Assessing medical students' training in end-of-life communication: a survey of interns at one urban teaching hospital

Acad Med. 2003 May;78(5):530-7. doi: 10.1097/00001888-200305000-00019.


Purpose: Although interns are responsible for caring for dying patients, little is known about end-of-life education and training, including communication skills, in U.S. medical schools. This study of three consecutive cohorts of new interns assessed their perceptions of the amount and types of classroom and clinical instructional strategies used during medical school, their self-rated skill and comfort levels in different aspects of end-of-life communication, and the associations between these measures.

Method: A self-administered questionnaire was given to three consecutive cohorts (1996-1998) of incoming interns (n = 162). Measures were self-reported amount and type of education and clinical experience with four end-of-life communication domains (giving bad news, discussing advance directives, discussing prognosis with the patient, and discussing with the patient's family) and self-perceived comfort and skill levels in relation to different types of end-of-life communication.

Results: A total of 157 interns completed the questionnaire. They reported very little classroom teaching, clinical observation, or clinical experience with end-of-life communication during medical school. They lacked comfort and skill in the end-of-life communication domains that were studied. More reported clinical observation and experience with caring for and communicating with dying patients was associated with greater perceived comfort and skill, while classroom teaching was not.

Conclusions: These interns, mostly U.S. medical school graduates (98.7%, n = 155) reported little training and low self-perceived comfort and skill with important elements of end-of-life communication that might contribute to a lack of preparedness to address these issues during their internship. Further research that confirms and explains the underlying reasons for these findings seems warranted.

MeSH terms

  • Adult
  • Advance Care Planning
  • Advance Directives
  • Attitude of Health Personnel
  • Chi-Square Distribution
  • Communication*
  • Education, Medical*
  • Female
  • Hospitals, Teaching
  • Hospitals, Urban
  • Humans
  • Internship and Residency*
  • Male
  • Physician-Patient Relations*
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Terminal Care*