Abstract
Background
Most surgical training programs have no curriculum to teach palliative care. Programs designed for nonsurgical specialties often do not meet the unique needs of surgeons. With 80-hour workweek limitations on in-hospital teaching, new methods are needed to efficiently teach surgical residents about these problems.
Methods
A pilot curriculum in palliative surgical care designed for residents was presented in three 1-hour sessions. Sessions included group discussion, role-playing exercises, and instruction in advanced clinical decision making. Residents completed pretest, posttest, and 3-month follow-up surveys designed to measure the program’s success.
Results
Forty-seven general surgery residents from Brown University participated. Most residents (94%) had “discussed palliative care with a patient or patient’s family” in the past. Initially, 57% of residents felt “comfortable speaking to patients and patients’ families about end-of-life issues,” whereas at posttest and at 3-month intervals, 80% and 84%, respectively, felt comfortable (P < .01). Few residents at pretest (9%) thought that they had “received adequate training in palliation during residency,” but at posttest and at 3-month follow-up, 86% and 84% of residents agreed with this statement (P < .01). All residents believed that “managing end-of-life issues is a valuable skill for surgeons.” Ninety-two percent of residents at 3-month follow-up “had been able to use the information learned in clinical practice.”
Conclusions
With a reasonable time commitment, surgical residents are capable of learning about palliative and end-of-life care. Surgical residents think that understanding palliative care is a useful part of their training, a sentiment that is still evident 3 months later.
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REFERENCES
Miner TJ, Jacques DP, Tavaf-Motamen H, Shriver CD. Decision making in surgical palliation based on patient outcome data. Am J Surg 1999; 177:150–4
Easson AM, Crosby JA, Librach SL. Discussion of death and dying in surgical textbooks. Am J Surg 2001; 182:34–9
Miner TJ, Jaques DP, Shriver CD. A prospective evaluation of patients undergoing surgery for the palliation of an advanced malignancy. Ann Surg Oncol 2002; 9:696–709
American College of Surgeons. The surgeon and palliative care. Principles guiding care at the end of life. Available at: http://www.facs.org/palliativecare/statement.html. Accessed March 1, 2006
McCahill LE, Dunn GP, Mosenthal AC, Milch RA, Krouse RS. Palliation as a core surgical principle: part 2. J Am Coll Surg 2004; 199:321–34
American Board of Surgery. Specialty of surgery (general surgery) defined. Available at: http://www.home.absurgery.org/default.jsp?aboutsurgerydefined. Accessed March 1, 2006
Association for Surgical Education. Available at: http://www.surgicaleducation.com/mc/page.do. Accessed January 28, 2007
Mccahill LE, Krouse RS, Chu DZ, et al. Indications and use of palliative surgery—results of Society of Surgical Oncology Survey. Ann Surg Oncol 2002; 9:104–12
Miner TJ, Jaques DP, Karpeh MS, Brennan MF. Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg 2004; 198:1013–21
McCahill LE, Krouse RS, Chu DZ, et al. Decision making in palliative surgery. J Am Coll Surg 2002; 195:411–22
Krouse RS, Easson AM, Angelos P. Ethical considerations and barriers to research in surgical palliative care. J Am Coll Surg 2003; 196:469–74
SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995; 274:1591–8
Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1,022 palliative procedures for advanced cancer. Ann Surg 2004; 240:719–27
Buckman R. Communication skills in palliative care: a practical guide. Neurol Clin 2001; 19:989–1004
Larson JL, Williams RG, Ketchum J, Boehler ML, Dunnington GL. Feasibility, reliability, and validity of an operative performance rating system for evaluating surgery residents. Surgery 2005; 138:640–7
Aucar JA, Groch NR, Troxel SA, Eubanks SW. A review of surgical simulation with attention to validation methodology. Surg Laparosc Endosc Percutan Tech 2005; 15:82–9
Cassell J, Buchman TG, Streat S, Stewart RM. Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life. Crit Care Med 2003; 31:1263–70
Galante JM, Bowles TL, Khatri VP, Schneider PD, Goodnight JE Jr, Bold RJ. Experience and attitudes of surgeons toward palliation in cancer. Arch Surg 2005; 140:873–8
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Klaristenfeld, D.D., Harrington, D.T. & Miner, T.J. Teaching Palliative Care and End-of-Life Issues: A Core Curriculum for Surgical Residents. Ann Surg Oncol 14, 1801–1806 (2007). https://doi.org/10.1245/s10434-006-9324-1
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DOI: https://doi.org/10.1245/s10434-006-9324-1