Background Making Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and treatment escalation decisions facilitate a dignified death for patients in acute hospital settings, but not all doctors find it easy to have the necessary discussions with patients.1 The GMC’s “Tomorrow’s Doctors” requires that medical schools adequately prepare trainees to “contribute to the care of patients and their families at the end of life”.2 We conducted a survey of the experience of junior doctors in UHBristol NHS Trust.
Method An online questionnaire was sent to all junior doctors. Respondents were asked to rate their confidence when discussing DNACPR decisions with patients and their families, what training they had received and whether or not they felt their undergraduate training had adequately prepared them for these conversations. A comments space was provided.
Results We received 84 responses. 68% of juniors felt confident when discussing DNACPR decisions with patients and families. However 15% did not.
Only 5% felt they had been well prepared by undergraduate teaching. 40% felt they could have been better prepared and 22% felt very unprepared. 50% reported learning by observing senior colleagues in the clinical environment.
There were mixed comments regarding which grade was the most appropriately placed doctor to have these discussions with patients; some believed only a consultant should, but others stated junior doctors were usually first to recognise the need for escalation decisions.
Several commented that they had learnt by observing seniors conducting these consultations but noted they were not always done well. Some thought practicing in the clinical environment (trial and error) was the best way to improve their communication skills.
Conclusion Acute hospitals cannot assume their junior doctors feel prepared to discuss DNACPR decisions with patients. Formal teaching opportunities should be provided to supplement the observation of seniors, the current mainstay of their learning.
. The British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation. 3rd edition (1st revision) 2016.
. General Medical Council. Tomorrow’s Doctors. Outcomes and standards for undergraduate medical education. September 2009
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