• J Palliat Med · May 2017

    Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

    • Maxwell T Vergo, Sharona Sachs, Meredith A MacMartin, Kathryn B Kirkland, Amelia M Cullinan, and Lisa A Stephens.
    • Section of Palliative Medicine, Department of Medicine, Geisel School of Medicine ,Lebanon, New Hampshire.
    • J Palliat Med. 2017 May 1; 20 (5): 542-547.

    BackgroundImproving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed.ObjectiveTo assess skills acquisition and acceptability for IM residents not selecting an elective.DesignA consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points.Setting/SubjectsIM second year residents from Dartmouth-Hitchcock were exposed to a required experiential palliative care rotation.MeasurementsPre- and post-OSCE using a standardized score card for behavioral skills, including patient-centered interviewing, discussing goals of care/code status, and responding to emotion, as well as a confidential mixed qualitative and quantitative evaluation of the experience.ResultsTwelve residents were included in the educational program (two were excluded because of shortened experiences) and showed statistically significant improvements in overall communication and more specifically in discussing code status and responding to emotions. General patient-centered interviewing skills were not significantly improved, but prerotation scores reflected pre-existing competency in this domain. Residents viewed the observed simulated clinical experience (OSCE) and required rotation as positive experiences, but wished for more opportunities to practice communication skills in real clinical encounters.ConclusionsA required palliative care experiential rotation flanked by OSCEs at our institution improved the acquisition of primary palliative care communication skills similarly to other nonclinical educational platforms, but may better meet the needs of the resident and faculty as well as address all required ACGME milestones.

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