End-of-Life Ethics Content in the Ten Residencies Offering Hospice and Palliative Medicine Fellowship

Outcomes 1. Through a review of exam outlines, participants will realize the lack of consistency in the end-of-life ethics content between residencies that lead into HPM fellowship. 2. Participants will recognize the relevance of standardizing ethics education across HPM fellowship programs. Key Message Ethics training is essential to hospice and palliative medicine (HPM) training. Ten residencies feed into HPM fellowship, but clinical ethics tested on board certification exams vary in content and weight across specialties. Given this variance, standardizing end of life ethics training for HPM fellowship programs presents an opportunity for educational improvement. Introduction The essence of end-of-life (EOL) communication stems from understanding modern bioethical principles and how they relate to topics such as informed consent, advance directives, DNR, surrogate decision-making, decision-making capacity, artificial nutrition and hydration, advance care planning/goal setting, and withdrawing life-sustaining treatments.1 Hospice and palliative medicine (HPM) training involves teaching fellows relevant ethics topics, acclimating them with discussing and handling ethical dilemmas with cultural humility and gaining the perspectives of involved stakeholders.2 There are ten residency programs (Anesthesiology, Emergency Medicine, Family Medicine, Internal Medicine, OBGYN, Pediatrics, PMR, Psychiatry and Neurology, Radiology, and Surgery) which can lead into HPM fellowship. However, EOL ethics tested on board certification exams vary in content and weight across specialties. Objectives This study reviewed EOL ethics content tested by board certification exams from residencies that lead into HPM fellowship across specialties. Methods This study analyzed relative frequencies of EOL ethics categories across and within specialties from the respective board certification exam content outline. Results The relative frequencies of categories across specialties were 23.5% informed consent; 17.6% advance directives; 11.8% DNR; 11.8% surrogate decision-making; 11.8% decision-making capacity; 11.8% advance care planning/goal setting; and 11.8% withdrawing life-sustaining treatment. The relative frequencies of categories within specialties were 28.1% Surgery; 15.6% Emergency Medicine; 12.5% Anesthesiology; 12.5% Internal Medicine; 9.4% Psychiatry and Neurology; 6.3% Family Medicine; 6.3% Obstetrics and Gynecology; 6.3% Pediatrics; 3.1% PMR; and 0% Radiology. Conclusion Our findings indicate that end-of-life ethics content tested on these board certification exams vary across specialties. Given this variance, standardizing end-of-life ethics training for HPM fellowship programs presents an opportunity for educational improvement. Keywords Ethical / Legal Aspects of Care