• more than one-quarter reported one hour or less of class time,

  • 39 percent recalled some reading on the topic, and

  • 37 percent rated the quality of teaching “ineffective” and 3 percent rated it “very effective.”

In contrast to the students’ evaluations, a national sample of cancer center directors and directors of nursing oncology reported high levels of satisfaction with supportive care instruction (greater than 90 percent) (Belani et al., 1994). However, in the one institution where students were actually studied, the level of satisfaction was 27 percent.

RELATED FINDINGS When Billings and Block reviewed the literature in the mid-1990s, they found a number of small, more detailed studies, all of which lend support to the need for more attention to end-of-life care. Their findings span research published from 1980 through 1995; thus, some findings may be less relevant in 2001 than when published, but the pace of change has not been so great that this is necessarily so. Following are some provocative observations from individual studies:

  • 30 percent of a random sample of generalists in Oregon recalled medical school training in dealing with dying patients, and 87 percent thought that more such instruction should be given in medical school;

  • 39 percent of a sample of young physicians felt they had good or excellent preparation for managing the care of patients who want to die;

  • 41 percent of students completing third-year clerkships were never present when an attending physician talked with a dying person, 35 percent had never discussed with an attending physician how to deal with terminally ill patients, 73 percent had never been present when a surgeon told a family about bad news after an operation, and one-third could not identify problems that would arise for family members when a dying patient was discharged to go home.

Articles on end-of-life care during residency reviewed by Billings and Block (1997) are consistent with the more recent survey findings. A similar survey of 1,068 accredited residency programs in family medicine, internal medicine, pediatrics, and geriatrics, published in 1995 (Hill, 1995) found that

  • 26 percent of all residency programs in the United States offer a standard course in end-of-life care,

  • almost 15 percent of programs offer no formal training in care of terminally ill patients, and

  • 8 percent require a hospice rotation and 9 percent offer an elective one.

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