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Special Article
Nov 2011

Coping With Death and Dying on a Neurology Inpatient Service: Death Rounds as an Educational Initiative for Residents

Author Affiliations

Author Affiliations: Department of Neurology, University of Washington (Drs Khot and Longstreth), Health Service Research and Development, Division of Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Health Care System (Dr Billings), and Palliative Care Service, Harborview Medical Center (Dr Owens), Seattle.

Arch Neurol. 2011;68(11):1395-1397. doi:10.1001/archneurol.2011.618

Background Residents in neurology may feel unprepared to care for dying patients. We developed Death Rounds to provide emotional support and end-of-life care teaching for residents caring for dying patients on the inpatient neurology service. Death Rounds are monthly 1-hour clinical case discussions where residents identify issues through shared experiences.

Objective To survey neurology residents' perceptions of Death Rounds with respect to end-of-life care teaching and emotional support.

Design, Setting, and Participants We conducted an electronic survey of all (n = 26) neurology residents and recent residency graduates at the University of Washington 2 years after instituting monthly Death Rounds.

Main Outcome Measure The survey consisted of 10 questions examining residents' perceptions of the extent to which Death Rounds provided emotional support and end-of-life care teaching. We dichotomized responses to statements about Death Rounds as agree or disagree.

Results All 26 residents responded to the survey and attended at least 1 Death Rounds session. More than half of residents attended more than 3 sessions. Residents agreed that Death Rounds helped them cope with dying patients (17 residents [65%]), delivered closure for the team (16 residents [61%]), and provided emotional support, more for the team (18 residents [69%]) than the individual (10 residents [38%]). Most residents felt that Death Rounds provided useful teaching about end-of-life care (18 residents [69%]), and they were satisfied overall with Death Rounds (16 residents [61%]).

Conclusions Death Rounds afford an opportunity for physicians-in-training to process as a group their feelings, intense emotions, and insecurities while learning from the dying process. In our inpatient neurology service, most residents found it a rewarding and valuable experience.

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