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43 Foundation trainee delivery of palliative care: a quality improvement project aiming at analysing and improving confidence in foundation doctors via medical education
  1. Yasmin Parkin,
  2. Stephanie Killick and
  3. Andrew Tan
  1. Hampshire Hospitals Foundation Trust (Royal Hampshire County Hospital)


Background The aim was to determine confidence levels of Foundation Year 1 and 2 trainees in managing palliative care patients, intervene to provide further support in highlighted areas and measure the impact of this support. Literature reviews demonstrate junior doctors from a range of specialties feeling ‘unprepared and unsupported in providing palliative care’.1

Methods Confidence levels were measured using a questionnaire prior to intervention at the beginning of the foundation year completed by 37 foundation trainees across various specialties. A teaching intervention was created from these results, of which 31 foundation trainees attended, and the same questionnaire completed for comparison.

Results The ‘Before Intervention’ questionnaire showed that a high proportion of trainees were ‘uncertain’ or ‘very uncertain’ in a range of palliative skills. 45% ranked this regarding who to ask for palliative care advice, 29% for how to have end of life conversations with NOK/family, 19% for advance care planning conversations, 35% for rationalizing medications and 61% for syringe driver commencement.

After the teaching intervention, only 4% of foundation doctors said they felt uncertain seeking palliative care advice. There was a large increase in confidence for talking to patients and relatives about dying. The proportion who felt ‘confident’ increased by 49%, and those who felt ‘uncertain-very uncertain’ decreased by 25%. Advance care planning conversations were deemed more achievable – those in the uncertain category decreased by 15.5%. Uncertainty about syringe driver commencing decreased to 12%.

Conclusions Medical education has an important role in palliative care and has demonstrated to have a positive impact on the foundation doctor’s confidence in delivering care. The aim will be to re-measure confidence levels after a period of clinical practice to determine long term impact of teaching, identify further areas to support the foundation doctors and employing appropriate education methods for the the wider multidisciplinary team.



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