Implementing a Multimodal Palliative Care Curriculum: Impact on Knowledge, Confidence, and Skills.

چکیده اصلی

INTRODUCTION: Emergency physicians frequently care for patients with serious or terminal illnesses, yet they often lack formal palliative care training. Our primary objective was to develop a structured, multimodal palliative care curriculum for emergency medicine (EM) residents and evaluate whether this curriculum improved residents' knowledge, comfort level, and perceived application of skills to care for patients with chronic or terminal illness in the emergency department (ED). Our secondary objective was to determine whether EM residents found palliative care education important and to identify which educational modalities are most effective for acquiring palliative care knowledge and skills. METHODS: We implemented an eight-hour multimodal curriculum for EM residents at a single, large Level I trauma center (four hours of didactics, a three-hour simulated patient communication skills lab, and one hour of high-fidelity simulation). Our primary outcome was pre- and post-intervention surveys (12 questions) that assessed perceived knowledge, comfort, and skill application on five-point Likert scales. We analyzed paired responses using the Wilcoxon signed-rank test, with a P value of < .05 considered statistically significant. Effect size was calculated using Cohen d. Our secondary outcome measure was a post-intervention survey (six questions) that assessed participants' opinions on the effectiveness of the different educational methods. RESULTS: There was a 100% response rate among 41 residents from all postgraduate years 1-3. Significant improvements (P < .001) were observed in residents' self-reported abilities across all domains with large effect sizes. Median scores and interquartile ranges increased for conducting goals-of-care discussions (4 [3-4] vs 4 [4-5]), interpreting advance directives (3 [2-4] vs 4 [4-4]), managing end-of-life symptoms (3 [2-3] vs 4 [3-4]), communicating bad news (3 [2-4] vs 4 [4-4]), and coordinating with palliative or hospice teams (2 [2-3] v. 4 [4-4]). All educational modalities were rated effective, with simulation and small-group sessions preferred over lectures. CONCLUSION: A structured, multimodal palliative care curriculum significantly enhanced EM residents' perceived preparedness to manage patients with palliative care needs. Embedding didactic and simulation-based palliative training in EM residencies is both feasible and impactful, addressing critical gaps in palliative competencies and aligning with national best-practice guidelines.

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