A Needs Assessment of Palliative Care Education among the United States Adult Neurology Residency Programs

Background: Palliative care (PC) needs in patients with neurological diseases are becoming more recognized by neurologists and PC physicians. Objective: To qualify and quantify the PC education available in the United States adult neurology programs since the Accreditation Council for Graduate Medical Education (ACGME) published updated mandates in 2009. Design: A 22-question survey was electronically distributed to each neurology residency program in the United States. Setting/Subjects: All program directors (PDs) and assistant/associate program directors (APDs) of adult neurology programs. Results: This study had a 35% survey response rate (49 programs). Of the participating programs, 20% offer no PC education to residents. Communication, prognostication, and withdrawing life-prolonging therapies were the domains identified as the most important for resident education; these were also the domains PDs/APDs were most comfortable providing for their own patients, and the domains their residents are the best trained in currently. Addressing spiritual distress was the domain considered the least important, the domain PDs/APDs were least comfortable providing for their own patients, and the domains residents are currently the least well-trained in. Forty-two percent of programs were dissatisfied with the PC education available at their program. Time for teaching, availability of faculty, and faculty expertise were the most common barriers. Conclusions: PC education varies greatly across the United States adult neurology residency programs despite ACGME requirements. As time and resources limit current training, utilization of interdisciplinary educational teams and nationally available PC educational material may improve implementation of PC education in these residency programs.