Structured teaching versus experiential learning of palliative care for surgical residents

Background: Previous end-of-life and palliative care curricula for surgical residents have shown improved learner confidence, but have not measured cognitive knowledge or skill acquisition. Methods: A nonrandomized trial evaluated a structured palliative care curriculum for 7 postgraduate year 2 surgical residents (intervention group) compared with 6 postgraduate year 5 surgical residents (comparison group). Outcomes were measured using an 18-item knowledge test, a 20-minute objective structured clinical examination simulating an intensive care unit family conference, and a survey measuring self-confidence. Results: The mean knowledge test scores for the intervention group, both before and after undergoing the structured palliative care curriculum, were no different from the comparison group. There was also no difference in objective structured clinical examination scores between the 2 groups. The intervention group felt less comfortable managing pain, breaking bad news, or addressing ethical issues. Conclusions: Junior surgical residents have similar palliative care knowledge to senior residents without a palliative care curriculum. After participating in a palliative care curriculum, they have simulated skills that are similar to chief residents. However, self-confidence is lower among junior residents despite undergoing a palliative care curriculum.