Table 6.
The “Hidden Curriculum”: Mixed Messages About End-of-life Care from Residents and Attendings in the Hospital (Student N = 1,455, Resident N = 296, Faculty N = 287)
| Extent Message is Conveyed, %* | ||||
|---|---|---|---|---|
| To What Extent Do Residents and Attendings in Your Hospital…† | A Lot | A Moderate Amount | Only a Little/Not At All | Likelihood Ratio χ2 Statistic, P Value |
| Convey the idea that having patients die is a medical failure | ||||
| Students | 4 | 18 | 78 | 37.04.05, <.0001 |
| Residents | 1 | 14 | 85 | |
| Faculty | 5 | 31 | 65 | |
| Consider dying patients to be good teaching cases for students | ||||
| Students | 15 | 40 | 46 | 20.25, <.001 |
| Residents | 10 | 35 | 55 | |
| Faculty | 9 | 33 | 58 | |
| Convey that treating the psychosocial needs of dying patients is a core clinical competency | ||||
| Students | 19 | 40 | 41 | 3.66, .45 |
| Residents | 22 | 34 | 44 | |
| Faculty | 21 | 37 | 42 | |
| Convey the idea that it's okay to express your feelings about the death of a patient | ||||
| Students | 16 | 32 | 52 | 29.90, <.0001 |
| Residents | 22 | 38 | 40 | |
| Faculty | 23 | 40 | 37 | |
| Convey the idea that working with dying patients is a rewarding experience | ||||
| Students | 10 | 30 | 60 | 10.71, <.03 |
| Residents | 14 | 34 | 52 | |
| Faculty | 8 | 36 | 56 | |
| Convey the idea that in order to provide the best end-of-life care, a physician should be emotionally uninvolved with their patient | ||||
| Students | 5 | 18 | 77 | |
| Residents | 4 | 18 | 78 | 9.46, .05 |
| Faculty | 4 | 27 | 69 | |
Not all percentages total 100% because of rounding.
Student question: “Often some of the lessons students learn in their clerkships aren't explicitly taught. Now I'd like to ask you about some of the messages about end-of-life care you may have received from residents and attendings. During your clerkships, to what extent do you think residents and attendings…” Resident question: “Often some of the lessons residents learn in their residency programs aren't explicitly taught. Now I'd like to ask you about some of the messages about end-of-life care you may have received from attendings and other residents. In your residency program, to what extent do you think attendings and other residents…” Faculty question: “Often some of the lessons medical students or residents learn in their clinical work aren't explicitly taught. Now I'd like to ask you about some of the messages about end-of-life care trainees may have received from other attendings or residents.”