Objective: To identify factors associated with internal
medicine interns' self-assessed competency in death pronouncement and
to evaluate the effectiveness of a 10-minute death pronouncement module
and pocket card guidelines.
Methods: In June 2003 at the Birmingham VAMC, Alabama, 48
internal medicine interns completed a survey of medical school education,
training, and experience in death pronouncement and a self-assessment of
death pronouncement competency. In September 2003, 33 of the 48 interns
completed a follow-up training/education survey and rated their
post-intervention competency. Using chi-square and paired
t-tests, we identified factors associated with variations among
baseline and post-intervention variables and examined pre-post changes in
self-assessed competency levels.
Results: At baseline, less than 30% of the interns had
medical school instruction in the process of death pronouncement. More
than 70% reported needing basic instruction/close supervision.
Post-intervention, close to 90% interns needed minimal or no assistance.
Over 50% reported using pocket card guidelines. We found significant
pre-post increases in mean rankings in each of the 5 self-assessed
competencies (p < .001). Factors associated with differences
in baseline and post-intervention assessments included medical school
training/experience and use of the pocket card guidelines.
Significance of results: When interns began training, most
had no instruction in death pronouncement and felt unprepared for this
task. With brief instruction, pocket card guidelines, and 3-months
experience, the majority of interns reported needing minimal/no
assistance in pronouncing death. A larger sample from multiple sites is
needed to confirm these findings.
