Assessment of Internal Medicine Resident Perspectives on Medical Aid-in-Dying in Future Practice

Dear Editor:

Medical aid-in-dying (MAID) was legalized in Oregon in 1997 and has since been legalized in seven other states and Washington, District of Columbia,¹ including Colorado in 2016.² MAID presents new challenges in end-of-life (EOL) communication and counseling when patients make requests for assisted death, in addition to other needs for palliative and EOL care training noted by medical students and physicians.^3,4 With the increasing legalization of MAID and to our knowledge, no studies addressing residents' perception of training, knowledge, and comfort addressing patient requests for MAID, we conducted a brief assessment of resident physician beliefs regarding MAID.

We developed a 24-question survey using the Qualtrics online survey tool to explore resident physicians' beliefs regarding their comfort level with different aspects of EOL care and any interest in further training in MAID. The survey was distributed by email to 197 residents in the Internal Medicine Program at the University of Colorado, including those completing a preliminary intern year (physicians with plans for subsequent training in anesthesiology, neurology, and dermatology). Data were analyzed using SPSS software version 27. Survey responses were summarized with frequencies and proportions. Institutional Review Board approval was not required for this educational needs assessment.

Respondents were 85 internal medicine residents (response rate: 43%) who were 54% female and 68% in the 20- to 30-year-old age category. Most respondents were interns (40% PGY-1), reflecting the larger number of interns in the total survey population. Ninety-one percent of residents reported caring for patients with life expectancies ≤6 months at least sometimes, often or daily with only 17% of residents reported to have received previous MAID education or training. Table 1 displays the future career plans for the residents related to EOL care with the majority (67%) expecting to care for patients with life expectancies ≤6 months in future careers often or daily. One-third (34%) of residents reported they were either somewhat or very likely to serve as primary or consulting MAID physicians in the future, although 74% reported feeling either somewhat or very unprepared to serve as a primary or consulting MAID physician. A majority of residents (81%) reported they were either somewhat or very interested in education or training related to MAID.

Table 1.

Future Career Plans for Internal Medicine Residents Related to End-of-Life Care (n = 85)

	n (%)
Expected future frequency of caring for patients with life expectancy ≤6 months
Never	0 (0)
Infrequently	8 (9)
Sometimes	20 (24)
Often	42 (49)
Daily	15 (18)
Likelihood to serve as primary or consulting MAID physician
Very unlikely	13 (15)
Somewhat unlikely	28 (33)
Neither unlikely or likely	15 (18)
Somewhat likely	23 (27)
Very likely	6 (7)
Preparedness to serve as primary or consulting MAID physician
Very unprepared	40 (47)
Somewhat unprepared	23 (27)
Neither unprepared or prepared	16 (19)
Somewhat prepared	5 (6)
Very prepared	1 (1)
Interest level in education or training related to MAID
Very uninterested	1 (1)
Somewhat uninterested	6 (7)
Neither uninterested or interested	9 (11)
Somewhat interested	28 (33)
Very interested	41 (48)
Importance of working for an institution that participates in MAID
Very unimportant	3 (4)
Somewhat unimportant	3 (4)
Neither unimportant or important	35 (41)
Somewhat important	32 (38)
Very important	12 (14)

MAID, medical aid-in-dying.

Our limitations include sampling from a single residency, which limits generalizability. In addition, there may be selection bias where residents who completed the survey were more likely to be interested in participating in MAID as part of their future practice (in contrast to the studied neutrality of American Academy of Hospice and Palliative Medicine).⁵

In conclusion, a majority of residents spend a significant portion of training caring for patients with serious illnesses and many plan to care for these patient populations in their future careers. With increasing legalization of MAID in states and a subsequent potential increase of patients wishing to learn more about assisted death, our study suggests that internal medicine residents are interested in more training to better recognize and discuss patients' requests for MAID. Further study is required to discern the appropriateness of training for participating in MAID as part of resident education.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsors had no role in the design, methods, or preparation of the article. The views in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Funding Statement

This study was supported, in part, by the National Institute on Aging of the National Institutes of Health (NIH) (award K76AG054782) and the Colorado Clinical and Translational Sciences Institute (CCTSI) with the Development and Informatics Service Center (DISC) grant support (NIH/NCRR CCTSI grant no. UL1 RR025780).