Transforming health care globally… through palliative care

1. Transforming health care globally… through palliative care www.PalliativeMed.org www.IPCRC.net

2. Challenges in Teaching Palliative Medicine Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicineat San Diego Hospice University of California San Diego University of Toronto

3. Objective…A Road Map to Build Palliative Care Capacity in Sweden through education…

5. Call to Action… Train ALL healthcare professionalsto provide palliative care…

6. Dixon 6: Goals of Education & Implementation • Awareness / Attitudes • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization / SocietyIncrease palliative care capacity Dixon J. Evaluation and the Health Professions, 1978Ferris et al. Knowledge Insufficient for Change, 2001

7. How will you teach…?

8. How People Learn • Memory:Short  intermediate  long-term • 3 major facts / hour • Information retention per unit time • 10 minutes new information • 2 minutes rest to process it

9. Principles of Learning in Healthcare • Practical • Participatory • Multiple demands Hank Slotnick, PhD, North Dakota

10. Reading / Online Retention ? • Awareness / Attitudes • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization/Society

11. Lectures Retention ? • Awareness / Attitudes Lectures 10 % • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization/Society

12. Group Learning Retention ? • Awareness / Attitudes Lectures 10 % • Knowledge Small-group Cases 25 % • Skills Role-play 35 % • Behavior Change Experience • Patient / Family • Organization/Society

13. Effective presentations‘ theater ’ • Movement • Body • Hands • Voice • Tone • Volume • Speed • Eye contact • Minimize distractions

14. Who will you teach…?

15. Palliative Care Skills... 1°Advanced SkillsCariology,Geriatrics,Oncology,Etc. 2°Expert skillsPalliative CareConsultants /Teams 1° Basic SkillsAll HealthcareProfessionals 3°AcademicPalliative Care

16. Interdisciplinary Care Nurse Spiritual counselor Volunteer Family Psychologist Physician PATIENT Pharmacist Community Social worker Physical therapist Bereavement counselor

17. What will you teach…?

18. PC Skills... 1° Basic SkillsAll HealthcareProfessionals

19. ‘ Buzz ’ Groups • 1 – 2 • 1 – 2

20. General Doctors ?

21. 1999

22. EPEC 1999 • National consensus of 280 ethics, hospice, palliative care experts • Linda Emanuel, Principal Aim: To teach all physicians and other members of the interdisciplinary team the core skills of palliative care Not intended to make every clinician a palliative care expert

23. EPEC 1999 • 4 plenary sessions • 12 modules • Open, train-the-trainer model • Widely accepted • Standard of practice ‘ inside ’

24. First 15 Months in the USARobinson K, Sutton S, von Gunten CFet al, J of Palliative Medicine 2004 • Sample 200 of first 585 trainers touched • 120,000 professionals in 15 months • Estimated patients & families affected

25. US Palliative Medicine Specialists • > 3.000 certified specialists • 80 % started training with EPEC

26. End-of-LifeNursing Education Consortium Curriculum…

27. Nurses ?

28. ELNEC – Nursing Curricula, 2002 Oncology Version:Open Adaptable Reproducible Google:ELNEC

29. Palliative Care Skills... 1°Advanced SkillsCariology,Geriatrics,Oncology,Etc.

30. Doctors seeing Advance Illnesses ?

31. 2007 The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

32. EPEC-O 2007 • National consensus of > 80 oncology experts Aim: To teach all oncologists and other members of the interdisciplinary cancer care team the advanced skills of palliative care Not intended to make every oncologista palliative care expert

33. Multiple Issues that Cause Suffering

34. Core Skills for Providing Palliative Care

35. EPEC-O 2007 • 32 modules - 3 plenaries, 2 how to teach • Syllabus, slides • Open, adaptable • Video vignettes • Teaching strategies • Annotated bibliography • Hyperlinks to references online

36. 2007 • Free CD / DVD • American Society of Clinical Oncology ( ASCO ) provides education credits • Online modules • Translations • Spanish • Ukrainian • www.IPCRC.net

37. IPM Interdisciplinary Curriculum Will you translate any of these curricula ?

39. A multi-yeareducation strategy to build palliative care capacity... www.PalliativeMed.org www.IPCRC.net

40. Time ( yr ) 3 5 7 9 11 Sensitization Courses ( Basic & Advanced ) Visiting Scholars ( Expert Identification ) Fellowships ( Experts ) Leadership ( Leaders ) Scholars in Residence ( Education & Research )

41. Nursing & Medical Trainees Nursing students • 9 schools UCSD Medical students Residents • Family practice • Internal medicine • Psychiatry Experiential ‘ bedside training ’ • Observational visits • Structured program • Electives

43. PC in Curricula / Exams • In US Boards • In several specialty exams • 10 % of Medical Oncology Exam

44. Physicians Practicingin San Diego • 10 % trained at UCSD School of Medicine • 33 % did their medical residency in San Diego

45. Practicing Clinicians • Continuing education – optional or compulsory ? • In California • To get a new license, since 2002, obligatory to demonstrate training in palliative / end-of-life care • To renew license in 2006, 12 hours education in pain & palliative care ( AB 487 )

46. Conference Presentations • Oncology • Cardiology • Geriatrics • Elder Care • Nephrology

47. Many Domestic & International Partners

48. In-Country Courses 3-5 day, 2 & 3 week 2004 – Jordan 32 2005 – Jordan 72 2006 – Mongolia 75 2007 – Jordan 50 Georgia 50 Mexico 75 2008 – Georgia – 75 Vietnam 75 Saudi Arabia 150 2009 – Ukraine 95 Egypt 105 Slovenia 50 2010 – Ukraine 36 Salzburg 40 MECC 50 2011 – Georgia 75 Vietnam 100 Cyprus 55 Turkey 52

50. First dose of oral morphine – Al Basheer Hospital