Minority Residents’ Palliative Care Training Quality Trails Other Medical Education
Internal medicine and family medicine residents at two medical schools at a historically Black college and a historically Black university (Morehouse College and Howard University) see palliative care as important. However, most residents believe the quality of their palliative care education was not as good as their other medical training.1
“Black medical schools are the leaders in training underrepresented minorities to become physicians,” says Robert M. Arnold, MD, one of the study’s authors and section chief of palliative care and medical ethics at the University of Pittsburgh. “If we are going to integrate palliative care broadly, and if we want to make sure that Black physicians have the skill set to take care of their patients, then we have opportunities.”
The 91 residents surveyed reported receiving less training on palliative care than they did on sepsis management. “They get very good training. But they felt less well-trained in palliative care than in many other areas of their training,” Arnold reports.
Half the residents reported receiving negative messages about palliative care. Two-thirds said they considered care for dying patients to be depressing.
“As we are worrying about ensuring that all patients have access to the best possible care, we need to make sure palliative care is integrated into all medical students’ curriculum,” Arnold offers.
Medical schools with the highest Black enrollment were less likely to offer palliative care rotations in family medicine or internal medicine residency training vs. schools with the lowest Black enrollment.2
“We wanted to understand the role that the medical education system might play in the lack of workforce diversity and health disparities that exist in palliative care,” says Lindsay Bell, MPH, the study’s lead author.
Bell and colleagues were surprised to learn that among historically Black colleges and universities with medical schools, none offered palliative care training during medical school or residency.
“National palliative care organizations that are committed to addressing this issue should look for opportunities to work with these institutions to enhance exposure and training for students and to support faculty with incorporating palliative care education into the curricula,” says Bell, research project coordinator for the University of Pittsburgh’s Palliative Research Center.
Palliative care skills are important to a cardiologist, an oncologist, or anyone who takes care of seriously ill patients. There also is the hope that more minority residents will choose to go into the palliative care field. There are ongoing concerns about a shortage of palliative care clinicians generally.3 “There is clearly not enough diversity in palliative care clinicians so that we look like the population of America,” Arnold says.4
Evidence suggests doctor-patient race concordance, particularly for minority patients, results in better care.5 “This is why having so few physicians of color in palliative care is such a problem,” Arnold explains. “We need to make sure our workforce represents the patients that we are caring for, as much as we can.”
- Bushunow V, Alamgir L, Arnold RM, et al. Palliative care attitudes and experiences among resident physicians at historically black colleges and universities. J Pain Symptom Manage 2021 Jul 14;S0885-3924(21)00432-2. doi: 10.1016/j.jpainsymman.2021.07.005. [Online ahead of print].
- Bell LF, Livingston J, Arnold RM, et al. Lack of exposure to palliative care training for black residents: A study of schools with highest and lowest percentages of Black enrollment. J Pain Symptom Manage 2021;61:1023-1027.
- Kamal AH, Wolf SP, Troy J, et al. Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Aff (Millwood) 2019;38:910-918.
- Quigley L, Lupu D, Salsberg E, et al. A profile of new hospice and palliative medicine physicians: Results from the survey of hospice and palliative medicine fellows who completed training in 2018. American Academy of Hospice and Palliative Medicine. January 2019.
- Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A 2020;117:21194-21200.
The 91 residents surveyed reported receiving less training on palliative care than they did on sepsis management. Half the residents reported receiving negative messages about palliative care. Two-thirds said they considered care for dying patients to be depressing.
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