Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital

2020 ◽  
pp. 104990912097917
Author(s):  
Cassandra Nicotra ◽  
Martin Barnes ◽  
Phyllis Macchio ◽  
Greg Haggerty ◽  
Carolina De Elia ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Medicine ◽  
Hospice Care ◽  
Medical Knowledge ◽  
Educational Opportunities ◽  
Short Term ◽  
Internal Medicine Residents ◽  
Post Test ◽  
Community Teaching ◽  
Question Survey

Background: The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice. Objective: This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains. Methods: An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort). Results: 65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well. Conclusions: Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents’ short-term comprehension and increased the number of palliative consults.

Education of residents in palliative and hospice care.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 118-118
Author(s):  
Ela Eris ◽  
Shyam Ravisankar ◽  
Jennifer A Larosa
Keyword(s):  
Palliative Care ◽  
Palliative Medicine ◽  
Hospice Care ◽  
Daily Practice ◽  
Comfort Level ◽  
Emotional Symptoms ◽  
Advanced Illness ◽  
Online Questionnaire ◽  
Post Test ◽  
Interactive Lecture

118 Background: Patients with chronic advanced illness have a heavy burden of physical and emotional symptoms. In addition to these symptoms, social and spiritual supports are fundamental tenets of palliative care (PC). PC is most effective when delivered early and when routine reassessments are undertaken. Ideally, it is woven into the daily practice of all practitioners. However, current medical education has far too little education around this vital discipline in their curricula. We hypothesized that a single palliative medicine didactic experience would increase practitioners’ familiarity with core concepts of PC. Methods: Palliative care education was delivered as a single interactive lecture for 27 Internal Medicine residents. Information was primarily derived from resources from the Center to Advance Palliative Care (CAPC). The lecture focused on the definition of PC, optimal symptom management and support structures in palliative medicine, and how palliative medicine differs from hospice care (HC). An online questionnaire with ten questions was used to assess pre- and post-lecture knowledge of fundamentals of this discipline. Results: 27 residents participated in the pre-test and 23 participated in post-test. The overall pre-test score was 70% and the post-lecture score was 77%. The biggest difference was seen in the comfort level of first year residents in referring patients to PC and the purpose of PC. Residents had good baseline knowledge of when to refer to HC and the purpose of HC. Conclusions: A single, interactive lecture based on the fundamental tenets of hospice and palliative medicine can improve residents’ knowledge of this discipline. [Table: see text]

Gender Differences in Milestone Ratings and Medical Knowledge Examination Scores Among Internal Medicine Residents

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Karen E. Hauer ◽  
Daniel Jurich ◽  
Jonathan Vandergrift ◽  
Rebecca S. Lipner ◽  
Furman S. McDonald ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Gender Differences ◽  
Medical Knowledge ◽  
Internal Medicine Residents

scholarly journals Internal Medicine residents use heuristics to estimate disease probability

2015 ◽  
Vol 6 (2) ◽  
pp. e71-e77 ◽  
Author(s):  
Sen Phang ◽  
Pietro Ravani ◽  
Jeffrey Schaefer ◽  
Bruce Wright ◽  
Kevin Mclaughlin
Keyword(s):  
Internal Medicine ◽  
Clinical Features ◽  
Bayesian Reasoning ◽  
Target Condition ◽  
Clinical Vignettes ◽  
Probability Estimates ◽  
Internal Medicine Residents ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Background: Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition.Method: We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition.Results:  When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025).Conclusions: Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

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