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

Background: 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. Methods: 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. Results: 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-Lip, 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." Conclusions: 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.