Exploring Challenges and Gaps of Internal Medicine Residents’ Perception, Attitude, and Practice towards Do-Not-Resuscitate

Objectives: Given the frequent encounter of palliative care and DNR patients, the study aims to assess internal medicine residents’ attitudes and practices concerning the care of DNR patients, and to understand the knowledge and practice gap in between juniors to seniors’ residents. Methods: A cross-sectional study conducted among internal medicine residents in 4 training centers at Riyadh, Saudi Arabia. Electronic survey distributed among internal medicine residents that contains demographic data and items addressing three domains: Factors that determine the decision of DNR, frequency of encountering and applying interventions for DNR patients, and confidence in interventions and treating DNR patients. Results: More than half of the residents didn’t have formal teaching on dealing with DNR (56.6%). Out of the factors determining DNR decision, disease prognosis was deemed the most important factor in the decision making by the participants (95.4%, n = 187). On the other hand, patient culture and background ranked the lowest (11.4%, n = 23). Over half of the participants have rarely or never applied advance directives or used assessment tools to evaluate prognosis, quality of life, and symptom severity (73.5% n = 144, 61.7% n = 121). On level-based analysis, 73.3% of seniors confirmed a high confidence level in leading family meetings compared to 20% of juniors (p-value = 0.001). Assessing and managing fear of death was reported to be highly confidence among 20% of the participants. Similarly, only 14% of the participants reported highly confidence in discussing organ transplant. Conclusion: The study demonstrates educational and clinical gaps in dealing with DNR patients among medical residents. With the increase in demand, continuous and formal teaching is needed to sharpen the residents’ skills.