Resident education and management of end-of-life care: The resident's perspective

Background: Twenty percent of Americans die in the intensive care unit of our nation's hospitals. Many of those individuals die after life-sustaining therapy has been withdrawn or withheld. Surgeons should be competent in discussing the withholding and withdrawal of life sustaining therapy (WWLST) with their patients. We surveyed surgical residents to learn their perspectives and training experience with discussing end-of-life care and WWLST with patients. Methods: We mailed a survey to residents in all accredited surgical residency programs in New England. Nonresponders were contacted by mail at 3 and 6 weeks after the initial mailing. Results: Nineteen of 20 (95%) programs participated in this study. Three hundred thirty-five residents were surveyed and 141 residents responded (response rate, 42%). Ninety-two percent (n = 129) of respondents had cared for patients where WWLST had occurred, and 74% (n = 104) had initiated a discussion about WWLST themselves. Most (n = 81, 60%) respondents felt competent to discuss WWLST, whereas 14% rarely (n = 13) or never (n = 6) felt comfortable discussing WWLST. Most (n = 119, 85%) respondents believed that they would be adequately trained at the end of their residencies; however, 39% (n = 53) felt they were inadequately trained in this area. Graduates before 2002 were significantly more likely to agree strongly or generally that they would be well trained in managing WWLST when they completed residency (p = 0.006). Conclusion: Almost all surgical residents will have to discuss WWLST with patients and their families, yet a significant number feel inadequately trained to do so. Steps should be taken to ensure that surgical residents can discuss WWLST as part of their core competencies, and this training should be reinforced throughout residency.