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End-of-Life Care Education forPsychiatric Residents:Attitudes, Preparedness, andConceptualizations of Dignity

Received July 14, 2008; revised October 13, 2008; accepted October 15, 2008. The authors are affiliated with the Department of Psychiatry and the Wilson Centre for Research in Medical Education at the University of Toronto in Toronto, Ontario. Dr. Tait is also affiliated with North York General Hospital in Toronto. Address correspondence to Glendon R. Tait, University of Toronto, Psychiatry, Wilson Centre, Toronto General Hospital, 200 Elizabeth St., 1ES-559, Toronto, Ontario M5G 2C4, Canada; glendon.tait{at}utoronto.ca (e-mail).

OBJECTIVE: The authors examined psychiatric residents’ attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. METHODS: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey had a mix of qualitative and quantitative questions. RESULTS: Eighty-two of 116 invited psychiatric residents participated for a response rate of 71%. With favorable attitudes, residents felt least prepared in existential, spiritual, cultural, and some psychological aspects of caring for dying patients. Trainees conceptualized dignity at the end of life in a way very similar to that of patients, including concerns of the mind, body, soul, relationships, and autonomy. Residents desired more longitudinal, contextualized training, particularly in the psychosocial, existential, and spiritual aspects of care. CONCLUSION: This is the first study to examine the end-of-life educational experience of psychiatric residents. Despite conceptualizing quality care and the construct of dignity similarly to dying patients, psychiatric residents feel poorly prepared to deliver such care, particularly the nonphysical aspects of caring for the dying. These results will inform curriculum development in end-of-life care for psychiatric residents, a complex area now considered a core competency.

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