Preparedness of internal medicine residents for oncologic emergencies and end-of-life discussions in a community training environment.

Abstract

9017 Background: Internal medicine (IM) residents often serve as first responders for patients with cancer in community hospitals, where oncologic emergencies frequently present before subspecialty involvement. Yet structured heme-onc and palliative training is limited. Preparedness in community settings - where workflow and resource constraints may heighten gaps between trainee knowledge and confidence - remains under-examined. Methods: We conducted a cross-sectional electronic survey of IM residents at a university-affiliated community hospital (Oct 17 - Nov 18, 2025). It included 14 vignette-based knowledge items, 8 confidence ratings (0-10), and questions on demographics, oncology exposure, and perceived barriers. Primary outcomes were total knowledge score (0-14) and composite confidence scores. Multivariable regression assessed associations between resident characteristics, knowledge, and confidence. Results: Thirty-three of 58 residents participated; mean age was 30.1 years, and 82% had not completed a hematology-oncology rotation. Knowledge was uniformly high (mean 13.0; SD 1.0) across key domains including febrile neutropenia and hospice eligibility. Confidence, however, was substantially lower and more heterogeneous (emergency mean 5.78; end-of-life mean 5.84). Senior trainees demonstrated greater confidence in both domains (β = 1.62 and 1.60; P < .001), and caring for ≥3 oncologic patients in the prior month independently predicted higher communication confidence (β = 1.87; P = .04). Residents identified recurrent barriers: delays in triage (72.7%), limited family availability (72.7%), language barriers (57.6%), and difficulty obtaining early intravenous access (39.4%). Free-text responses emphasized the need for concise reference tools, structured exposure, and simulation-based practice. Conclusions: IM residents demonstrated excellent factual knowledge but substantially lower confidence in managing acute oncologic conditions and conducting serious-illness conversations. Confidence was influenced more by experience and workflow realities than by knowledge alone. Our findings highlight an actionable opportunity. Experiential curricula, streamlined clinical pathways, and integrated oncologic teaching may strengthen frontline preparedness for high-stakes cancer care in community settings. Resident demographics, clinical exposure, and selected barriers (N = 33). Selected measure n/N (%) Resident sex: male 20/33 (60.6%) Resident sex: female 11/33 (33.3%) Training level: PGY-1 15/33 (45.5%) Training level: PGY-2 8/33 (24.2%) Training level: PGY-3 10/33 (30.3%) Oncology exposure: 0–2 cancer patients/month 18/33 (54.5%) Oncology exposure: ≥3 cancer patients/month 10/33 (30.3%) Barrier: workload or paging delays 13/33 (39.4%) Barrier: cultural or linguistic challenges 19/33 (57.6%)