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Serious Illness Communication Training in Family Medicine Residencies: A National Study of Program Director
Emma Ernst1, Kayla Sheehan2, Dongru Chen2
1National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA.
Background And Objectives:
Serious illness communication (SIC) skills promote care that is aligned with patient preference and essential for well-rounded family physicians. We aimed to show that the presence of family medicine faculty with hospice and palliative care (HAPC) expertise improves the quality of SIC training.
Methods:
The Council of Academic Family Medicine Educational Research Alliance's 2023 survey of program directors (PDs) explored SIC training in family medicine residency programs (FMRPs). We used χ2 tests and logistic regressions to compare independent program and PD predictors of perceived resident ability to lead serious illness conversations.
Results:
A total of 271 PDs responded (37.9% response rate). Of the programs represented, 97% of FMRPs provided SIC training, and 60% of programs lacked faculty with HAPC expertise. Having faculty with HAPC expertise increased the odds of SIC training at least yearly (vs. less than yearly; aOR: 2.41, 95% CI: 1.24-4.68) and residents leading conversations versus consulting specialists (aOR: 2.81, 95% CI: 1.34-5.8). Programs where PDs rated residents better prepared to lead conversations had higher odds of residents leading their own discussions than referring to specialists (aOR 4.87, 95% CI: 2.08-11.43). The training method/frequency did not vary according to program characteristics.
Conclusions:
Our findings indicate key areas for improvement and further exploration. Reassuringly, the study identified SIC training in more than 90% of surveyed FMRPs. Our associative data imply that residencies might invest in faculty with HAPC expertise to enhance resident abilities in this important skill set.
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