End-of-life care: A retreat format for residents

Background: The challenge of teaching end-of-life care involves finding ways to incorporate both the science and the art of medicine. Objectives: To develop a curriculum so that internal medicine residents could more effectively (1) elicit patient's values, goals, and preferences for health care at the end of life, (2) communicate "bad news," (3) discuss patient preferences for nutrition and hydration, ventilator withdrawal, and cardiopulmonary resuscitation, (4) prescribe opioids using different routes of administration and, (5) Recommend appropriate treatment of symptoms common at the end of life Design: The daylong retreat utilized case presentations and problems for presenting scientific content and the film Wit to convey information related to communication, whole-patient assessment, and the palliative care approach. Materials from the Education for Physicians on End-of-Life Care (EPEC) project and the film Wit provided the main educational resources. Setting: All second-year internal medicine, and family medicine residents, and geriatric fellows from a community hospital in South Carolina attended. Results: The residents positively evaluated the seminar content and format. Pretests and posttests revealed that residents significantly improved their knowledge regarding pain management (p < 0.001), symptom management (p < 0.001) and whole-patient assessment (p < 0.014). Scores on the pretest and posttest related to communication skills did not significantly change (p = 0.092). Yet, qualitative postretreat evaluations showed that residents perceived that the retreat would affect their communication with patients and other less easily quantifiable factors. Conclusion: Quantitative methods that work well for documenting scientific principles and learning may not apply as well in assessing the art of medicine.