative Care Education for Trainees in U.S. Medical Residencies and Fellowships: A Scoping Review. J Palliat Med 2020; 24:354-375. [PMID: 32640863 DOI: 10.1089/jpm.2020.0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: The medical profession increasingly recognizes the growing need to educate nonpalliative physicians in palliative care. Objective: This study aims to provide a scoping review of the primary palliative care (PPC) education currently available to graduate medical trainees in primary and specialty tracks. Design: Studies of PPC interventions in U.S. residency or fellowship programs of all subspecialties published in English and listed on MEDLINE, CINAHL, and EMBASE through January 2020 were included. To meet admission criteria, studies had to describe the content, delivery methods, and evaluation instruments of a PPC educational intervention. Results: Of 233 eligible full texts, 85 studies were included for assessment, of which 66 were novel PPC educational interventions and 19 were standard education. Total number of publications evaluating PPC education increased from 8 (2000-2004) to 36 (2015-2019), across 11 residency and 10 fellowship specialties. Residency specialties representing the majority of publications were emergency medicine, general surgery, internal medicine, and pediatric/medicine-pediatrics. PPC content domains most taught in residencies were communication and symptom management; the primary delivery method was didactics, and the outcome assessed was attitudes. Fellowship specialties representing the majority of publications were pediatric subspecialties, nephrology, and oncology. The PPC content domain most taught in fellowships was communication; the primary delivery method was didactics and the outcome evaluated was attitudes. Conclusions: While PPC education has increased, it remains varied in content, delivery method, and intervention evaluations. Future studies should include more widespread evaluation of behavioral outcomes, longitudinal persistence of use, and clinical impact.
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Affiliation(s)
- Kate Paulsen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - David S Wu
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, University of California, Los Angeles Medical Center, Santa Monica, California, USA
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Glod SA, Kang A, Wojnar M. Family Meeting Training Curriculum: A Multimedia Approach With Real-Time Experiential Learning for Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10883. [PMID: 32175474 PMCID: PMC7062545 DOI: 10.15766/mep_2374-8265.10883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Effective communication skills are widely recognized as an important aspect of medical practice. Several tools and curricula for communications training in medicine have been proposed, with increasing attention to the need for an evidence-based curriculum for communication with families of patients in the intensive care unit (ICU). METHODS We developed a curriculum for internal medicine residents rotating through the medical ICU that consisted of a didactic session introducing basic and advanced communication skills, computer-based scenarios exposing participants to commonly encountered dilemmas in simulated family meetings, and experiential learning through the opportunity to identify potential communication challenges prior to facilitating actual family meetings, followed by structured peer debriefing. Seventeen residents participated in the study. RESULTS We administered the Communication Skills Attitude Scale to participants before and after participation in the curriculum, as well as a global self-efficacy survey, with some items based on the Common Ground rating instrument, at the end of the academic year. There were no significant changes in either positive or negative attitudes toward learning communication skills. Resident self-perceived efficacy in several content domains improved but did not reach statistical significance. DISCUSSION Our curriculum provided interactive preparatory training and an authentic experience for learners to develop skills in family meeting facilitation. Learners responded favorably to the curriculum. Use of the Family Meeting Behavioral Skills (FMBS) tool helped residents and educators identify and focus on specific skills related to the family meeting. Next steps include gathering and analyzing data from the FMBS tool.
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Affiliation(s)
- Susan A. Glod
- Associate Professor, Department of Medicine, Penn State College of Medicine
- Medicine Clerkship Director, Penn State College of Medicine
| | - Ashley Kang
- Resident, Internal Medicine Residency Program, Montefiore Medical Center
| | - Margaret Wojnar
- Professor, Department of Medicine, Penn State College of Medicine
- Pulmonary/Critical Care Fellowship Director, Penn State College of Medicine
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Schoenborn NL, Cayea D, McNabney M, Ray A, Boyd C. Prognosis communication with older patients with multimorbidity: Assessment after an educational intervention. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:471-481. [PMID: 26885757 PMCID: PMC5826548 DOI: 10.1080/02701960.2015.1115983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to assess how internal medicine residents incorporated prognosis to inform clinical decisions and communicated prognosis in primary care visits with older patients with multimorbidity after an educational intervention, and resident and patient perspectives regarding these visits. Assessment used mixed-methods. The authors assessed the frequency and content of prognosis discussions through residents' self-report and qualitative content analysis of audio-recorded clinic visits. The authors assessed the residents' perceived effect of incorporating prognosis on patient care and patient relationship through a resident survey. The authors assessed the patients' perceived quality of communication and trust in physicians through a patient survey. The study included 21 clinic visits that involved 12 first-year residents and 21 patients. Residents reported incorporating patients' prognoses to inform clinical decisions in 13/21 visits and perceived positive effects on patient care (in 11/13 visits) and patient relationship (in 7/13 visits). Prognosis communication occurred in 9/21 visits by self-report, but only in six of these nine visits by content analysis of audio-recordings. Patient ratings were high regardless of whether or not prognosis was communicated. In summary, after training, residents often incorporated patients' prognoses to inform clinical decisions, but sometimes did so without communicating prognosis to the patients. Residents and patients reported positive perceptions regarding the visits.
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Affiliation(s)
- Nancy L. Schoenborn
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Danelle Cayea
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Matthew McNabney
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
| | - Anushree Ray
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
- Ms. Ray was working as research assistant during this project at the Johns Hopkins School of Medicine but has since moved. She currently works as project manager at Medline Industries
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine
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Bear A, Keuter T, Patel JJ. The Impact of Teaching Prognostication at the End of Life: A Pre-Post Interventional Study. Am J Hosp Palliat Care 2017; 35:473-477. [PMID: 28731361 DOI: 10.1177/1049909117721697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Providing accurate and valid prognostic information significantly influences end-of-life care. Disclosing a poor prognosis can be among the most difficult of physician responsibilities, thus having appropriate knowledge during training is crucial for appropriate prognostication. OBJECTIVE To provide internal medicine (IM) house staff with a pre- and posteducational survey to determine their ability to accurately prognosticate 5 common end-stage diseases. DESIGN We conducted a pre- and posteducational intervention survey-based study. A preintervention survey was administered to IM postgraduate year 1 (PGY-1) and PGY-2-4 house staff. The survey consisted of case scenarios for 5 common end-stage diseases, containing 1 question on comfort level and 2 on prognostication (totaling 10 points). A 30-minute educational intervention was presented immediately after the initial survey. The same survey was readministered 4 weeks thereafter. An identical survey was administered once to palliative care faculty. RESULTS Forty house staff completed pre- and posteducational surveys. Eight palliative care faculty completed the survey. No difference was found between all house staff pre- and postscores (mean 2.70 [1.45] vs 2.78 [1.59], P = .141). There was no significant difference between PGY-1 and PGY-2-4 pretest scores (mean 2.63 [1.71] vs 2.81 [1.42], P = .72). The PGY-2-4 posttest score was significantly greater than PGY-1 posttest score (3.38 [1.58] vs 2.38 [1.58], P = .05). Total house staff posttest score was significantly lower than gold standard palliative care faculty (mean 4.71 [1.98] vs 2.78 [1.59], P = .006). CONCLUSIONS Our pre-post intervention survey-based study demonstrates no significant increases in all house staff scores. The PGY-2-4 postintervention scores improved significantly. We speculate the optimal time for prognostication education may be after the PGY-1 year when house staff have had sufficient exposure to common conditions.
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Affiliation(s)
- Alexandria Bear
- 1 Division of Palliative Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tucker Keuter
- 2 Department of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jayshil J Patel
- 3 Division of Pulmonary, Critical Care & Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Cheng HY, Davis M. Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes. J Grad Med Educ 2017; 9:33-45. [PMID: 28261392 PMCID: PMC5319626 DOI: 10.4300/jgme-d-16-00037.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. OBJECTIVE This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? METHODS We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. RESULTS Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). CONCLUSIONS Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.
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Affiliation(s)
- Huai Yong Cheng
- Corresponding author: Huai Yong Cheng, MD, MPH, University of Virginia, Division of General Medicine, Geriatrics, and Palliative Care Medicine and Hospital Medicine, PO Box 800901, Charlottesville, VA 22981, 434.924.4849, fax 434.243.9282,
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Yacht AC, Suglia SF, Orlander JD. Evaluating an End-of-Life Curriculum in a Medical Residency Program. Am J Hosp Palliat Care 2016; 23:439-46. [PMID: 17210997 DOI: 10.1177/1049909106294829] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The ability to meet patient needs at the end of life is important. Boston University Residency Program in Medicine initiated a 1-week-long end-of-life curriculum that included a hospice care orientation, core articles, and home hospice visits. Evaluated was the impact of the rotation on participant knowledge and attitude. Knowledge was assessed by pretest and posttest questionnaires and compared with more senior resident controls, naïve to the curriculum. Attitudes toward issues relating to end-of-life care and subjective change in knowledge were assessed comparing subjects' retrospective preintervention and postintervention responses included in the postintervention questionnaire. Forty-five second-year participants completed both questionnaires. Participants demonstrated significant improvements in attitude and self-assessed knowledge of end-of-life care in 23 of 24 Likert-type scale questions. The end-of-life curriculum led to significant improvements in participant knowledge and attitudes about the conceptual and practical aspects of end-of-life care. The structure of the rotation should be reproducible in many locales.
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Schoenborn NL, Boyd C, Cayea D, Nakamura K, Xue QL, Ray A, McNabney M. Incorporating prognosis in the care of older adults with multimorbidity: description and evaluation of a novel curriculum. BMC MEDICAL EDUCATION 2015; 15:215. [PMID: 26628049 PMCID: PMC4665923 DOI: 10.1186/s12909-015-0488-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/18/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Prognosis is a critical consideration in caring for older adults with multiple chronic conditions, or "multimorbidity". Clinicians are not adequately trained in this area. We describe an innovative curriculum that teaches internal medicine residents how to incorporate prognosis in the care of older adults with multimorbidity. METHODS The curriculum includes three small-group sessions and a clinical exercise; it focuses on the assessment, communication, and application of prognosis to inform clinical decisions. The curriculum was implemented with 20 first-year residents at one university-based residency (intervention group). Fifty-two first-year residents from a separate residency affiliated with the same university served as controls. Evaluation included three components. A survey assessed acceptability. A pre/post survey assessed attitude, knowledge, and self-reported skills (Impact survey). Comparison of baseline and follow-up results used paired t-test and McNemar test; comparison of inter-group differences used t-test and Fisher's exact test. A retrospective, blinded pre/post chart review assessed documentation behavior; abstracted outcomes were analyzed using Fisher's exact test. RESULTS The curriculum was highly rated (4.5 on 5-point scale). Eighteen intervention group residents (90 %) and 29 control group residents (56 %) responded to the Impact survey. At baseline, there were no significant inter-group differences in any of the responses. The intervention group improved significantly in prognosis communication skills (5.2 to 6.6 on 9-point scale, p < 0.001), usage of evidence-based prognostic tools (1/18 to 14/18 responses, p < 0.001), and prognostic accuracy (1/18 to 9/18 responses, p = 0.005). These responses were significantly different from the control group at follow-up. Of 71 charts reviewed in each group, prognosis documentation in the intervention group increased from 1/25 charts (4 %) at baseline to 8/46 charts (17 %) at follow-up (p = 0.15). No prognosis documentation was identified in the control group at either time point. Inter-group difference was significant at follow-up (p = 0.006). CONCLUSION We developed and implemented a novel prognosis curriculum that had significant short-term impact on the residents' knowledge and communication skills as compared to a control group. This innovative curriculum addresses an important educational gap in incorporating prognosis in the care of older adults with multimorbidity.
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Affiliation(s)
- Nancy L Schoenborn
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 2200, Baltimore, MD, 21224, USA.
| | - Cynthia Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 2200, Baltimore, MD, 21224, USA.
| | - Danelle Cayea
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 2200, Baltimore, MD, 21224, USA.
| | - Kelly Nakamura
- Harborview Medical Center, University of Washington, Seattle, WA, USA.
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 2200, Baltimore, MD, 21224, USA.
| | | | - Matthew McNabney
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 2200, Baltimore, MD, 21224, USA.
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Yamamoto R, Kizawa Y, Nakazawa Y, Morita T. The Palliative Care Knowledge Questionnaire for PEACE: Reliability and Validity of an Instrument To Measure Palliative Care Knowledge among Physicians. J Palliat Med 2013; 16:1423-8. [DOI: 10.1089/jpm.2013.0112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ryo Yamamoto
- Palliative Care Team, Saku Central Hospital, Nagano, Japan
| | | | - Yoko Nakazawa
- Department of Palliative Care Nursing, University of Tokyo, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan
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Keijsers CJPW, van Hensbergen L, Jacobs L, Brouwers JRBJ, de Wildt DJ, ten Cate OTJ, Jansen PAF. Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review. Br J Clin Pharmacol 2013; 74:762-73. [PMID: 22416832 DOI: 10.1111/j.1365-2125.2012.04268.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The rate of medication errors is high, and these errors can cause adverse drug reactions. Elderly individuals are most vulnerable to adverse drug reactions. One cause of medication errors is the lack of drug knowledge on the part of different health professionals. Medical curricula have changed in recent years, resulting in less education in the basic sciences, such as pharmacology. WHAT THIS STUDY ADDS Our study shows that little curricular time is devoted to geriatric pharmacology and that educational programmes in geriatric pharmacology have not been thoroughly evaluated. While interest in pharmacology education has increased recently, this is not the case for geriatric pharmacology education. Education on geriatric pharmacology should have more attention in the curricula of health professionals, given the often complex pharmacotherapy in elderly patients. Educational topics should be related to the known risk factors of medication errors, such as polypharmacy, dose adjustments in organ dysfunction and psychopharmacotherapeutics. AIMS Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms 'pharmacology' and 'education' in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1-935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given.
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Affiliation(s)
- Carolina J P W Keijsers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, The Netherlands
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Manu E, Marks A, Berkman CS, Mullan P, Montagnini M, Vitale CA. Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:515-520. [PMID: 22477667 DOI: 10.1007/s13187-012-0351-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia.
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Affiliation(s)
- Erika Manu
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA
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Dickson RP, Engelberg RA, Back AL, Ford DW, Curtis JR. Internal medicine trainee self-assessments of end-of-life communication skills do not predict assessments of patients, families, or clinician-evaluators. J Palliat Med 2012; 15:418-26. [PMID: 22475195 DOI: 10.1089/jpm.2011.0386] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the strength of association between trainees' self-assessments of the quality of their end-of-life communication skills and the assessments of their patients, patients' families, and clinician-evaluators. METHODS As part of a randomized trial, pre-intervention survey data were collected at two sites from internal medicine trainees and their patients, patients' families, and clinician-evaluators. In this observational analysis, comparisons using regression analysis were made between (1) trainees' scores on a scale of perceived competence at communication about end-of-life care and (2) patients', families', and clinician-evaluators' scores on a questionnaire on the quality of end-of-life communication (QOC). Secondary analyses were performed using topic-focused subscales of these measures. RESULTS Internal medicine trainees (143) were studied with both self-assessment and external assessments. No significant associations were found between trainee perceived competence scores and primary outcome measures (p>0.05). Of the 12 secondary subscale analyses, trainees' self-ratings were significantly associated with external assessments for only one comparison, but the association was in the opposite direction with increased trainee ratings being significantly associated with decreased family ratings on "treatment discussions." We also examined the correlation between ratings by patients, family, and clinician-evaluators, which showed significant correlations (p<0.05) for 7 of 18 comparisons (38.9%). CONCLUSIONS Trainee self-evaluations do not predict assessments by their patients, patients' families, or their clinician-evaluators regarding the quality of end-of-life communication. Although these results should be confirmed using the same measures across all raters, in the meantime efforts to improve communication about end-of-life care should consider outcomes other than physician self-assessment to determine intervention success.
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Affiliation(s)
- Robert P Dickson
- Department of Medicine, University of Washington, Seattle, WA, USA
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Shoemaker LK, Aktas A, Walsh D, Hullihen B, Khan MIA, Russell KM, Davis MP, Lagman R, LeGrand S. A Pilot Study of Palliative Medicine Fellows’ Hospice Home Visits. Am J Hosp Palliat Care 2012; 29:591-8. [DOI: 10.1177/1049909111433810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit. More than half of the persons were women. Most were Caucasian. Median age was 75 years; 57% had cancer; 77% were do-not-resuscitate. 76% HV occurred in the home. The median visit duration was 60 minutes; median travel distance and time 25 miles and 42 minutes, respectively. A hospice nurse case manager was present in 95%. The most common issues addressed during HVs were: health education, symptom management, and psychosocial support. Medication review was prominent. Physicians identified previously unreported issues. Symptom control was usually pain, although 27 symptoms were identified. Medications were important; all home visits included drug review and two thirds drug change. Physicians had unique responsibilities and identified important issues in the HV. Physicians provided both education and symptom management. Physician HVs are an important intervention. HVs were important in continuity of care, however, time-consuming, and incurred considerable travel, and professional time and costs.
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Affiliation(s)
- Laura K. Shoemaker
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Aynur Aktas
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Declan Walsh
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
- The Harry R. Horvitz Chair in Palliative Medicine
| | - Barbara Hullihen
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Mohammed I. Ahmed Khan
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
- Hospice of Cleveland Clinic, Cleveland, OH, USA
| | - Kraig M. Russell
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Mellar P. Davis
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Ruth Lagman
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
| | - Susan LeGrand
- Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, The Harry R Horvitz Center for Palliative Medicine, Cleveland, OH, USA
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Ahmed NN, Farnie M, Dyer CB. The Effect of Geriatric and Palliative Medicine Education on the Knowledge and Attitudes of Internal Medicine Residents. J Am Geriatr Soc 2011; 59:143-7. [DOI: 10.1111/j.1532-5415.2010.03235.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shaw EA, Marshall D, Howard M, Taniguchi A, Winemaker S, Burns S. A Systematic Review of Postgraduate Palliative Care Curricula. J Palliat Med 2010; 13:1091-108. [DOI: 10.1089/jpm.2010.0034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Elizabeth Ann Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Taniguchi
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Winemaker
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario, Canada
| | - Sheri Burns
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Singer Y, Carmel S. Teaching end-of-life care to family medicine residents--what do they learn? MEDICAL TEACHER 2009; 31:e47-e50. [PMID: 19330664 DOI: 10.1080/01421590802331420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In order to address adequately basic palliative care issues, post graduate teaching programs for physicians should provide, in addition to basic knowledge in the field and clinical skills, also training in terms of orientations and skills which enable physicians to overcome their emotional difficulties as well as professional barriers. This paper presents a model of teaching and its evaluation. AIMS The purpose of this project was to develop an educational program for residents in family medicine and evaluate its effect over time. The focus was on the self-perceived ability of physicians for understanding and communicating with terminally ill patients; the physicians' ability to deal with their own emotional difficulties while caring for the terminally ill; and the physicians' confidence regarding the management of over-all suffering. METHODS Structured questionnaires were filled out by 21 physicians before and after an 8 months program of residency training in palliative care. RESULTS Factor analysis yielded three factors: (A) Beliefs focusing on the resident's ability to understand terminally-ill patients and to communicate with them, (B) Beliefs regarding the effect of the program on the resident, and (C) Beliefs about self-professional skills. A comparison with the responses at the end of the program indicated a trend towards increased communication capabilities, relating increased importance to the program and a significant improvement in self confidence in professional skills. CONCLUSIONS The results of the evaluation indicate that this teaching program has achieved its goals by not only improving the physician's knowledge, but also causing a positive change in attitudes regarding end-of-life care. Considering our positive results it is recommended to incorporate similar training programs in physicians' post-graduate studies.
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Affiliation(s)
- Yoram Singer
- Ben Gurion University of the Negev, Beer Sheva, Israel
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Olden AM, Quill TE, Bordley D, Ladwig S. Evaluation of a Required Palliative Care Rotation for Internal Medicine Residents. J Palliat Med 2009; 12:150-4. [DOI: 10.1089/jpm.2008.0246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aaron M. Olden
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
- Center for Ethics, Humanities, and Palliative Care, University of Rochester Medical Center, Rochester, New York
| | - Timothy E. Quill
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
- Center for Ethics, Humanities, and Palliative Care, University of Rochester Medical Center, Rochester, New York
| | - Donald Bordley
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Susan Ladwig
- Center for Ethics, Humanities, and Palliative Care, University of Rochester Medical Center, Rochester, New York
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Ogle KS, McElroy L, Mavis B. No relief in sight: postgraduate training in pain management. Am J Hosp Palliat Care 2008; 25:292-7. [PMID: 18403575 DOI: 10.1177/1049909108315915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated training in pain management in postgraduate medical education programs. A mail survey of program directors was conducted, evaluating the format of training in pain management and the self-assessed adequacy of the training. The response rate was 70%, with 188 total respondents. It included all programs in a large Midwestern state, representing most specialties. Just over half of all programs offered any formal training in pain management, and even fewer required it. Less than one quarter required a clinical component to such training. Nonetheless, an overwhelming majority of program directors (85%) rated their training as adequate or excellent. Improvements are clearly needed in postgraduate training in pain management, and external incentives, such as requirements in the accreditation process, will be needed.
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Affiliation(s)
- Karen S Ogle
- Michigan State University, Department of Family Medicine, East Lansing, MI 48824, USA.
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Maurer MS, Costley AW, Miller PA, McCabe S, Dubin S, Cheng H, Varela-Burstein E, Lam B, Irvine C, Page KP, Ridge G, Gurland B. The Columbia Cooperative Aging Program: an interdisciplinary and interdepartmental approach to geriatric education for medical interns. J Am Geriatr Soc 2006; 54:520-6. [PMID: 16551323 DOI: 10.1111/j.1532-5415.2005.00616.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns.
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Affiliation(s)
- Mathew S Maurer
- Department of Medicine/Cardiology and Family Medicine, Columbia Cooperative Aging Program, Allen Pavillion of New York-Presbyterian Hospital, New York, New York 10034, USA.
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