U.S. medical students' perceptions of the adequacy of their schools' curricular attention to care at the end of life: 1998-2006.

BACKGROUND: Little is known about the long-term effectiveness of recent efforts to improve end-of-life care education at U.S. medical schools. OBJECTIVE AND DESIGN: Longitudinal, observational study using national data from the Graduation Questionnaire of the Association of American Medical Colleges from 1998-2006, comparing national trends with those at New York Medical College (NYMC), where a required 1-day clinical rotation to a palliative care hospital began in 1998. RESULTS: The fraction of graduating U.S. students reporting that their instruction time on death and dying was at least adequate rose from 70.8% in 1998 to 79.5% in 2006 (p < 0.001); instruction time in pain management rated as at least adequate rose from 34.3% in 1998 to 55.3% in 2005 (p < 0.001); training in palliative care rated as at least adequate rose from 59.9% in 2000 to 74.8% in 2006 (p < 0.001). Improvement began earlier at NYMC compared with national trends, but by 2004 NYMC was no longer significantly different. In multivariate analyses, women, Asians, and older students gave lower ratings of the quality of their end-of-life care education. CONCLUSION: While much remains to be done, there have been significant improvements since 1998 in graduating U.S. medical students' ratings of the adequacy of their instruction time in end-of-life care.