End of Life Skills & Professionalism for Critical Care Residents in Training (ESPRIT): A Canada-Wide Educational Survey
CCCF ePoster library. Arora S. Nov 7, 2018; 234197; 27 Disclosure(s): This project was funded by an educational grant from the PSI Foundation.
Dr. Samantha Arora
Dr. Samantha Arora
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End of life (EOL) care is a pivotal component of comprehensive care for critically ill patients.  EOL care in the ICU includes providing grieving patients and families with medical, psychological, and spiritual support, as well as supporting the patient or family’s wishes for organ donation when death is a probable or expected outcome. To prepare future critical care medicine (CCM) physicians to provide this care, training programs should include teaching on EOL care as part of their formal curricula.



The objective of the ESPRIT Study (End of Life Skills & Professionalism for Critical Care Residents in Training) was to conduct a cross-sectional survey of Canadian CCM residents and program directors to describe and analyze current educational practices about EOL care.



We identified survey topics and items following a focused literature review related to each critical care national objective of training. We then created questions about each topic to address 3 domains of interest: 1) curricular content & evaluation methods, 2) resident’s preparedness to meet these objectives, and 3) how learning could be improved. We formatted a self-administered instrument tailored to each respondent group, performed pilot testing for each instrument, and used a Clinical Sensibility Questionnaire to test our resident survey instrument. We then distributed the ESPRIT Survey to all CCM residents and program directors across the 13 CCM programs in Canada.



Our national response rate was 82% (n=78) for the resident survey and 92% (n=12) for the program director survey. For 7 of 8 EOL learning objectives, residents reported direct observation as the teaching modality used most effectively in their training, followed by informal advice and academic half-day teaching. For non-donation EOL objectives, residents reported most comfort on a 5-point Likert scale with withdrawal of life-sustaining therapy (WLST) (mean 3.6; SD 0.8) and pain & symptom management (mean 3.6; SD 0.8), and the least comfort with cultural awareness (mean 3.2; SD 1). For donation-related skills, residents were most comfortable identifying neurologically deceased potential donors (NDDs) (mean 3.6; SD 1), and least comfortable with conducting a donation after cardiac death (DCD) (mean 2.5, SD 1.1).

Similarly, program directors cited academic-half day, direct observation, and palliative care experiences as the most commonly used teaching modalities to address EOL learning objectives in their program. Program directors ranked WLST as the most effectively taught objective (mean 3.67; SD 0.7), and cultural awareness as least effectively taught (mean 2.67; SD 0.8). For donation-related objectives, program directors ranked declaration of death by neurologic criteria as the most effectively taught (mean 4.5; SD 0.7), and discussing DCD with families as least effectively taught (mean 2.67; SD 1.2). 



EOL learning objectives in Canada are currently most effectively taught through direct observation, informal advice, and academic-half day sessions. Residents self-report a modest level of comfort with all EOL teaching objectives except for those related to donation after cardiac death- an area which program directors also identify as requiring more effective teaching.   Critical care medicine residency programs may consider implementing a comprehensive EOL curriculum including focus on these objectives.  Particular attention should be devoted to organ donation to ensure these competencies are attained.



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