Competencies and concerns in end-of-life care for medical students and residents

A palliative medicine comfort-confidence survey developed by Weisman et al was utilized to assess self-reported competence and comfort with four end-of-life dimensions and determine future educational preferences. The survey was completed by 3rd and 4th year medical students (M3 and 4) and residents PGY 1-5. Self-reported competence increased with level of training. All trainees indicated the least comfort with 1) discussing home-hospice referrals; 2) conducting a family conference; 3) discussing the change from curative to comfort care; and 4) discontinuing i.v. hydration in a dying patient not taking oral nourishment. When withdrawing parenteral antibiotics from a non-decisional dementia patient with sepsis at the request of his legal guardian, M3 and 4 expressed a greater concern for violating medical practice standards while PGY4 and 5 showed a greater concern for the violation of personal religious or ethical beliefs. Pain management, pain assessment, hospice care and end-of-life communication where the most requested topics for future education.