In a 2008 focus group study regarding the improvement of palliative care in the Emergency Department, it was reported that 7 of 10 Emergency Medicine residents believed their training in pain management was inadequate (1). This statistic, coupled with the fact that outpatient palliative care consultation tripled in the decade spanning 2000 to 2010, calls for consideration of how well Emergency Medicine Residency programs are training their residents in palliative medicine (2). Palliative care focuses on alleviating physical and emotional pain in patients with terminal illnesses. Palliative care allows patients to make the most of the time that they have left and to live out the rest of their lives with minimal physical discomfort, as well as providing emotional support for both the patient and their family. While palliative care is popular within Internal Medicine and Family Practice, the approach is not as widely emphasized for Emergency Medicine physicians. The success of palliative care has led to plans of incorporating treatment aimed at “restorative, curative, and life-prolonging goals” (3). Palliative care differs from hospice care in that hospice care is geared toward treating the symptoms of patients for whom curative treatment has been discontinued and death is anticipated. Palliative care is also unique because it is not limited to geriatric patients and thus can be incorporated into treatment plans for diseases such as Cancer, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, kidney failure, Alzheimer’s, HIV/AIDS, and Amyotrophic Lateral Sclerosis (4).
Several goals were laid out at the study’s inception: The primary goals were to assess how common education in palliative care is in Emergency Medicine Residency programs throughout the country and to also see what methods are used to educate their residents. A secondary goal of the study sought to identify barriers that exist and prevent Residency programs from providing further competency training to their residents in palliative medicine. The results of the study will provide an assessment of current palliative care training in residencies and allow programs to incorporate such training into their residencies in a successful manner.
In order to assess the palliative care competency of Emergency Medicine physicians, an electronic survey was E-mailed--and then subsequently postal mailed as follow up--to the Program Directors, Assistant Directors, and Associate Directors of 200 American Council of Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) accredited Emergency Medicine Residency programs throughout the United States. The survey asked each residency program’s leadership about their respective program’s palliative care teaching methods, the leadership’s personal opinions regarding palliative care practice in Emergency Medicine, and the barriers that prevent such care from being provided in the Emergency Department. A monetary incentive was included for the Residency Program Coordinator of each residency program in order to encourage participation.
Responses to the survey received as of 7/22/13 (n= 81) showed that only 48.15% (n=39) of Residency programs train their residents in palliative care. When asked of the importance of palliative care competency training in residency programs, a majority of respondents were neutral (49.4%, n=40) to its significance in emergency medicine. Respondents placed didactic training such as seminars, lectures, and case conferences as the most useful form of teaching (86.05%, n=37), followed by bedside teaching (48.84%, n=21) and case-based simulation (39.53%, n=17). Some significant barriers identified by respondents that prevent further education in palliative care included lack of faculty experience or lack of faculty interest in palliative care, lack of a palliative care curriculum, and poor or lack of communication with a hospice and/or palliative care consult service.
The study confirmed that Emergency Medicine Residency competency training in palliative care has not increased at the same rate that the patient demand for palliative care has increased. The fact that nearly half of residency programs are split on including palliative care in their program curriculum could be swayed toward promotion of palliative care training should the demand for palliative care continue to increase. While respondents identified several methods for training residents, it does not seem that all institutions incorporate these methods into the training of their residents due to several different factors. Also, it is shown that many results of this study are likely to change in the coming years in correlation with the expected increase in emphasis on palliative care.
1. Dev, R., E. Del Fabbro, M. Miles, A. Vala, D. Hui, and E. Bruera. "Growth of an Academic Palliative Medicine Program: Patient Encounters and Clinical Burden." Pubmed.gov. Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Feb. 2013. Web. 15 July 2013.
2. Smith, Alexander K., Jonathan Fisher, Mara A. Schonberg, Daniel J. Pallin, Susan D. Block, Lachlan Forrow, Russell S. Phillips, and Ellen P. McCarthy. "Am I Doing the Right Thing? Provider Perspectives on Improving Palliative Care in the Emergency Department." Annals of Emergency Medicine 54.1 (2009): 86-93.e1. Print.
3. Arnold, Robert, J. Andrew Billings, Susan D. Block, Nathan Goldstein, Laura J. Morrison, Tomasz Okon, Sandra Sanchez-Reilly, Rodney Tucker, James Tulsky, Charles Von Gunten, David Weissman, Dale Lupu, and Judy Opatik Scott. "Hospice and Palliative Medicine Core Competencies." Diss. 2003. Hospice and Palliative Medicine Core Competencies. American Academy of Hospice and Palliative Medicine, Sept. 2009. Web. 13 June 2013.
4. "Defining Palliative Care." CAPC.org. Center to Advance Palliative Care, n.d. Web. 18 July 2013.
Published In/Presented At
Meyers, M., & Kurt ,A. (2013, July 26). Evaluating Palliative Medicine Competency Training in Emergency Medicine Residency Programs. Poster presented at: Research Day 2013, Lehigh Valley Health Network, Allentown, PA.
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