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

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An Online Palliative and End of Life Care Course
for Medical Students
Ilene Lewis, MS II University of California
Davis School of Medicine
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Current Palliative and End of Life Care
Curriculum in Medical Schools
AAMC Association of American Medical
Colleges Curriculum Directory http//services.aam
c.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
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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

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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

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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

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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

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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 modules content

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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 Buckmans Communication Skills
• Opioid Equianalgesic Card
• Additional Resources
• Websites
• Movies
• Recommended Readings
• Advance Directive Examples
• Do-Not-Resuscitate Form

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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)

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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

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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

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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

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Module 2 Communication Skills

• 4 Required hours (including 1 hr self-assessment)
• Breaking Bad News
• Confidentiality and Families
• Working with an Interdisciplinary Team

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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

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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

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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

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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

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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

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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