To the Editor: The study by Billings and colleagues is a significant one, conducted with a population that remains underresearched within the field of palliative care medicine. The researchers aimed to learn how residents' experiences and perceptions affect their views of their competence in providing end-of-life care. While the residents' mean competence score (52.3 with a range from 20 to 75) on the end-of-life care scale is certainly reassuring, in a future study of this type it would be interesting to further probe the research question by having extensive interviews with the residents to try to understand what they mean by competence in end-of-life care. Also, it would be interesting to find out whether residents' experiences with breaking bad news and discussing end-of-life care were gained in outpatient clinics or inpatient wards, in part because residents in outpatient continuity clinics are in an ideal position to gain competence in end-of-life care because of longer, more committed relationships with patients.
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