Academic Psychiatry

, Volume 33, Issue 6, pp 451–456

End-of-Life Care Education for Psychiatric Residents: Attitudes, Preparedness, and Conceptualizations of Dignity

Original Article



The authors examined psychiatric residents’ attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity.


The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey had a mix of qualitative and quantitative questions.


Eighty-two of116 invited psychiatric residents participated for a response rate of 71%. With favorable attitudes, residents felt least prepared in existential, spiritual, cultural, and some psychological aspects of caring for dying patients. Trainees conceptualized dignity at the end of life in a way very similar to that of patients, including concerns of the mind, body, soul, relationships, and autonomy. Residents desired more longitudinal, contextualized training, particularly in the psychosocial, existential, and spiritual aspects of care.


This is the first study to examine the end-of-life educational experience of psychiatric residents. Despite conceptualizing quality care and the construct of dignity similarly to dying patients, psychiatric residents feel poorly prepared to deliver such care, particularly the nonphysical aspects of caring for the dying. These results will inform curriculum development in end-of-life care for psychiatric residents, a complex area now considered a core competency.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Population Projections for Canada, Provinces and Territories: 2000–2026, Statistics Canada, Catalogue #91-520, p 124Google Scholar
  2. 2.
    Mount BM: This I Believe. Available at
  3. 3.
    Kerrihard T, Breitbart W, Dent K, et al: Anxiety in patients with cancer and human immunodeficiency virus. Semin Clin Neuropsychiatry 1999; 4: 114–132PubMedGoogle Scholar
  4. 4.
    Breitbart W, Bruera E, Chochinov H, et al: Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain Symptom Manage 1995; 10: 131–141PubMedCrossRefGoogle Scholar
  5. 5.
    Chochinov HM: Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin 2006; 56: 84–103PubMedCrossRefGoogle Scholar
  6. 6.
    Breitbart W, Rosenfeld B, Pessin H, et al: Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000; 284: 2907–2911PubMedCrossRefGoogle Scholar
  7. 7.
    Chochinov HM: Dignity conserving care: a new model for palliative care. JAMA 2002; 287: 2253–2260PubMedCrossRefGoogle Scholar
  8. 8.
    Chochinov HM, Hack T, McClement S, et al: Dignity in the terminally ill: an empirical model. Soc Sci Med 2002; 54: 433–443PubMedCrossRefGoogle Scholar
  9. 9.
    Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC.) Available at
  10. 10.
    Sullivan AM, Lakoma MD, Block SD: The status of medical education in end-of-life care: a national report. J Gen Intern Med 2003; 18: 685–695PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Kvale S: Interviews: An Introduction to Qualitative Research Interviewing. Thousand Oaks, Calif, Sage Publications, 1996Google Scholar
  12. 12.
    Oneschuk D, Moloughney B, Jones-McLean E, et al: The status of undergraduate palliative medicine education in Canada: a 2001 survey. J Palliat Care 2004; 20: 32–37PubMedGoogle Scholar
  13. 13.
    Block SD: Psychological considerations, growth, and transcendence at the end of life: the art of the possible. JAMA 2001; 285: 2898–2905PubMedCrossRefGoogle Scholar
  14. 14.
    Andreasen N: What is psychiatry? Am J Psychiatry 1997; 154: 591–593PubMedGoogle Scholar

Copyright information

© Academic Psychiatry 2009

Authors and Affiliations

  1. 1.Department of Psychiatry and the Wilson Centre for Research in Medical EducationUniversity of Toronto, Toronto General HospitalTorontoCanada
  2. 2.North York General HospitalTorontoCanada

Personalised recommendations