Using death rounds to improve end-of-life education for internal medicine residents

While internal medicine interns provide much of the care to patients dying in the hospital, few report that they have received adequate training in end-of-life care.

To address this perceived lack of training, we undertook a study to evaluate Death Rounds as an educational tool in end-of-life care and to address the emotional needs of trainees providing care to dying patients.

We used a behavioral interventional study using a pre-post study design.

The study included all internal medicine interns at the University of Washington (n = 62) during the academic year 2007-08. Interns from the 2006-07 academic year (n = 64) received the survey and served as the control group.

Death Rounds, a one-hour session dedicated to discussion of emotional reactions to patient death.

We used a 14-item electronic measure with questions directed toward the impact of perceived insufficient end-of-life care and the role of Death Rounds in resident education.

Results are drawn from a total of 39 surveys completed by the intervention group, for a response rate of 63%. Seventy-four percent (29) felt that Death Rounds contributed to their education in end-of-life issues. Seventy-two percent (28) reported that Death Rounds was "somewhat" or "very" helpful in improving their comfort with discussing end-of-life issues. Ninety-seven percent (38) of participants thought that having an opportunity to discuss the emotional aspects of patient death should be included in their training.

This study suggests that learning to deal with the strong emotions that arise in the care of dying patients is an important part of physician training. Death Rounds provides an opportunity to explore these emotions with colleagues in a supportive environment and is a valuable addition to the resident curriculum.