Introduction: In Japanese emergency departments, many physicians have to decide immediately whether they should limit life-sustaining treatments for critically ill elderly patients who may be at their end-of-life (EOL) or in cardiopulmonary arrest. To propose effective medical training, we investigated the ability of junior residents to recognize this challenging problem.

Method: We conducted a semi-structured interview of 38 junior residents who had completed the junior residency program of University Hospital, Kyoto Prefectural University of Medicine. We then qualitatively analyzed the transcripts of the interviews.

Results: Through observation of the attending physician's interview, which is a discussion about decision-making with the patients and their families, junior residents recognized the problem of EOL and made their decision. Finally, they preferred "doctor-led discussion" or "neutral discussion."

Discussion: We recommend that attending physicians should give junior residents many opportunities to observe their interview about decision-making.