Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice

Author:

von Gunten Charles F.1,Mullan Patricia B.2,Nelesen Richard3,Garman Karen4,McNeal Helen5,Savoia Maria6,Muchmore Elaine6,Ikeda Tyson6,Amundson Stan7,McKennett Marianne7,Diamant Joel8,Pepper Patricia9,Gray Cynthia10,Weissman David11

Affiliation:

1. Kobacker House, OhioHealth, Columbus, OH, USA

2. Department of Medical Education, University of Michigan, Ann Arbor, MI, USA

3. Independent Reseacher, San Diego, CA, USA

4. Institute for Palliative Care, California State University–San Marcos, San Marcos, CA, USA

5. Healthcare Education, Leadership, and Performance Inc, San Diego, CA, USA

6. School of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA

7. Department of Internal Medicine, Scripps Mercy Hospital, San Diego, CA, USA

8. Department of Internal Medicine, Scripps Green Hospital, San Diego, CA, USA

9. Department of Internal Medicine, U.S. Naval Hospital, San Diego, CA, USA

10. Department of Family Medicine, U.S. Naval Hospital, Camp Pendleton, CA, USA

11. Department of Palliative Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

Abstract

Effective approaches to teaching attitudes, knowledge, and skills to resident physicians in primary care that can be implemented in any residency program are needed. We examined the feasibility and impact of a single palliative care residency curriculum, including a clinical rotation with a hospice program, across 5 cohorts of residents in 7 divergent primary care residency programs (both family medicine and internal medicine). The didactic content was drawn from the national Education for Physicians on End-of-Life Care Project. A total of 448 residents completed the curriculum. A large effect size was seen in measures of knowledge change (*Cohen d = .89) when compared to a national sample of primary care residency programs. Additionally, measures of confidence to perform palliative care skills and ethical concerns also improved significantly ( P < .001). A frequent comment is wishing the rest of medicine were like that experienced in the hospice setting. In a separate, ancillary evaluation, the average length of stay of patients enrolled in hospice care was 18.5 days longer for the alumni of this program when compared to physicians referring for hospice care who hadn’t experienced the curriculum.

Publisher

SAGE Publications

Subject

General Medicine

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