ABSTRACT #18

EVALUATING MEDICAL RESIDENT’S COMFORT AND KNOWLEDGE ON CARING FOR PATIENTS AT THE END OF THEIR LIFE (EOL).

Fionnuala Crowley, Neha Debnath, Sonal Gandhi, Yosef Joseph Rene Amel Riazat Kesh, Jennifer Fung

PURPOSE AND GOALS: Studies have highlighted that residents generally across a number of specialties are uncomfortable with end of life discussions. One study from a single institution found that 88.1% of 175 residents surveyed had no formal classroom training in conducting goals of care discussions despite having these conversations frequently (Schmit, 2016). This needs assessment aims to identify knowledge and skills deficits when caring for patients at the end of life.

METHODS: Surveys were distributed to residents at the Mount Sinai Morningside West internal medicine residency program. Surveys were emailed, distributed by text and also distributed to documentation rooms.

EVALUATION PLAN: Analysis of survey answers was descriptive and was done using SPSS.

SUMMARY OF RESULTS: 36 residents completed the needs assessment (response rate 30%). 17 (47.2%) were PGY-1s, 6 (16.7%) were PGY-2s, 13 (36.1%) were PGY-3. When asked how much classroom teaching they had received during residency on EOL discussions the responses were as follows: None (10, 27.8%), Very little (1-2 lectures) (21, 58.3%), Some (1-2 week course or lecture series) (4, 11.1%), A Lot (>3 weeks) (0, 0.0%), I don’t know (1, 2.8%).

When asked how often they have had EOL discussions during residency 2 (5.7%) said none, 8 (22.9%) said 1-5 times, 7 (20.0%) said 6-10 times, 5 (14.3%) said 11-15 times, 3 (8.6%) said 16-25 times, 6 ( 17.1%) 26-50 times and 4 residents said greater than 50 times. Twenty residents (57%) responded that most of these conversations were unsupervised. 22.9% said they learned how to conduct these conversations through “trial and error’, 25.7% from watching attendings conduct conversations, 31.4% from sitting in on family meetings. When asked about their comfort levels having these conversations there was a lot of variation: I feel very comfortable (8, 23.5%), I feel mostly comfortable (11, 32.4%), I am neither comfortable nor uncomfortable (7, 20.6%), I feel mostly uncomfortable (6, 17.6%), I feel very uncomfortable (1, 2.9%), I’m not sure (1, 2.9%). 4 (11.8%) of respondents felt lack of adequate supervision or training for end-of-life discussions negatively impacted patients care often while 17 (50%) said it sometimes did. Discomfort with patient/ families’ reaction or emotions (17, 48.6%) was cited as the biggest barrier to being honest with families about the likely outcomes of CPR/trial of critical care. Teaching during rotations was the more preferred method of teaching delivery for this content (60%), followed by small group workshops (42.9%).

REFLECTIVE CRITIQUE: There needs to be additional teaching around conducting end of life discussions in the internal medicine curriculum. Over 50% of residents felt a lack of adequate supervision or training for end-of-life discussions negatively impacted patients care. In addition to knowledge and communication skills teaching residents would also benefit from teaching on managing emotional reaction to bad news and emotionally supporting patients and their families.