The goal of this investigation was to perform a nationwide, structured survey of post-graduate year four (PGY-4) adult neurology residents, determining educational needs in palliative care. We hypothesized they receive less teaching in end-of-life care compared to common neurologic conditions (e.g. stroke) and uncommon conditions (e.g. temporal arteritis); they lack objective knowledge of palliative care; they feel unprepared to manage non-neurologic symptoms at end-of-life; and they feel training in end-of-life care is important.

Neurology patients and their caregivers have unmet palliative care needs. Palliative care training requirements for neurology residents lack specificity.

This investigation employed a survey adapted from a previously validated survey, revised by experts. Likert scale responses were analyzed via descriptive statistics and Wilcoxon rank-sum tests along with thematic evaluation of one free text question. Four multiple choice questions assessed basic knowledge.

We reached 524 residents with 99 responses (response rate 19%). Residents receive less quantity of teaching in end-of-life (mean 3.2±1.1) than in common (mean 4.9±0.4, p<.0001) neurologic disorders and the same amount of teaching as in uncommon (mean 3.3±0.9, p=0.8931) neurologic disorders. They receive less quality of teaching in end-of-life (mean 3.1±1.1) than in common (mean 4.7±0.6, p<.0001) and uncommon (mean 3.5±1.1, p=0.0077) neurologic disorders. They receive less role-modeling in end-of-life care (mean 3.4±1.0) than in common (mean 4.7±0.6, p<0.0001) and uncommon (mean 3.8±1.0, p=0.0024) neurologic disorders. They perform more family meetings (mean 4.2±1.0) than a common neurophysiologic procedure (mean 3.2±1.3); yet, they receive the same amount of observation/feedback (mean 2.7±1.2 vs 2.9±1.4, p=0.1690). They lack symptom management knowledge (mean 57%). Residents identify end-of-life care as important (mean 4.3±0.9) with a positive attitude (mean 4.9 ± 0.4) towards it.

While neurology residents rated themselves competent performing primary palliative care skills, they desire more formal training, including in communications skills. This study supports development of formal curricula.