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U N I V E R S I T Y O F P I T T S B U R G H |
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Volume VIII, Number 2 |
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U N I V E R S I T Y O F P I T T S B U R G H |
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Volume VIII, Number 2 |
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A Program for Medical Residents’ Discussions
with Seriously Ill Patients
 Paul K.J. Han and Robert M. Arnold, School of Medicine, point out that doctors “have identified the care of patients at the end of life, and in particular the development of skills in communicating with dying patients, as serious deficiencies in medical education.” Reflecting on his own training, Han notes, “I learned by experience.” While the medical profession calls for new resident training programs in end-of-life care, only a “handful” of universities have implemented them. And, according to Han and Arnold, these programs convey “no formal expectations that trainees demonstrate competence in communicating with terminally ill patients.” They plan to correct this by making end-of-life care a formal component of the internal medicine curriculum. Emphasizing instruction, observation, and evaluation, their project, A Structured Educational Program for Observing, Evaluating, and Documenting Internal Medicine Residents’ Discussions with Seriously Ill Patients, will develop a more rigorous program of teaching end-of-life communication. Han and Arnold plan a program with two central goals. First, the project will foster a belief that residents’ discussions with terminally ill patients are important procedures requiring instruction and evaluation. Second, it will implement procedures for teaching and evaluating residents’ skills in giving bad news to patients and discussing patients’ wishes regarding medical interventions (such as “do not resuscitate” orders). The project will be implemented for a defined cohort—approximately 20 interns in the Categorical and Medicine/Pediatrics Internal Medicine Residency Training Program at UPMC Shadyside and approximately 30 interns in the Categorical, Primary Care, and Women’s Health tracks of the Internal Medicine Residency Training Program at UPMC Montefiore. The residents will be instructed and evaluated for an entire year. During the first month, they will attend a session on giving bad news and discussing end-of-life issues with patients. Because residents are to be observed at least twice, six expert clinicians will observe all discussions. The relevance of the project extends beyond internal medicine. Han and
Arnold assert, “It has the potential to further the mission of the University
and Medical Center of producing well-rounded physicians who are able
to communicate effectively with seriously ill patients. If the intervention
can be proven feasible and effective, it could be employed throughout
the training of internal medicine residents, and could also be expanded
to other specialty training programs (e.g., pediatrics, general surgery,
family practice) and to other institutions.” | |||||
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A newsletter devoted to the support of teaching and learning at the University of Pittsburgh |
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Center for Instructional
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