Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors

Abstract

CONTEXT: Emergency Medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. OBJECTIVES: To assess PC competency education in EM residency programs. METHODS: This was a mixed-mode survey of residency program directors (PDs), associate PDs (APDs), and assistant PDs (aPDs) at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents; 2) senior resident skills in PC competencies; 3) effectiveness of educational methods; and, 4) barriers to training. RESULTS: Response rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn and 59% reported that they teach PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents’ skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine (HPM) faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for: management of the dying child, withdrawal/withholding of non-beneficial interventions, and ethical/legal issues. CONCLUSION: There are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, non-beneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies.