Palliative care education: an intervention to improve medical residents' knowledge and attitudes

J Palliat Med. 2003 Jun;6(3):391-9. doi: 10.1089/109662103322144709.


Background: Medical care at the end of life remains poor. One approach to improving end-of-life care is through education of medical trainees. However, evidence regarding the structure of an ideal educational intervention is sparse.

Objective: To test an innovative curriculum designed to improve medical resident knowledge and decrease anxiety surrounding end-of-life care.

Methods: Quasiexperimental study of medical trainees in a large academic internal medicine residency. Attitudes and knowledge were measured at baseline and at completion of a 1-month clinical ward rotation for both control (n = 40) and intervention groups (n = 30) using the Collett-Lester Death Anxiety Scale (C-LDAS), the Semantic Differential Scale (SDS), and a 16-question knowledge-based test. Residents in the intervention group completed four 1-hour sessions focused on end-of-life issues.

Results: Baseline anxiety levels were high while knowledge scores were poor. Linear regression modeling demonstrated that pretest scores were the strongest predictor of post-test scores for all three measures. Additional significant predictors for the knowledge test were prior palliative care experience and year of training (p = 0.02), while prior palliative care experience alone contributed to the SDS model (p = 0.06). No significant improvements on the SDS, C-LDAS, or knowledge test occurred after the curriculum intervention.

Conclusions: Our classroom intervention had no significant effect on residents' attitudes towards or knowledge of end-of-life care. The fact that prior palliative care experience affects baseline scores provides a strong argument for continued research for an effective curriculum for end-of-life education, perhaps focusing on clinical rather than didactic experiences in palliative care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Death
  • Chi-Square Distribution
  • Clinical Competence
  • Education, Medical, Graduate / organization & administration*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Internship and Residency*
  • Linear Models
  • Palliative Care*
  • Physicians / psychology
  • Predictive Value of Tests
  • Terminal Care / methods*