The humanities in palliative medicine training: perspectives of academic palliative medicine physicians and trainees | BMC Medical Education

Our review of the Canadian palliative medicine training standardsrevealed that palliative medicine trainees in Canada are expected to develop humanities-based skills during their training. In accordance with these expectations, most survey participants (83.91%) agreed the humanities have an important role in palliative medicine residency programs. When examined based on role, over 84% of trainees and staff physicians agreed the humanities have an important role in palliative medicine residency programs, whereas roughly 67% of program directors agreed. Despite this high level of agreement, when asked about the role of the humanities within their own program, level of agreement decreases to between 50 and 62% depending on role, with staff physicians being the most agreeable.

Further analysis looking at participants identified institution revealed that 88.2% of participants from the same institution as the study investigators, the University of Ottawa, agreed that their own program would benefit from further humanities content. Comparatively, 60% of participants who were from different institutions from the study investigators agreed to the same. Both groups generated over 50% agreement suggesting an alignment within all Canadian institutions that further humanities would be beneficial in palliative medicine training program across the country. That said, it is important to recognize that participants from the same institution as the research investigators did have higher levels of agreement, which may also suggest a potential partial bias towards the beliefs of this specific institution.

Furthermore, most survey participants believed that the humanities have an important role in medical training, both at the undergraduate (95% of participants) and postgraduate levels (93% of participants). However, there is little literature discussing the use of the humanities in medical training, particularly at the postgraduate level. Consequently, although this finding promotes the need for additional training in the humanities at both levels, it may be particularly important at the postgraduate level.

Moreover, participants felt that humanities skills were more beneficial in some areas of palliative care than others. Specifically, more than 90% of participants strongly agreed or agreed that skills in the humanities are beneficial for helping provide care and communicating with patients, whereas only 54% of participants strongly agreed or agreed that skills in the humanities are beneficial for discussing end-of-life planning and goals of care. In addition, 34% of participants strongly disagreed that the humanities content would benefit them in end-of -life planning and goals of care. With current literature suggesting that end of life planning and goals of care can at least be partially affected by ones religious and cultural beliefs [10,11,12,13], both of which are branches of the humanities, this was unexpected. This may suggest that further education on the humanities and their role in palliative medicine training would be beneficial for palliative care trainees and physicians. Moving forward, it could also prove meaningful to explore more in-depth this variance which may be better studied through interviews.

Despite being important groups to understand when discussing palliative medicine education training programs, trainees and resident program directors accounted for the minority of participants, Nonetheless, 8 of the 14 palliative residency training programs in Canada were represented within the pool of participating program directors in this study, accounting for an over 50% representation. Contrary to this, only 8 trainees completed the survey from an estimated 60 palliative medicine residents at the time (based on active resident members of the Canadian Society Palliative Care Physician at that time), accounting for only roughly 13% of palliative medicine trainees. Perhaps the very low trainee participation may have been due to a non-response bias from trainees who could have felt they have less experience and/or knowledge to inform changes in this area of medical education. Time constraints, which are especially common among trainees with busy schedules commonly out of their control, may have also been a factor. Further research with a design focused on trainees and their level of experience may help better understand their important perspective. It could also prove meaningful to complete further studies through the form of interviews for more in-depth exploring of trainees’ perspectives and thoughts.

Finally, participants felt that their palliative medicine residency programs would most benefit from further humanities training in ethics, philosophy, and culture. This overlap with our review of the Canadian palliative medicine training standardswhich identified primarily ethical, cultural, and spiritual domains as the areas where palliative medicine trainees are most expected to develop humanities-based skills. This raises the question of whether learners are being provided sufficient training to meet the Canadian palliative medicine training standardsand to properly hone their humanities skills in these domains. To inform curriculum design, the survey revealed that the most common form of teaching by which participants were exposed to the humanities during their palliative medicine training was informal discussion. Perhaps more formal methods of teaching, such as scheduled teaching sessions or online modules, may be more helpful for learners in obtaining the expected humanities-based skills during their training.

Limitations

Although every Canadian university with a palliative medicine residency program in Canada was represented by survey participants [14], there was a disproportionately higher representation from the University of Ottawa. This could be because the study researchers were from the University of Ottawa; thus, participants had further motivation to participate in the study to support their colleagues. Furthermore, data collection was limited with only an approximately 17% response rate. Although, initial recruitment invitations and invitation reminders were asked to be sent out for completion of the survey, these were done via indirect means through the CSPCP office and resident program administrators. This was done to maintain participant anonymity (i.e. without the need for participants to share their emails with recruiters). In the future, we may benefit from further reminders to be sent out or a shorter survey to minimize time requirements. Additionally, an incentive for survey completion could also be considered (e.g. a gift card honorarium).

Volunteer bias is another probable limitation of our study [15]. Specifically, the survey could have attracted participants with an interest in the field of humanities or in medical education and, consequently, could have skewed the results toward participants who would champion humanities content in palliative medicine residency programs. To help mitigate this bias, we included methods to help increase overall volunteer participation [16, 17]. These methods included ensuring the anonymity and confidentiality of participants and keeping the survey brief and straightforward [16, 17].