Equipping future physicians to recognize a palliative approach to care: A mixed methods study on palliative care training needs in internal medicine residency.

Abstract

Background: A palliative approach to care emphasizes holistic assessment and treatment planning for individuals with life-limiting illnesses. Despite Canadian national frameworks and competency guidelines, internal medicine (IM) residents often report limited exposure and comfort with palliative care.

Objective: The purpose of this investigation is to assess the training needs of IM residents at McMaster University and inform future curriculum development.

Design: A sequential mixed-methods design was employed. Both quantitative survey and qualitative interview data were reviewed together to develop recommendations for internal medicine curriculum planning.

Methods: Phase 1 included an online survey distributed to post-graduate years (PGY) 1 to 5 IM residents, assessing exposure, comfort, and preferences regarding palliative care education. Phase 2 consisted of semi-structured interviews with PGY4-5 subspecialty residents to explore perspectives in greater depth. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis using inductive coding.

Results: Twenty-four residents completed the survey. While 54% rated palliative care as "very important" to their future practice, only 50% were satisfied with current training. Residents reported comfort with symptom management and communication but discomfort with outpatient resources and discussing artificial nutrition. Interviews with five senior residents revealed appreciation for early exposure and experiential learning but noted barriers such as limited role modeling and scheduling conflicts. Suggestions included mandatory rotations, case-based learning, and integration of community-based care.

Conclusions: IM residents value palliative care education and support its integration into residency training. Findings highlight the need for a structured curriculum that balances didactic and experiential learning, addresses identified gaps and promotes longitudinal skill development. Such efforts are essential to prepare future specialists to deliver comprehensive, patient-centered care.