Why End of Life Training is Valuable for Residents

Written by: Dr. Kathy Gennuso

According to Vivian Wang (yaledailynews.com), a new Yale study demonstrates what common sense would profess: “physicians’ level of training may influence how willing they are to comply with patients’ end of life requests.”

Connecticut physicians were surveyed on honoring specific patient requests in five scenarios: withholding of life-saving treatment; extubation/removal of life-sustaining treatment; potentially lethal doses of narcotics; prescription of sufficient sleeping pills to commit suicide; and lethal injection. Only the first three scenarios are legal in Connecticut.

That study showed physicians with experience in end-of-life situations more willing to comply with their patients’ requests for the legal scenarios than were residents.

Although Yale is certainly moving in the right direction, many other residents may need deeper understanding of ethics and end-of-life care, and they are often expected to learn ethics from one talk by another physician or academic.  Couldn’t more formalized ethics training help?

A 2010 national survey of family medicine residency programs regarding residents’ ethics training found considerable variation in content and delivery, as well as “a lack of specification of explicit curricular aims for ethics teaching allied to ACGME or AAFP competencies; a tendency not to designate the responsibility of clinical ethics to an individual; and a lack of formal assessment of ethics competencies” (H. M. Manson et al.).

Without adequate ethics training and assessment, residents are left to observe ethical dilemmas and extrapolate the lesson, if possible, on an ad hoc, personal basis as issues surface.

Guess who (besides the resident!) this affects? The Patient.