End-of-Life Curriculum Reform: Outcomes and Impact in a Follow-Up Study of Internal Medicine Residency Programs

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Abstract
In 1998 we initiated a pilot project to evaluate the feasibility of recruiting and training internal medicine residency programs in methods designed to enhance and integrate end-of-life (EOL) instruction and assessment into their curriculum. To evaluate participants' assessment of the training program and the 12-month impact of the training on the 32 residency programs' EOL teaching. Prospective multi-institutional study. After participating in training, all participants agreed/strongly agreed that the skills-related objectives of the training were met. Mean ratings of intention to continue with the program were consistent across trainees representing different academic ranks (F = 2.8, p = 0.07), levels of experience in EOL education (F = 1.3, p = 0.28), and involvement in other national EOL training programs (F = 1.5, p = 0.23). Twelve months after training, most programs (78%) continued with the project and had initiated EOL curriculum reform in seven key EOL domains.). The study suggests that focused training in EOL teaching methods and institutional change strategies can facilitate EOL curriculum reform.