Feasibility and impact of a case-based palliative care workshop for general surgery residents

Abstract

Background: The American Board of Surgery has emphasized that palliative care education should be included in surgical training. The few formal curricula for teaching palliative care, although effective, are time-intensive and have low longitudinal participation rates. The aim of this project was to design a feasible and effective palliative care intervention for general surgery residency training.

Study design: A multidisciplinary group developed a 2-hour case-based palliative care workshop including a brief introductory didactic, 4 case-based scenarios, and role-playing exercises. Program effectiveness was assessed using pre- and 3 weeks post-workshop surveys to measure attitudes toward and knowledge of palliative care. Fisher's exact test was used for data analysis; statistical significance was accepted at p < 0.05.

Results: Twenty-two (88%) residents attended the workshop and completed the baseline survey; 16 (72.7%) completed the post-workshop survey. The workshop changed residents' attitudes to be more consistent with accepted palliative care principles. Statistically significant shifts were seen in attitudes about the use of total parenteral nutrition for malignant small bowel obstruction (31.8% disagree with use pre- vs 68.8% post-workshop; p < 0.0001); the use of surgical therapy for malignant small bowel obstruction (45.5% disagree pre- vs 68.8% post-workshop; p = 0.002); and that depression is normal in terminal illness (22.7% disagree pre- vs 43.8% post-workshop; p = 0.002). Residents also performed considerably better on knowledge questions about CPR, patient autonomy, and withdrawal of life-sustaining therapy.

Conclusions: A brief, interactive workshop is effective in changing general surgery residents' attitudes toward and knowledge of palliative care. The results demonstrate that a single teaching session is a useful intervention.