ASSESSMENT AND KNOWLEDGE IN PALLIATIVE CARE IN 2ND-YEAR FAMILY MEDICINE RESIDENTS

Inadequate physician knowledge, particularly in areas of pain assessme nt and use of analgesics, has been identified as a major factor contri buting to poor pain management in cancer patients. In most medical sch ools, teaching in Palliative Care at both the undergraduate and postgr aduate levels is limited or nonexistent. Baseline knowledge and change s in knowledge in areas relevant to Palliative Care were assessed by t he use of 2 16-question examinations (Exams A and B) in 78 second-year Family Medicine Residents from the University of Alberta Family Medic ine Residency Program. The residents participated in a two-week rotati on on the Acute Palliative Care Unit at the Edmonton General Hospital or Grey Nuns Community Health Centre between September 1991 and Februa ry 1996. The residents were randomly assigned on the first day (Time I ) to complete either Exam A or B and were subsequently crossed oz,er o n their final day of the rotation to complete the alternate Exam (Time 2). Six domains were represented in the Exams as follows: pain assess ment, opioid use, adjuvant medications, delirium, urinary catheterizat ion, and hydration. Improvements were noted in the mean percentage res ults in Time 2 compared with Time 1 for Exams A, B, and A and B combin ed. Mean global percentage results were 53 +/- 15 versus 73 +/- 13 (p < 0.001) at Times I and 2, respectively. There were significant improv ements for domains in Time 2 compared to Time I (p less than or equal to 0.05) for combined A and B Exam except for urinary catheterization. Despite these documented improvements in scares, serious deficiencies were identified particularly in the areas of pain assessment and opio id;nse, namely opioid sude effects and issues involving dependence, ad diction, and tolerance. Examinations, such as the two used in this stu dy, can be a useful aid in assessing physician knowledge in addition t o structuring teaching in Palliative Care. Examination content will re quire updating as knowledge in Palliative Care evolves. (C) U.S. Cance r Pain Relief Committee, 1997.