Improving knowledge and communication through an advance directives objective structured clinical examination.

Many physicians and patients do not discuss care at the end of life and most practicing physicians have had little formal education concerning end-of-life discussions. To address this deficiency, our internal medicine residency faculty participated in the National End of Life Residency Education Project and implemented a series of educational initiatives including an advance directives Objective Structured Clinical Examination (OSCE). The 20-minute station assessed knowledge about the key issues that differentiate types of advance directives; and communication issues that arise when discussing advance directives. OSCE results revealed that most residents readily learned to differentiate types of advance directives, appreciated fear and psychosocial factors as barriers to communication, and emphasized that do-not-resuscitate (DNR) orders did not mean a lack of treatment. Residents had difficulty discussing the influence of coping style and psychological defensiveness on behavior, and recognizing that patient's thoughts and concerns about dying or DNR orders might influence end of life wishes and behavior. The Advance Directives OSCE is a useful initial assessment of knowledge and ability to address basic end of life issues.