Creating Required Palliative Care Exposure in Internal Medicine Residency: Curriculum Development and Evaluation

Outcomes 1. Utilizing a curriculum-based approach, upon completion, participants will self-report the ability to develop, apply, and evaluate a curriculum for a palliative care rotation for internal medicine interns for future education applications. 2. Utilizing a curriculum-based approach, participants will self-report the ability to develop and apply a communication skills workshop for residents for future education applications. Key Message The ACGME requires palliative care training opportunities for Internal Medicine (IM) residency, though does not specify type of exposure. This session will focus on development and evaluation of a palliative care curriculum for Yale Primary Care IM residents, with description of communication skills workshop, two-week structured clinical rotation, and program evaluation. Introduction All IM residents care for seriously ill and dying patients. Trainees currently feel unprepared to provide palliative care (1). Further training is desired (2). Objectives We developed a comprehensive curriculum for IM residents, evaluating if it improved interns' comfort with, and knowledge of, core topics in palliative care. Methods We designed a communication skills simulation workshop powered by VitalTalk for all interns and residents. We also developed a palliative care rotation for interns with learning objectives, entrustable professional activities, and rotation evaluation. The rotation included goal setting, observed clinical encounters, symptom management, family conferences, and participation in interdisciplinary meetings. Interns completed a pre, post, and end-of-year survey with 8 comfort questions and 14 knowledge questions, compared with historical control. Data was evaluated through paired and unpaired T-tests. Results In 2022-2023, 52 interns and residents completed the VitalTalk workshop. 18 interns completed the Palliative Care rotation, which was made permanent for future classes. Individualized learning goals encompassed communication, prognostication, symptom management, hospice and local resource discussion, advance care planning, and mindful practice. Pre and post results (n=5) demonstrate significant increases in both comfort with skills (8 item mean: 2.4 to 3.5 out of 5, p=0.05) and knowledge (14 item mean: 51% to 82%, p=0.04). End of year learning outcomes (n=4) compared to historical control (n=11) suggest significant increases in both comfort with skills (mean 4 to 2.7 out of 5, p=0.05) and knowledge (mean 72% to 56%, p=0.01). Conclusions This curriculum represents a robust example of IM intern and resident exposure to palliative care core competencies. Interns' comfort with skills and their knowledge of palliative care improved. Future directions will incorporate feedback to improve the curriculum and track longitudinal interest in subspecialty training. Keywords Workforce / Career Development / Communication