Table 3.

Qualitative Results by Learning Objective Domain of a Mixed-Methods Program Evaluation of the One-Week Rotation in Hospice and Palliative Medicine for Military Residents

Thematic domain	Residents (n = 43 reflective essays)a	Preceptors (n = 11 interviews)b
Hospice and palliative care operations	Residents generally had little (if any) prior experience with hospice care prior to the rotation, but by “seeing hospice in action” gained new knowledge, perspectives, and understanding. Illustrative quote: “During this week, I was able to learn a lot about hospice and palliation as a medical sub-specialty and the multi-disciplinary elements that go into delivering good palliative care.”	Preceptors also stressed the importance of early exposure to hospice and palliative care. Illustrative quote: “The notion and idea of exposing physicians early in their training to what palliative care and hospice is, is invaluable. That is part of the ongoing needs for physicians to be more informed and gives them a different option for the broad area of services that can be provided, different from the traditional model. … It comes at an important point for transition to deal with end of life … that's again, an invaluable need.”
Knowledge of grief, loss, and bereavement	Residents described learning about how important hospice was in supporting not only the patient, but also his/her family and friends. Some also reported not knowing much about grief counseling prior to this rotation. Many residents described specific experiences working with the patient and family experiencing intense grief surrounding the death of their loved one, although not all experiences were positive. Illustrative quote: “Physicians often feel helpless in regards to grief and I now feel that I have some tools to, at least, begin to address the grief experienced by these individuals.”	Preceptors expressed the importance of exposing residents to all aspects of hospice care, including grief and bereavement care. Additionally, preceptors commented on the importance of helping the residents work through their own thoughts and emotions as they go through the week. Because of the intense nature of this experience, and the fact that they encounter many patients and families who are facing the end of life in one week, some of the preceptors thought that it was important to discuss with the residents how the experience affected them.
Pain and symptom identification and treatment	Residents described new knowledge about pain management, including learning about different medications to treat pain as well as new routes of administration. They also described the importance of communication with patients and their families about pain, non-pain symptoms, and their management. Illustrative quote: “It was interesting learning the different forms of pain management. It certainly is an art form that must be learned, and I am sure, very much appreciated by patients.”
Family as the palliative unit of care	Residents described numerous experiences where they witnessed conflict within the family unit due to the illness and death. This was sometimes related to the family not accepting the death, or to differences in coping strategies and abilities among family members.	Preceptors described the value for residents to work with patients in their homes, rather than only in clinics and hospitals, to which many residents are limited. Residents are able to experience a whole new aspect of the patients and families that they are not accustomed to seeing in the acute care setting. Illustrative quote: “They're able to interact with people in homes … and I think they, from what they have told me, they benefit a lot from seeing, personally. … It's a total eye opener for them.”
Effective communication strategies with patients and families facing the end of life.	Residents chronicled numerous examples of effective communication between the care team and the patient and family, including communicating about goals of care and how important this communication is in shaping quality of care. However, residents identified communication about non-medical issues as equally important to the patient and family.	Preceptors described the importance of exposing residents to those “difficult conversations” with patients and families, even if the resident is not having conversations or holding family meetings with patients during the rotation. Illustrative quote: [It is valuable for residents to appreciate] “the importance of bedside manner when having those difficult conversations, what it looks like to be compassionate.”

^aQualitative dataset includes 43 essays by military residents reflecting on their one-week rotation in hospice and palliative medicine at a community-based provider organization.

^bInterview dataset includes 11 interdisciplinary hospice preceptors including two nurses, two grief counselors, two physicians, two chaplains, one nurse manager, one social worker, and one certified nursing assistant.