ABSTRACT
INTRODUCTION: Inadequate training of medical students in palliative care has been identified as a barrier to its universal provision. Family medicine physicians frequently provide these services, yet the extent of palliative care training in the family medicine clerkship has been unknown. This study describes the status of palliative care training in the family medicine clerkship, as well as clerkship director perceptions of this training. METHODS: Data were attained through a cross-sectional survey of 141 US and Canadian family medicine clerkship directors administered in fall 2016. Survey items included clerkship director perceived value, interest, and background in palliative care education; presence of educational objectives; hours of training provided; and perceived barriers to palliative care instruction. RESULTS: Of the clerkship directors who responded (120/141, 81.5%), 31 (25.8%) reported providing no palliative care education and 75 (62.5%) reported palliative care competencies were not specifically assessed. Background in palliative care and explicit educational objectives were associated with more hours of training in palliative care. Clerkship director training in palliative care correlated with value of teaching it in the clerkship. CONCLUSION: Palliative care education in the family medicine clerkship is prevalent but a large portion of clerkships do not offer it, and the majority of clerkship directors do not evaluate this learning. Our study found a positive correlation between clerkship director training in palliative care and value placed on palliative training in the family medicine clerkship. Assessing this training in the family medicine clerkship and pursuing additional clerkship director training in the subject could improve the overall quality of education provided.
ABSTRACT
BACKGROUND AND OBJECTIVES: Caring for geriatrics and palliative care patients requires integrated interprofessional care. Studies regarding interprofessional education in family medicine reveal concerns by residents regarding applicability in future practice. Our study objective was to determine the effectiveness of teaching multispecialty geriatric and palliative care skills to family medicine residents using an interprofessional clinic curriculum. METHODS: We evaluated an interprofessional geriatric and palliative care outpatient curriculum from March 2014 to June 2015. The interprofessional team included pharmacists, psychologists, family medicine geriatricians, and palliative care providers. Family medicine residents in a 3-year residency program completed pre- and postassessments evaluating their confidence and knowledge in specific areas of geriatric and palliative care. These assessments covered their abilities in starting advance care planning and setting goals in care discussions, as well as fall and depression assessment and elderly medication review. The subsequent resident perception of teaching effectiveness was also assessed. Qualitative comments were evaluated for themes. Patient perceptions were also surveyed. RESULTS: Family medicine residents completed 52 surveys (51%). Improvements in all areas were significant (P<0.05). Postevaluation mean scores by year and by session demonstrated significant improvements in palliative care tools and teaching effectiveness. Qualitative comments revealed three themes: overall positive or negative educational value and understanding of assessments, reflection on interprofessional collaboration and team experience value, and improvements in logistics and collaboration. Patient satisfaction surveys reported improved satisfaction with their PCMH. CONCLUSIONS: The use of an interprofessional and multispecialty clinic curriculum to teach geriatric and palliative care improved resident self-assessed knowledge and confidence as well as teaching effectiveness. Further studies evaluating resident exposure to such visits could substantiate the long-term influence of this educational endeavor.
