End-of-Life Training in US Internal Medicine Residency Programs: A National Study

Background: End-of-life care is a required and important component of medical training for internal medicine residents; many of whom will go on to provide care for adults at the end-of-life stage. Although a body of past research suggests that physician training in end-of-life care needs significant improvement, a comprehensive national study of end-of-life education within US internal medicine residency programs has never been published. Objective: To determine the status of end-of-life education in internal medicine residency programs in the United States. Method: The study was a cross-sectional, observational study of all internal medicine Residency Program Directors in the US as of May 2015. Postal mail and email were used to disseminate a multi-wave survey to program directors. Results: More than half (52%) of all program directors completed the survey. Although directors strongly believed in the benefits of residents integrating end-of-life care components into clinical practice, only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Of those programs that taught end-of-life topics or skills, the majority did not formally evaluate residents’ competence. Moreover, 24% of residency programs did not have an end-of-life curriculum; 34% did not offer a rotation in hospice care; and 31% did not have structured conference teaching on topics dealing with end-of-life. Conclusions: Although end-of-life training of physicians has improved over the years, deficiencies remain within US internal medicine residency programs