Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4 week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

How I Do It a Surgical Palliative Care Rotation for Residents.

To address the need for increased exposure to the essential components of Palliative Care in our residency, we created a 4 week rotation in Surgical Palliative Care for all of our categorical interns. The rotation includes time on an interdisciplinary inpatient consultative palliative care service as well as time in the outpatient clinic and in the operating room with the Surgical Palliative Care attending. Most patients who are seen and evaluated have surgical issues, allowing exposure to the fundamental aspects of palliative care as they pertain to surgical practice across the continuum of healthcare settings. Communication around serious illness, complicated decision making, complex pain and symptom management, withdrawal of life-sustaining treatment, and end-of-life care are all integral parts of the rotation. The rotation has been very favorably received by the residents, and the impact on the culture of the department has been tremendous as well. The structured approach provided, including goals and objectives and the weekly schedule, make this rotation easily replicable in other residency programs.

Mitigating Burnout.

Burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. All physicians, and especially surgeons, are at risk for developing burnout. The best strategies for mitigating burnout mimic a modern approach to medicine: the development of preventive practices to protect, promote, and maintain health and well-being. Job satisfaction, job engagement, and compassion satisfaction help protect from burnout. Individual commitment to self-care in conjunction with support from within health care organizations create the optimal framework in which burnout can be mitigated.

Surgical palliative care training in general surgery residency: An educational needs assessment.

INTRODUCTION: There is increasing recognition that Surgical Palliative Care is an essential component of the holistic care of surgical patients and involves more than end-of-life care in the intensive care unit. General surgery residents are clinically exposed to patients with palliative care needs during each year of training, but few have a dedicated surgical palliative care curriculum. We undertook this educational needs assessment as the first step towards a longitudinal curriculum. METHODS: We conducted an anonymous survey of 94 general surgery residents and 115 faculty at community and university hospitals to assess their experience and comfort with surgical palliative care delivery. Residents and faculty were asked multiple choice and open-ended questions. RESULTS: There was a 55% response rate from residents and 33% response rate from faculty. The majority (77%) of respondents were junior residents (PGY1-3) and university-based faculty (66%). Approximately half of residents felt comfortable leading conversations in goals of care (58%), comfort-focused care (52%) and delivering bad news (57%), while greater than 90% of faculty agreed that chief residents needed additional training. All residents agreed they needed additional training and 85% wanted a formal curriculum. Analysis of open-ended questions suggests a deficiency in the pre-operative setting as no residents had participated in these conversations in an outpatient setting. CONCLUSION: Residents and faculty believe trainees would benefit from further education in surgical palliative care with a dedicated curriculum. The outpatient, pre-operative counseling of patients was identified as a key learning need. These data support our ongoing work to develop a surgically pertinent palliative care curriculum.