• Tomasz R Okon, Jonathan M Evans, Carlos F Gomez, and Leslie J Blackhall.
• Division of General Internal Medicine, Section of Palliative Care, University of Virginia, Charlottesville, VA, USA. okon.tomasz@marshfieldclinic.org
• J Palliat Med. 2004 Apr 1;7(2):279-95.

BackgroundHouse officers frequently lack basic competency in end-of-life care. Few studies have evaluated educational interventions deliberately utilizing physicians' learning strategies, particularly in the context of a concomitant effort at modification of practice patterns.Study DesignProspective controlled trial utilizing pre-intervention and post-intervention cross-sectional surveys.ParticipantsInternal medicine residents at a university hospital in their first, second, and third years of training.SurveyA 25-item survey modified from previously published instruments.InterventionResidents in the intervention group utilized an experiential learning intervention (integrated, end-of-life clinical pathway: PEACE Tool). The control group delivered care in a standard fashion.Data AnalysisSURVEY item and test responses were tabulated and pair-wise comparisons between group means evaluated statistically using two-sample t tests.ResultsFifty-four internal medicine residents (n = 24, first-year; n = 17, second-year; and n = 13, third-year) completed the survey. Pre-intervention mean scores on a 16-item knowledge scale were 7.4 (46% correct) for first-year, 8.1 (51%) for second-year, and 9.2 (58%) for third-year residents. Eighteen first-year residents participated in the intervention phase (8 in the intervention, 10 in the control). Mean overall knowledge scores were 46% higher in the intervention group compared to the control group (11.8 versus 8.1 p < 0.001).ConclusionsA time-effective, practice-based strategy led to a significant improvement in knowledge of end-of-life care. Prior to implementation of this strategy competency in end-of-life care was suboptimal among internal medicine residents, in spite of desirable attitudes. Factual knowledge improved slightly with standard, pre-intervention training and experience.

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