Regulatory and educational initiatives fail to promote discussions regarding end-of-life care.

We conducted an observational cohort study to determine if hospital-based, reinforcing regulatory and educational interventions could encourage physicians to discuss end-of-life (EOL) care with their patients. Specifically, we measured the effect of (1) administrative prompts to encourage discussions about EOL care and (2) a mandatory educational seminar focusing on EOL issues. Study subjects were patients consecutively admitted to the medicine service who faced an anticipated 3-year mortality rate of at least 50%. The main study endpoint was the frequency of documented EOL discussions between physicians and patients. In the inception cohort of 184 patients, physicians discussed EOL care with 64 patients (34. 8%), and in the follow-up cohort of 121 patients, 41 individuals (33. 9%) had documented discussions regarding EOL issues (P = 0.90). Actual "Do Not Resuscitate"(DNR) orders were written for 53 patients (28.8%) in the inception cohort and for 33 persons (27.3%) in the follow-up cohort (P = 0.71). We conclude that enhanced, mutually reinforcing regulatory and educational efforts focusing on EOL care proved ineffectual at promoting either discussions about EOL issues or the use of DNR orders.

The American College of Physicians' Resident Abstract Competition: success of U.S. military trainees.

Research is a central aspect of internal medicine (IM) training, and accreditation organizations require that residency programs show that their residents participate in scholarly activity. To better understand the research productivity and the quality of research conducted by military IM trainees, we reviewed the records of the American College of Physicians' Resident Abstract Competition from 1995 to 1997. This national competition is prestigious, blindly judged, and highly selective. We found that although military residents account for less than 2% of all U.S. and Canadian IM trainees, they author more than 11% of the abstracts selected for presentation (p < 0.001). We conclude that military IM residents are disproportionately represented compared with their civilian peers in an objective, national competitive forum. This is consistent with the higher scores on in-service examinations and higher board-certification pass rates for military IM residents.