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Medicine Residents' Self-Perceived Competence in End-of-Life Care

Billings, Martha E. MD; Curtis, J Randall MD, MPH; Engelberg, Ruth A. PhD

doi: 10.1097/ACM.0b013e3181bbb490
Graduate Medical Education

Purpose Internal medicine residents frequently provide end-of-life care, yet feel inadequately trained and uncomfortable providing this care, despite efforts to improve end-of-life care curricula. Understanding how residents' experiences and attitudes affect their perceived competence in providing end-of-life care is important for targeting educational interventions.

Method Medicine residents (74) at the University of Washington and Medical University of South Carolina enrolled in a trial investigating the efficacy of a communication skills intervention to improve end-of-life care. On entry to the study in the fall of 2007, residents completed a questionnaire assessing their prior experiences, attitudes, and perceived competence with end-of-life care. Multivariate regression analysis was performed to assess whether attitudes and experiences with end-of-life care were associated with perceived competence, controlling for gender, race/ethnicity, training year, training site, and personal experience with death of a loved one.

Results Residents had substantial experience providing end-of-life care. In an adjusted multivariate model including attitudes and clinical experience in end-of-life care as predictors, only clinical experience providing end-of-life care was associated with self-perceived competence (P = .015).

Conclusions Residents with more clinical experience during training had greater self-perceived competence providing end-of-life care. Increasing the quantity and quality of the end-of-life care experiences during residency with appropriate supervision and role modeling may lead to enhanced skill development and improve the quality of end-of-life care. The results suggest that cultivating bedside learning opportunities during residency is an appropriate focus for educational interventions in end-of-life care education.

Dr. Billings is senior fellow, Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.

Dr. Curtis is professor of medicine, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington.

Dr. Engelberg is research associate professor of medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.

Correspondence should be addressed to Dr. Billings, Division of Pulmonary Critical Care Medicine, Box 359762, Harborview Medical Center, 325 Ninth Avenue, Seattle WA 98104; telephone: (206) 744-3356; fax: (206) 744-9982; e-mail: (

© 2009 Association of American Medical Colleges