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An Online Palliative and End of Life Care Course for Medical Students

An Online Palliative and End of Life Care Course for Medical Students. Ilene Lewis, MS II University of California – Davis School of Medicine. Current Palliative and End of Life Care Curriculum in Medical Schools. AAMC = Association of American Medical Colleges

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An Online Palliative and End of Life Care Course for Medical Students

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  1. An Online Palliative and End of Life Care Course for Medical Students Ilene Lewis, MS II University of California – Davis School of Medicine

  2. Current Palliative and End of Life Care Curriculum in Medical Schools AAMC = Association of American Medical Colleges Curriculum Directory: http://services.aamc.org/currdir/section4/start.cfm NOTE: AAMC represents 125 allopathic medical schools accredited by the LCME (Liaison Committee on Medical Education) including 17 Canadian medical schools

  3. Current Palliative and End of Life Care Curriculum in Medical Schools • According to the AAMC Curriculum Directory, the following schools have clerkships for the Class of 2008: • SUNY-Downstate Medical Center COM • Primary Care II Clerkship in Geriatrics and Palliative Care Hours: 296, Weeks: 4 • Ponce School of Medicine • Community Medicine and Geriatrics, Hours: 65 • Geriatrics, Hours: 65 • University of Miami School of Medicine • Geriatrics, Weeks: 4, with Psychiatry, Weeks: 2 • Geriatrics, Weeks: 6

  4. Current Palliative and End of Life Care Curriculum at UC - Davis • Year 1 – Doctoring (Required Course) • Culture and Medicine • Spirituality • Death Awareness • Bereavement • Communication Skills • Breaking Bad News • Adult and Geriatric Development • Elder Abuse • Assigned home visits with a geriatric patient • ~ Monthly • Follow same patient all 4 years • Medical Ethics and the Law • Small Group Discussions • 2 different groups: Application of Medical Principles (AMP), and Doctoring small group • Each group meets once a week • Simulated patients, role playing, and learning issues are researched and presented to the groups

  5. Current Palliative and End of Life Care Curriculum at UC - Davis • Year 2 - Oncology (Required Course) • End of Life and Hospice Care Lecture • Year 4 – Elective Clerkships • Geriatrics in Community Health • Practicum in Care for the Terminally Ill • Law and Medicine (can be taken during any year) • Physician Assisted Suicide, Terminal Sedation, Medical Ethics, Pain Management

  6. Role of Online Curriculum • Provide more focused and comprehensive preparation for caring for patients and families at the end of life • Provide continuity in presentations • Can be integrated into existing curriculum in the 1st and 2nd year

  7. Online Curriculum Proposal • Required 2 year web based series of PowerPoint presentations and exercises on palliative and end of life care • Presentations will be designed by medical school faculty and will be ~ 50 min each • “Virtual Preceptors” will be available via e-mail to respond to student questions • Chat room available for students to communicate with each other • Each module will have a review of key points and suggested readings • Self-assessment quizzes will be provided for each module that will generate score reports to identify areas for review • Question Bank for each module • One final comprehensive examination after all modules are completed (90% is passing – able to retake until score is achieved) • Required evaluations of each module’s content

  8. Curriculum Materials and Resources • Curriculum Materials: • Textbook/Syllabus • Pocket Guides • American Academy of Hospice and Palliative Medicine Guide • American Pain Society: Principles of Pain Management • Robert Buckman’s Communication Skills • Opioid Equianalgesic Card • Additional Resources: • Websites • Movies • Recommended Readings • Advance Directive Examples • Do-Not-Resuscitate Form

  9. Online Curriculum Format • Modules will be based on American Board for Hospice and Palliative Medicine (ABHPM) Physician Credentialing Standards: • Non-Pain Symptom Management (30%) • Pain Management (25%) • Ethical and Legal Decision Making (8%) • Communication and Teamwork (7%) • Impending Death (7%) • Psychosocial and Spiritual Issues (7%) • Hospice and Palliative Approach to Care (6%) • Grief and Bereavement (5%) • Prognostication (5%)

  10. Online Curriculum Format • Modules will be organized to reflect existing curriculum presentations • Deadlines for completing modules and self-assessment quizzes will correspond with the conclusion of existing lecture series on given topics

  11. Online Curriculum Format • Generally: • Completed in Year 1: 20 Required Hours • Introduction to Palliative and End of Life Care (17%) • Includes Prognostication • Communication Skills (11%) • Ethical and Legal Decision Making (17%) • Psychosocial and Spiritual Issues (11%) • Completed in Year 2: 16 Required Hours • Non-Pain Symptom Management (14%) • Pain Management (17%) • Impending Death (14%) • Includes Grief and Bereavement

  12. Module 1: Introduction to Palliative and End of Life Care 6 Required hours (including 1 hr self-assessment) • Defining Palliative and End of Life Care • Accessing End of Life Care Delivery Systems • Quality of Life Assessments and Prognostication • Specific Populations: Elderly, Substance Abusers, and Incarcerated • Pediatric Palliative and End of Life Care • Optional Exercises: • Death Attitude Survey • A Good Death Survey

  13. Module 2: Communication Skills 4 Required hours (including 1 hr self-assessment) • Breaking Bad News • Confidentiality and Families • Working with an Interdisciplinary Team

  14. Module 3: Ethical and Legal Decision Making 6 Required hours (including 1 hr self-assessment) • Informed Consent and Patient Rights • Advance Care Planning • Nutrition and Hydration in End of Life Care • Medical Procedures and Diagnostic Tests in End of Life Care • Physician Assisted Suicide and Terminal Sedation

  15. Module 4: Psychosocial and Spiritual Issues 4 Required hours (including 1 hr self-assessment) • Psychosocial Responses • Culture and End of Life Care • Religious Beliefs and Practices • Optional Exercises: • Vignettes of Patients/Families speaking about their experiences • Scenarios – “choose your adventure” style

  16. Module 5: Non-Pain Symptom Management 5 Required Hours (including 1 hr self-assessment) • Common Symptoms at the End of Life e.g. Fatigue, Incontinence, Cachexia, etc. • Respiratory Symptoms at the End of Life • Gastrointestinal Symptoms at the End of Life • Delirium, Agitation, and Depression

  17. Module 6: Pain Management 6 Required Hours (including 1 hr self-assessment) • Acute and Chronic Pain • Pain Assessment • Pharmacologic Management of Pain • Non-Pharmacologic Management of Pain • Barriers to Pain Management

  18. Module 7: Impending Death 5 Required Hours (including 1 hr self-assessment) • Signs of Impending Death • Symptom Management During Last Days of Life • Managing Caregiver Stress and Other Family Issues • The Grief Process • Optional Exercises: • Grief-Loss Inventory

  19. Implementation Goals • Present to curriculum committee to secure support for project • Contact medical school faculty to prepare presentations/be virtual preceptors for project • Develop website design with programmer • Contact publishers/book suppliers for donations of curricular materials • Write grant proposal for future purchases of curricular materials

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