Development and Implementation of a Palliative Care Curriculum for Internal Medicine Residents

Key Message : Training non-specialists in palliative care, and integrating this early in medical education, improves accessibility. We illustrate the successful implementation of a palliative care curriculum into an internal medicine residency program, using a framework that leverages adult learning theory which can be applied regardless of the learner’s specialty.

Abstract:

Background: Internal medicine (IM) residents report low levels of knowledge and comfort in effective palliative care (PC) skills, citing a lack of exposure or formal training(1); in IM programs that do offer training, it is heterogenous and often informal(2). While the availability of specialist PC services is expanding nationwide, training non-specialists like IM residents in “primary” PC skills has become essential in improving patient access to PC. Integrating primary PC in residency training, however, remains a challenge, particularly in smaller or rural/suburban health systems(3), where specialist PC services are less prevalent.

Objectives: We aim to implement a PC curriculum within the IM residency program of a medium-size suburban academic-affiliated community hospital, and measure its effect on 1) residents’ self-reported knowledge and comfort, 2) objective knowledge, and 3) residents’ documentation behaviors related to PC.

Methods: An extensive literature review, and consultation with stakeholders and education experts, were used to develop a PC curriculum and identify evidence-based tools for assessment.

The curriculum consists of 10 hours of didactics addressing five core topics: serious illness communication, advance care planning, symptom evaluation and management, principles of PC and systems-based practice, and interpersonal skills.

Pre- and post-curriculum surveys will assess residents’ knowledge and comfort, as well as measures of sustained learning and self-reported use of new skills over time. A pre- and post-curriculum chart review will measure rates of resident documentation of procedures related to palliative care.

Results: The curriculum was approved by the Program Evaluation Committee and will be implemented between November 2025-January 2026. Assessment will be used to identify healthcare disparities and improve future iterations.

Implications: This multidimensional, structured curriculum provides IM residents with efficient and standardized translation of PC principles into clinical practice. This addresses the heterogeneity of existing training methods, and the critical need for increased PC accessibility.

References: 1. Mulder SF, Bleijenberg G, Verhagen SC, et al. Improved competence after a palliative care course for internal medicine residents. Palliat Med. 2009 Jun;23(4):360-8. doi: 10.1177/0269216308100250. Epub 2008 Dec 19. PMID: 19098108
2. Spiker M, Paulsen K, Mehta AK. Primary Palliative Care Education in U.S. Residencies and Fellowships: A Systematic Review of Program Leadership Perspectives. J Palliat Med. 2020 Oct;23(10):1392-1399. doi: 10.1089/jpm.2020.0331. Epub 2020 Aug 5. PMID: 32757977.
3. Rogers M, Meier DE, Morrison RS, Moreno J, Aldridge M. Hospital Characteristics Associated with Palliative Care Program Prevalence. J Palliat Med. 2020 Oct;23(10):1296-1299. doi: 10.1089/jpm.2019.0580. Epub 2020 Apr 28. PMID: 32349621; PMCID: PMC7523015.