Structured teaching versus experiential learning of palliative care for surgical residents

• Published in: The American journal of surgery Vol. 200; no. 4; pp. 542 - 547
• Main Authors: Bradley, Ciarán T., M.D., M.A, Webb, Travis P., M.D, Schmitz, Connie C., Ph.D, Chipman, Jeffrey G., M.D, Brasel, Karen J., M.D., M.P.H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2010; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Clinical Competence; Cognitive ability; Core curriculum; Curriculum; End-of-life; Ethics; Female; General aspects; General Surgery - education; Graduate studies; Hospice care; Humans; Internship and Residency - methods; Intervention; Learning; Male; Medical residencies; Medical sciences; Middle Aged; Motor skill learning; Pain; Palliation; Palliative care; Palliative Care - methods; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproducibility of Results; Residency; Surgery; Surveys and Questionnaires; Teaching - methods; Teaching. Deontology. Ethics. Legislation; Palliative care; End-of-life; Curriculum; Surgery; Residency; End of life; Teaching; Learning; Medicine; Educational program; Ethics; Acquisition process; Treatment; Resident (student); Nursing home; Comparative study
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.12.014

Abstract Background Previous end-of-life and palliative care curricula for surgical residents have shown improved learner confidence, but have not measured cognitive knowledge or skill acquisition. Methods A nonrandomized trial evaluated a structured palliative care curriculum for 7 postgraduate year 2 surgical residents (intervention group) compared with 6 postgraduate year 5 surgical residents (comparison group). Outcomes were measured using an 18-item knowledge test, a 20-minute objective structured clinical examination simulating an intensive care unit family conference, and a survey measuring self-confidence. Results The mean knowledge test scores for the intervention group, both before and after undergoing the structured palliative care curriculum, were no different from the comparison group. There was also no difference in objective structured clinical examination scores between the 2 groups. The intervention group felt less comfortable managing pain, breaking bad news, or addressing ethical issues. Conclusions Junior surgical residents have similar palliative care knowledge to senior residents without a palliative care curriculum. After participating in a palliative care curriculum, they have simulated skills that are similar to chief residents. However, self-confidence is lower among junior residents despite undergoing a palliative care curriculum.