End-of-life discussions remain a thorny issue for hospitals, but assigning them to medical residents could both improve their care and provide a valuable learning experience for those residents, argues a piece from STAT News.
While resident physicians-in-training have considerable autonomy, that freedom stops at end-of-life conversations, writes Ravi Parikh, a resident at Boston’s Brigham and Women’s Hospital. “I initially didn’t protest when a patient’s long-term physician would ask me not to have an end-of-life discussion without him or her present,” Parikh writes. “But the problem, I’m learning, is that these conversations often need to happen right away. I’m also learning that there are consequences to disregarding the expectation that residents defer these conversations.”
Training for residents operates according to the principle “See one, do one, teach one,” according to Parikh, and as such training involves first-hand experience along with other training. However, while they are required to prove proficiency by performing a certain number of spinal taps, for example, before being independently certified to perform or supervise them, there is no such requirement for end-of-life conversations, with residents instead simply left to rely on doctors for permission. Even as palliative care advances, nearly half of residents say they’re not comfortable discussing end-of-life topics with patients.
The lack of attention to the process is a mistake, Parikh writes, because much like surgical procedures, residents must improve their discussion skills by repetition--even if it means failing in the early going. But even this room for error might not be necessary to improve the training process, according to Parikh; rather, if residents are given more time for practicing end-of-life discussions or shadowing the doctors performing them, a trial and error approach may not be necessary.
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