Institution and Program description

AtlantiCare Regional Medical Center is a 637-bed Community hospital which sponsors an Internal Medicine Residency program with 41 medical residents. ARMC is part of AtlantiCare Health System, an integrated system that includes outpatient services, medical equipment company, Medicare Certified Home Hospice, and Home Health agencies. In response to identified need for improved Palliative Care services to hospitalized patients, ARMC instituted a Palliative Care Service in February 2005 with a nurse-practitioner and a physician.

Innovation

To enhance Medical Resident education in geriatrics, palliative care, and hospice medicine, a month-long rotation for third year residents was initiated in July 2006. The rotation includes weekly outpatient hospice and inpatient palliative care consults and rounds, house calls, nursing home, and office geriatrics. As part of the general educational curriculum, the Palliative Care team provides a didactic lecture to the entire resident class annually.

Outcomes

A survey instrument to assess factual knowledge and personal attitudes concerning Advance Directives, Palliative Care, Hospice, end-of-life issues, and pain management was administered to the entire resident class. The knowledge-based questions covered hospice, palliative care management, and questions taken from the Education for Physicians on End-of-life Care (EPEC) modules (EPEC Project, the Robert Wood Johnson Foundation). Attitudes concerning death and dying were assessed using the modified Collett-Lester Fear of Death scale. Resident performance was compared between those who had completed the rotation and those who had not. Residents who had completed the rotation scored better on the factual knowledge exam. Residents who completed the rotation also scored lower anxiety levels on aspects of the dying of others. This included less anxiety on talking about death and dying, suffering, pain and physical degeneration. Anxiety scores for aspects of their own death and dying and the death of others were not impacted by the rotation.

Lessons Learned

An exposure to Palliative Care, Hospice, and Geriatrics in the form of a month-long rotation working closely with hospice nurses, palliative care nurse-practitioners, and faculty supervisors can improve knowledge and lessen a medical resident’s anxiety dealing with the dying process of others.