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March 1991

Discussing Life-Sustaining Treatment: A Teaching Program for Residents

Author Affiliations

From the Medical Service, Portland (Ore) Veterans Affairs Medical Center (Dr Gordon), and the Division of General Internal Medicine (Drs Gordon and Tolle) and the Center for Ethics in Health Care (Dr Tolle), Oregon Health Sciences University, Portland.

Arch Intern Med. 1991;151(3):567-570. doi:10.1001/archinte.1991.00400030105019

Ideally, physicians and patients should discuss patient preferences for life-sustaining treatment before the onset of cognitive impairment or a life-threatening illness; however, these conversations often do not occur. We developed an educational program in which residents practiced discussing advance directives with volunteer simulated outpatients and then received feedback from the patient, an observing resident, and a faculty member. Residents found the training sessions to be realistic, relevant, and useful. Resident self-ratings improved significantly on eight items representing knowledge, skills, and attitudes about discussing advance directives with patients. Resident learning occurred in four major areas: technical knowledge about advance directives; introducing the topic to patients; giving patients information; and eliciting patients' values and feelings. We conclude that residents need and want training in this area and that simulated patients act as a catalyst for their learning.

(Arch Intern Med. 1991;151:567-570)

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