Ambulatory hospice training in family medicine residency.

End-of-life care has become an important competency for primary care physicians, and yet many family physicians feel unprepared in the areas of hospice and/or palliative medicine. In preparation for designing an ambulatory geriatrics rotation within a family medicine residency training program, a needs assessment revealed gaps in hospice training specific to the philosophy of hospice and the common settings in which it is practiced. A hospice-focused core curriculum unit was developed, using a community-based hospice experience and formal seminars. The resident's community-based experiences included home visits and nursing home contacts as part of a multispecialty hospice team. End-of-rotation resident assessments and rotations evaluations revealed enhanced resident understanding of hospice philosophy and venues, increased knowledge of the criteria for hospice admission and medical management of the dying patient and an increased intention to refer patients to a hospice program, although follow-up audits of referral patterns were inconclusive to date.