What Kind of Physician Will You Be? End-of-Life Care and Its Effect on Residency Training

This report utilizes Dartmouth Atlas data to show differences in resource utilization among the 22 academic medical centers most commonly matched into by Dartmouth medical students pursuing a residency in internal medicine. The variables selected specifically measure resources used in the last six months of life, reflecting the way that physicians at different institutions approach end-of-life care. The findings explained in this report are especially relevant to internal medicine residents; however, they may also be applicable to other specialties, as many types of residents contribute to the care of terminally ill patients.

Through this report, we aim to share what we have learned about end-of-life care at different hospitals and demonstrate that this variation in care may affect residency training and eventual behavior as practicing physicians. The way that the physicians at training hospitals deliver care will guide residents' habits; therefore, we argue that training at hospitals with lower utilization of health care will better prepare residents to coordinate care, be judicious in consults, and listen to patient preferences. We also hope that by seeing how the Dartmouth Atlas can be used to understand practice patterns, medical students and residents may be more likely to draw directly on this resource in the future.