M.R.Rajagopal MD

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Teaching Palliative Care in India
M.R.Rajagopal MD Amrita Institute of Medical
Sciences Kochi, Kerala, India mrraj5_at_sify.com
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Palliative care education

• Why?
• Who?
• How?

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The Indian reality..

• 1-2 million Indians with cancer need palliative
  care.
• A tiny minority of them have access to it.

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The ideal palliative care physician

• GP?
• Oncologist?
• Internist?
• Anesthetist?
• Psychiatrist?
• Or someone else?

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Domains of care
Physical
Psycho- spiritutal
Social
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Domains of care
Physical
Psycho- spiritutal
Social
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Palliative care practice needs..

• Heart
• Head
• Hands

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Palliative care practice needs..

• Heart (Attitude)
• Head (Knowledge)
• Hands (Skill)

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How?

• Distance education
• Didactic course / workshop
• Hands-on training (how long?)

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Distance education

• Heart (Attitude)
• Head (Knowledge)
• Hands (Skill)
• Needs to be supplemented with
• hands-on training

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Distance education

• Heart (Attitude)
• Head (Knowledge)
• Hands (Skill)
• Advantage
• Can reach large numbers.
• Can be done in spare time

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Our experience with hands-on training

• 1-3 days sensitisation courses
• 7-14 days foundation courses
• 4-6 weeks certificate courses
• 2 year diploma course

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Our experience

• 1-3 days sensitisation courses
• 7-14 days foundation courses
• 4-6 weeks certificate courses
• 2 5 days refresher courses
• 2 year diploma course

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Certificate course

• 6 weeks
• Calicut, Kochi, Trivandrum, Kerala
• 4 weeks.
• Tata Memorial Hospital, Mumbai

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DPPM (Kochi, Kerala) Objectives

• To generate a corps of
• palliative care physicians with the right
  attitude, knowledge and skills
• Teachers for the future
• Trend-setters who influence policy

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Diploma in Pain and Palliative Medicine (DPPM)

• Fits in with system of existing PG education
• 2 year residential course
• Entry criterion Basic medical qualification
• Students work as full-time residents

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How do they learn?

• Academic sessions 6 hours/week
• Assignments / projects
• Teaching medical students / 6 weeks course
• From patients
• Outpatient
• In patient (hospital-based)
• Home visits

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What should the palliative care specialist be
able to do ?

• To practice palliative care
• As it should be practiced.

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Multi-disciplinary model of care

• Still in the beginning phase in India
• Priorities
• Volunteers training
• Palliative nursing education
• Medical social workers involvement

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To teach palliative care

• Teaching methodology
• should be
• an essential part of training

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Quality assurance

• Monitoring the service
• Conducting audits
• Doing need-based research

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Health economics

• Ensuring cost-effective measures
• Improving access to affordable medication

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Advocacy

• Improving public awareness
• Guiding governmental policy
• Guiding hospital policy

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Catch them young!

• Palliative care should be an essential part of
  undergraduate education
• nursing and medical.
• Pain symptom management
• Communication with the patient
• Medical ethics

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Conclusions

• Palliative care education should empower the
  trainee to
• practice palliative care
• demonstrate it to others (role model)
• teach palliative care
• monitor / audit / research
• ensure cost-effective care
• guide and fight for policy.

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Conclusions

• Medical and nursing councils should
• incorporate palliative care into
• UG PG curricula