Academic Medicine

Skip Navigation LinksHome > November 2009 - Volume 84 - Issue 11 > Medicine Residents' Self-Perceived Competence in End-of-Life...
Academic Medicine:
doi: 10.1097/ACM.0b013e3181bbb490
Graduate Medical Education

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

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

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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.

© 2009 Association of American Medical Colleges


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