Improving Education Pertaining to Issues Concerning the End of Life Benjamin Dieter

1. EOL @ ECU Improving Education Pertaining to Issues Concerning the End of Life Benjamin Dieter East Carolina University Class of 2007

2. OBJECTIVES • Identify current EOL curriculum @ ECU • Identify areas that need improvement • Outline a strategy to effectively implement improvements

3. Home Sweet Home

4. Current Curriculum • First Year (covered in two courses only) • Behavioral Sciences: two 30 minute lectures (“Death and Dying” and “Bereavement”) followed by one 60 minute small group discussion • Ethical and Social Issues in Medicine I: three small group topics • “Advanced Directives” • “Assisted Suicide, Active and Passive Euthanasia, and Palliative Care” • “Dying Issues as in Tolstoy’s ‘The Death of Ivan Illyich’”

5. How First Years Treat Ethics and Behavioral Science zzzzzzzzz

6. Current Curriculum • Second Year • Clinical Skills Course: three sessions, 6hrs total • “Grief and Depression” lecture followed by small group with standardized patient ‘Elderly Woman in the Office After the Sudden Death of Her Husband’ • Only one student interviews • “Giving Bad News” lecture followed by standardized patient small group with ‘Man Receiving News of Non-resectable Pancreatic Cancer’ • Only one student interviews • Viewing of “Wit” with group discussion

7. Current Curriculum • Second Year (continued) • Psychopathology – one session • 30 minute “Death and Dying” lecture followed by sixty minute small group discussion on the similarities and differences in the perspectives on dying and death among patients, family members, and physicians • Ethical and Social Issues in Medicine II – two sessions • “Conflict Over Life Sustaining Care: The Case of Terri Schiavo” • “Medical Futility”

8. Current Curriculum • Second Year (concluded) • Medical Pharmacology – two lectures • “Pain Management” and “Palliation” are covered in the Cancer Chemotherapy section

9. Current Curriculum • Third Year • Internal medicine rotation – one hour lunch session • 15 minute presentation followed by group discussion Getting Sparse...

10. Current Curriculum • Fourth Year • Medical Humanities elective “Death and Dying: Philosophical and Moral Issues” – one month long 5 hrs/wk for 4 weeks Party Time

11. Room for Improvement • Thoughts: • ECU’s curriculum is (understandably) front-loaded • No interaction with true patients until third and fourth year at which point specific EOL education exposure becomes sparse • Thus students will only be exposed if the clinicians they work with are skilled at addressing EOL issues/palliative care AND actively seek to involve students • This current state of affairs does not guarantee each student the appropriate tools to address EOL issues and palliative care as a first year intern

12. Room for Improvement • Specific areas to improve: • Make exposure in first and second year more memorable • Increase EOL/palliative care education experiences in third year • Offer more diverse electives in fourth year • Provide students interested in issues of Death and Dying access to extracurricular education

13. Time to Go on the Offensive

14. THE PLAN • Step 1: Making First and Second year Experiences Stick • Physiology lecture: “Physiologic changes as Death nears: Correlation with the stages of dying” • Neuroscience lecture: “Brain-Death and PVS: Definitions and their clinical implications” • Devote test questions to these lectures (make sure to mention them in the review session!) • Incorporate all students into SP experiences in clinical skills sessions on EOL issues

15. THE PLAN • Step 2: Focused EOL/Palliative Care educational experiences in the third year • Palliative Care Consult team rounds bimonthly while on medicine, family medicine, and pediatrics • Emphasis by clerkship directors to residents on student presence at family meetings and delivering bad news with residents

16. THE PLAN • Step 3: Offering more electives dealing with EOL/palliative care issues in the fourth year • New elective “Palliative Care and Hospice Care” has been suggested, but needs student interest

17. THE PLAN • Step 4: Offering extracurricular exposure to those interested • Volunteer Program with Local Hospices for those interested • Death and Dying Interest Group • Meet monthly to conduct various learning modules, view movies, and organize lunch lectures

18. THE PLAN • Also on the Horizon…  • ECU has just received a $15,000 grant from AMSA to implement changes in our geriatrics curriculum • Two classmates and I have been chosen to sit on the curriculum committee to provide student voices during the meetings….

19. Ben Dieter's Got His Foot in the Door?? AAGGHHH!