PALLIATIVE MEDICINE COMPETENCY EDUCATION IN EMERGENCY MEDICINE RESIDENCY TRAINING: A SURVEY OF EMERGENCY MEDICINE EDUCATION LEADERS

Background: Emergency physicians care for patients with palliative and hospice needs. More than 75 percent of patients visit the ED in the last 6 months of life, and two-thirds of those patients die while hospitalized. Objectives: To assess hospice and palliative medicine (HPM) instruction in EM residency programs and to identify barriers and opportunities for integrating instruction in HPM into EM training. Methods: IRB-approved, cross-sectional, mixed-mode survey (web-based and paper-based) of EM residency program directors (PDs), associate PDs (APDs), and assistant PDs (aPDs) distributed to 402 subjects. Demographic variables and institutional characteristics were collected. A five-point Likert scale (1=least, 5=most) assessed Four Domains: 1 - Importance of HPM competency for senior EM residents; 2 - Senior resident skill level in HPM competencies; 3 - Effectiveness of educational methods for HPM training; and 4 - Barriers to training. Results: There was a 50 percent response rate, a 60/40 percent distribution between paper and web-based modes, and no statistical differences in demographics between groups. Most respondents identified HPM training as important and teach HPM in their programs. In Domain 1, crucial conversations (mean 4.88, SD 0.40), management of pain (4.77, 0.53), and management of the imminently dying (4.74, 0.53) had the highest mean Likert scores for importance. In Domain 2, residents were reported to be skilled in crucial conversations (4.28, 0.66), management of pain (4.17, 0.72), and management of the imminently dying (3.91, 0.88). In Domain 3, bedside teaching (4.53, 0.81), mentoring from HPM faculty (4.11, 0.97), and case-based simulation were identified as the most effective educational methods. In Domain 4, lack of HPM expertise among faculty (3.57,1.21), lack of faculty (3.42, 1.20) and resident interest in HPM (3.04, 1.20) were identified as the greatest barriers. Six competencies (withholding/withdrawal of non-beneficial interventions, management of imminently dying, HPM referrals, ethical/legal issues, spiritual/cultural issues, management of dying child) showed large differences between perceived importance and reported senior resident skill level. Conclusions: This study is the first comprehensive description of HPM competency training in EM residencies. The results provide a foundation for focused educational interventions and future research to improve HPM training for EM residents