Thirty-five years of end-of-life issues in US medical schools

Evaluation of a Palliative Care Longitudinal Curriculum for Medical Students Using the Context-Input-Process-Product Model

Palliative care (PC) longitudinal curricula are increasingly being recognized as important in Undergraduate Medical Education (UME). They are however, not yet commonplace, and where they do exist may be implemented without a systematic, prospective approach to curriculum evaluation. This paper describes an implementation of a new longitudinal curriculum at the Perelman School of Medicine (PSOM) at the University of Pennsylvania. We used the Context Input Process Product (CIPP) model, a holistic evaluation model, to assess the local environment, design the curriculum, guide the improvement process, and evaluate outcomes. Comprehensive models such as CIPP provide a more robust approach to curriculum evaluation than outcomes-only models and may be of use to other programs who are implementing new curricula or improving upon existing programs.

Palliative care in undergraduate medical education - consolidation of the learning contents of palliative care in the final academic year

Background: Demographic change and the medical imperative to accompany patients at all times and also in the case of illness leading to death require good basic knowledge of palliative care in large parts of the medical profession. Palliative care has been introduced into undergraduate medical education as a compulsory subject: "interdisciplinary subject 13 palliative care" (Q13). While course concepts for Q13 have already been positively evaluated, assessment of the consolidation and practical relevance of the knowledge taught is lacking. Methods: Assessment of the consolidation of the learning content from Q13 after the practical year (the "practical year" is the sixth and final year of undergraduate medical education in Germany) by means of a survey with a proven questionnaire and integrated qualitative free-text analysis of a cohort of medical students (n=176) who had already participated in an evaluation before and after Q13. Results: The response rate was 96% after Q13 and 45% after the practical year (PY). Teaching was predominantly perceived as more helpful than the PY (p<0.001). Compared to the status after Q13, students rated themselves as less competent after the PY in all areas surveyed, including drug-based pain therapy (p=0.0386). The certainty in informing patients about the incurability of the disease also decreased significantly after the PY (p=0.0117), although the preparation in Q13 was positively highlighted. Conclusion: The knowledge acquired in Q13 could not be anchored in the PY. On the contrary, after initial practical experiences, the students found it challenging to conduct conversations in cases of serious illness and to deal with their own uncertainty in the care of seriously ill patients. Structural factors regarding palliative care in the PY, as well as intrinsic motives of students, such as prior knowledge or motivation to learn, should be analyzed to identify ways to close the gap between theoretical and practical training in general palliative care. To generate samples that are sufficiently representative, future studies on teaching should be easily accessible to students and consider attractive forms of evaluation including electronic methods and social media.

Role of Palliative Medicine Training in Surgical Oncology

The importance of integrated palliative care in surgical oncology has been established by high-level evidence demonstrating improved patient-centered outcomes. There has been substantial improvement in efforts to incorporate palliative medicine training into medical and surgical education over the last decade. However, although trainees may feel confident in managing patients at the end of life, they may not have the insight or proficiency to provide optimal palliative care. Surgeons and palliative care physicians should collaborate on methods to optimize palliative care education for both trainees and practicing surgeons. A growing number of palliative care resources are available to this end.

Health care utilization as a predictor of death anxiety in older adults

The relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N = 3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient-provider communication and alleviate patients' death anxiety. Future research should explore the directionality between study variables.

Confessions of a Reluctant Caregiver Palliative Educational Program: Using Readers' Theater to Teach End-of-Life Communication in Undergraduate Medical Education

End-of-life care can be stressful for patients, caregivers, and providers. Caregivers often experience high levels of burden from caregiving duties such as performing medical tasks, communicating with providers, and making decisions. Similarly, many physicians feel unprepared to provide end-of-life care or communicate with patients and families about sensitive issues associated with death and dying. Physicians often attribute their lack of preparation to inadequate training in medical school. Previous research suggests that drama-based learning opportunities are valuable supplements to existing end-of-life curricula. The current study evaluates the success of the Confessions of a Reluctant Caregiver Palliative Educational Program - a drama-based educational program that depicts patient and caregiver experiences. A total of 477 osteopathic medical students participated in the program, which includes viewing a play, engaging in a facilitated post-performance talkback session, and completing an evaluation survey. The results suggest the program is a valuable learning experience that is positively associated with important facets of experiential learning using narratives such as perceived realism, increased reflection, strong emotions, and increased comfort with difficult behaviors. The program offers a safe environment for medical students to identify, understand, and process the sensitive and complex issues associated with end-of-life care. Moreover, the play offers insight into the often-overlooked experiences of family caregivers who are at risk of experiencing high caregiver burden while managing health-related communication and decision-making.

Medical student confidence in care of the dying and their family: a systematic review

BACKGROUND

The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.

AIM

This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.

DESIGN

A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.

DATA SOURCES

MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms 'medical student', 'confidence' and 'dying', alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.

CONCLUSION

This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.

PROSPERO REGISTRATION NUMBER

CRD42019119057.

"Whatever happens, happens" challenges of end-of-life communication from the perspective of older adults and family caregivers: a Qualitative study

Background

Effective communication is integral to the delivery of goal-concordant care for older adults and their family caregivers, and yet, it is uncommon in people with serious illness. This study explores the challenges of integrating end-of-life communication into heart failure management from the perspectives of older adults and family caregivers.

Methods

In a qualitative study of older adults with heart failure and their family caregivers, fourteen semi-structured interviews were conducted with 19 participants in Ontario, Canada. The interviews were transcribed verbatim and thematic analysis was applied to analyze the data.

Results

Four themes were identified in the context of participants’ understanding of illness: 1) trivializing illness-related challenges, 2) positivity in late life, 3) discomfort in having end-of-life conversations, and 4) reluctant to engage despite need. These challenges often intertwine with one another. Most participants had not engaged in end-of-life discussions with their clinicians or family members.

Conclusion

The findings provide insights that can inform approaches to integrate end-of-life communication for older adults with serious illness and caregivers. The identified challenges highlight a need for end-of-life communication to occur earlier in illness to be able to support individuals throughout the period of decline. In addition, end-of-life communication should be introduced iteratively for those who may not be ready to engage. Alternative approaches to communication are needed to elicit the challenges that patients and caregivers experience throughout the progression of illness to improve care for people nearing the end of life.

Students' Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students' Written Reflections

BACKGROUND

Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students' experiences with death and dying, describe the range of students' emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death.

METHODS

We provided a writing prompt to newly matriculated medical students asking them to "reflect on experiences you may have had with family or friends near the end of life." Content analysis was performed to identify themes in the responses.

RESULTS

The 104 students in the entering class submitted 90 individual free-text responses (87%). Most (57%) students specifically mentioned at least 1 personal experience with death, with a range of emotional responses including sadness (29%), surprise (14%), and guilt (12%). Distinct themes emerged on content analysis including personal experiences with death, anticipated response to death in future, changes in body or mind of the dying person, thoughts and observations about others, and cognitive or existential responses. Few students wrote about religion or spirituality (8%) or palliative or hospice care (2%).

CONCLUSIONS

An understanding of students' premedical school experiences and emotional reactions to death may help educators frame curricula around end-of-life care. Educators could apply enhanced awareness to help students process their own experiences as they begin caring for patients and to focus on areas that were underrepresented in students' comments, such as religion, spirituality, palliative care, and hospice.

Incorporating Older Adults as "Trained Patients" to Teach Advance Care Planning to Third-Year Medical Students

BACKGROUND

Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training.

OBJECTIVE

We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home.

DESIGN

Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills.

SETTINGS AND PARTICIPANTS

A total of 223 US MS3s participated in the curriculum.

RESULTS

Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains ( P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations.

CONCLUSIONS

The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.

Development of a Hybrid Simulated Patient Experience to Practice Care of the Dying Older Adult

INTRODUCTION

Care of the dying older adult includes critical skills that emerging physicians should master but are not consistently taught. Simulation has been shown to be an excellent tool for teaching these skills in a standardized fashion. Simulation allows direct observation to assess and provide learner feedback. Our goal was to develop a learning activity to practice skills caring for the older adult at the end of life and identify areas in need of improvement.

METHODS

We developed a hybrid simulation in which fourth-year medical students and internal medicine (IM) residents cared for a 70-year-old patient (Laerdal SimMan 3G) who was actively dying in the emergency department. He was accompanied by his wife (standardized patient) and a nurse (standardized role). Over the academic year 2012-2013, we observed and videotaped 83 fourth-year medical students and 22 first-year IM residents in this setting. We assessed the learners' completion of 15 tasks associated with good end-of-life care.

RESULTS

All learners demonstrated professional activity working with the nurse, and all medical students but one gave opioids appropriately for pain. Only 19% of the medical students appropriately disclosed the patient's status to the wife using the words death and/or dying, and only 50% of the IM residents did so.

DISCUSSION

We successfully developed a learning activity in which learners can practice their skills caring for the dying older adult. We also determined that there is opportunity for improvement concerning communication, especially with the use of the words death and dying.

Experiences of Female and Male Medical Students With Death, Dying, and Palliative Care: One Size Does Not Fit All

BACKGROUND

Medical students learn about death, dying, and palliative care (DDPC) through formal curricular offerings and informal clinical experiences; however, the lessons learned in the clinic may be at odds with the formal curriculum. Reflective writing is a means for students to "bracket" their DDPC experiences and reconcile conflicts between the formal and informal curriculum.

OBJECTIVES

The aim of this study is to compare the level of reflection demonstrated in medical students' narratives on DDPC with other experiences and to examine the domains of professionalism that students perceive to be prevalent in their DDPC experiences.

METHODS

Third-year medical students submitted professionalism narratives during their internal medicine clerkship. We identified a subset of narratives related to DDPC (n = 388) and randomly selected control narratives (n = 153). We assessed the level of reflection demonstrated in the narratives using a validated rubric and analyzed the professionalism domains that students identified as relevant to their experience.

RESULTS

There was no difference in reflective level between DDPC and control narratives. Within the DDPC group, female students demonstrated higher reflection (2.24 ± 0.71) than male students (2.01 ± 0.77; P < .001). Caring, compassion and communication, and honor and integrity were prominent among DDPC narratives. More females identified caring, compassion, and communication as relevant to their DDPC experiences, whereas more males identified altruism.

CONCLUSION

Males and females have different perceptions of DDPC experiences, and female students appear to be more deeply impacted. These findings can help clinical faculty engage students more effectively with this challenging topic.

A survey of palliative medicine education in Japan's undergraduate medical curriculum

BACKGROUND

This study aimed to examine the status of undergraduate palliative care education among Japanese medical students using data from a survey conducted in 2015.

METHODS

A questionnaire was originally developed, and the survey forms were sent to universities. The study's objectives, methods, disclosure of results, and anonymity were explained to participating universities in writing. Responses returned by the universities were considered to indicate consent to participate. Descriptive statistical methodology was employed.

RESULTS

The response rate was 82.5% (66 of 80 medical faculties and colleges). Palliative care lectures were implemented in 98.5% of the institutions. Regarding lecture titles, "palliative medicine," "palliative care," and "terminal care" accounted for 42.4, 30.3, and 9.1% of the lectures, respectively. Teachers from the Department of Anesthesia, Palliative Care, and Psychiatry administered 51.5, 47.0, and 28.8% of lectures, respectively. Subjects of lectures included general palliative care (81.8%), pain management (87.9%), and symptom management (63.6%). Clinical clerkship on palliative care was a compulsory and non-compulsory course in 43.9 and 25.8% of the schools, respectively; 30.3% had no clinical clerkship curriculum.

CONCLUSIONS

Undergraduate palliative care education is implemented in many Japanese universities. Clinical clerkship combined with participation in actual medical practice should be further improved by establishing a medical education certification system in compliance with the international standards.

Improving end-of-life care: Recommendations from the IOM

A 2014 consensus report by the Institute of Medicine offers recommendations for healthcare providers to decrease unwanted care and improve the quality of life at the end of life. This article discusses the recommendations of interest to advanced practice registered nurses.

Palliative Care in Undergraduate Medical Education—How Far Have We Come?

Purpose:

There is an increasing demand for quality palliative care teaching within undergraduate medical education. Studies suggest that many junior doctors feel underprepared to perform end-of-life care. Previous systematic reviews on palliative care teaching within medical schools have identified significant variability and lack of consistency in teaching. This review aims to update the literature on the current status of palliative care teaching to undergraduates within medical schools.

Method:

A systematic review was undertaken on articles published from December 2001 to November 2015 on palliative care teaching for undergraduate medical students. In all, 650 abstract citations were obtained, of which 126 were relevant to the research questions. Thematic analysis was performed on remaining articles according to whether they discussed content and/or methodology of palliative care education, and data collated.

Results:

There is greater consistency in the content being delivered as part of end-of-life care education within medical schools. The most frequently taught topics include attitudes to death and dying, communication skills, and pain management. Pediatric care and religious/cultural issues are less frequently addressed. Teaching institutions are also utilising a broader range of teaching modalities.

Conclusion:

There is significant progress in palliative care education within medical schools. Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care.

Medical Students' Professionalism Narratives Reveal That Experiences With Death, Dying, or Palliative Care Are More Positive Than Other Experiences During Their Internal Medicine Clerkship

PURPOSE

More physicians need to acquire the skills of primary palliative care. Medical students' clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students' preparedness for primary palliative care.

METHOD

Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011. We identified DDPC-related narratives and then randomly selected control narratives. Narratives were compared by valence (positive or negative) and professionalism-related themes.

RESULTS AND CONCLUSION

Less than 10% of the narratives were related to DDPC, but the majority was positive. There was a significant overlap in professionalism themes between DDPC and control narratives. The results suggest student preparedness for primary palliative care may be improved by addressing the common professionalism challenges of clinical clerkships.

Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care

Background:

The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized.

Methods:

Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ2 or Fisher exact test, and improvement was measured by weighted κ coefficient.

Results:

On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response.

Conclusions:

Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.

Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students

PROBLEM

Meeting the needs of patients with life-limiting and terminal illness requires effectively trained physicians in all specialties to provide skillful and compassionate care. Despite mandates for end-of-life (EoL) care education, graduating medical students do not consistently feel prepared to provide this care.

INTERVENTION

We have developed a longitudinal, integrated, and developmental 4-year curriculum in EoL care. The curriculum's purpose is to teach basic competencies in EoL care. A variety of teaching strategies emphasize experiential, skill-building activities with special attention to student self-reflection. In addition, we have incorporated interprofessional learning and education on the spiritual and cultural aspects of care. We created blended learning strategies combining interactive online modules with live workshops that promote flexibility, adaptability, and interprofessional learning opportunities.

CONTEXT

The curriculum was implemented and evaluated in the 4-year program of studies at Yale School of Medicine.

OUTCOME

A mixed-method evaluation of the curriculum included reviews of student written reflections and questionnaires, graduating student surveys, and demonstration of 4th-year students' competency in palliative care with an observed structured clinical examination (OSCE). These evaluations demonstrate significant improvements in students' self-reported preparedness in EoL care and perceptions of the adequacy in their instruction in EoL and palliative care, as well as competency in primary palliative care in a newly developed OSCE.

LESSONS LEARNED

A 4-year longitudinal integrated curriculum enhances students' skills and preparedness in important aspects of EoL care. As faculty resources, clinical sites, and curricular structure vary by institution, proven and adaptable educational strategies as described in this article may be useful to address the mandate to improve EoL care education. Teaching strategies and curricular components and design as just described can be adapted to other programs.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives

BACKGROUND

In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country.

METHODS

As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries.

RESULTS

There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015).

CONCLUSION

Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

Curricular innovations for medical students in palliative and end-of-life care: a systematic review and assessment of study quality

BACKGROUND

Recent focus on palliative and end-of-life care has led medical schools worldwide to enhance their palliative care curricula.

OBJECTIVE

The objective of the study was to describe recent curricular innovations in palliative care for medical students, evaluate the quality of studies in the field, and inform future research and curricular design.

METHODS

The authors searched Medline, Scopus, and Educational Resource Information Center (ERIC) for English-language articles published between 2007 and 2013 describing a palliative care curriculum for medical students. Characteristics of the curricula were extracted, and methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

The sample described 48 curricula in 12 countries. Faculty were usually interdisciplinary. Palliative care topics included patient assessment, communication, pain and symptom management, psychosocial and spiritual needs, bioethics and the law, role in the health care system, interdisciplinary teamwork, and self-care. Thirty-nine articles included quantitative evaluation, with a mean MERSQI score of 9.9 (on a scale of 5 to 18). The domain most likely to receive a high score was data analysis (mean 2.51 out of 3), while the domains most likely to receive low scores were validity of instrument (mean 1.05) and outcomes (mean 1.31).

CONCLUSIONS

Recent innovations in palliative care education for medical students represent varied settings, learner levels, instructors, educational modalities, and palliative care topics. Future curricula should continue to incorporate interdisciplinary faculty. Studies could be improved by integrating longitudinal curricula and longer-term outcomes; collaborating across institutions; using validated measures; and assessing higher-level outcomes including skills, behaviors, and impact on patient care.

Hospice Attitudes of Physicians and Nurses

The purpose of this study was to gauge the attitudes of internal medicine (IM) physicians and hospice nurses on the hospice programs in a Southeastern US county. A postal survey sought views on the following issues: (1) the level of control that hospice affords dying patients; (2) health care professionals’ education and communication involving the dying process; (3) the hospice referral process; (4) characteristics of a “good death”; and (5) gender versus professional role regarding hospice attitudes. The data revealed that occupational role in hospice care has a more significant function in the development of cognitive attitudes than of gender regarding hospice programs and that professional education needs more emphasis on the study of end-of-life issues, as well as open communication between health care professionals and patients during the dying process. Physicians were less likely than nurses to agree that patient control was important. Additionally, what constitutes a good death was similar to previous studies.

End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors

PURPOSE

End-of-life and palliative care (EOL/PC) education is a necessary component of undergraduate medical education. The extent of EOL/PC education in internal medicine (IM) clerkships is unknown. The purpose of this national study was to investigate the presence of formal EOL/PC curricula within IM clerkships; the value placed by IM clerkship directors on this type of curricula; curricular design and implementation strategies; and related barriers and resources.

METHOD

The Clerkship Directors in Internal Medicine conducted its annual survey of its institutional members in April 2012. The authors analyzed responses to survey items pertaining to formal EOL/PC curriculum and content using descriptive statistics. The authors used qualitative techniques to analyze free-text responses.

RESULTS

The response rate was 77.0% (94/122). Of those responding, 75.8% (69/91) believed such training should occur in the IM clerkship, and 43.6% (41/94) reported formal curricula in EOL/PC. Multiple instructional modalities were used to deliver this content, with the majority of programs dedicating four or more hours to the curriculum. Curricula covered a wide range of topics, and student assessment tools were varied. Most felt that students valued this education. The qualitative analysis revealed differences in the values clerkship directors placed on teaching EOL/PC within the IM clerkship.

CONCLUSIONS

Although many IM clerkship directors have implemented formal curricula in EOL/PC, a substantial gap remains between those who have implemented and those who believe it belongs in the clerkship. Time, faculty, cost, and competing demands are the main barriers to implementation.

End-of-Life Issues in UK Medical Schools

OBJECTIVE

A descriptive study to determine the current status of end-of-life (EOL) issues in UK medical schools.

METHODS

A brief questionnaire was mailed to the 31 medical schools in the United Kingdom in the spring of 2013. Data analysis consisted of frequency distributions.

RESULTS

All schools offered some exposure to the topic of dying, death and bereavement, and palliative care, although the orientation had increased somewhat from an earlier study in 2000. The palliative medicine specialist and the nurse specialist in palliative care are the most consistent members of the team. Most schools have hospice participation, with time spent with a hospice patient increasing over the period.

DISCUSSION

Data suggest that UK medical schools have addressed EOL issues. These findings should have significance for medical schools considering changes in their EOL offerings.

Palliative care education in U.S. medical schools

CONTEXT

Medical educators in the U.S.A. perceive the teaching of palliative care competencies as important, medical students experience it as valuable and effective, and demographic and societal forces fuel its necessity. Although it is encouraged by the Association of American Medical Colleges, the only palliative care-related mandate in U.S. medical schools is the Liaison Committee on Medical Education directive that end-of-life (EoL) care be included in medical school curricula, reinforcing the problematic conflation of EoL and palliative care.

FINDINGS

A review of US medical school surveys about the teaching of palliative and EoL care reveals varied and uneven approaches, ranging from 2 hours in the classroom on EoL to weeks of palliative care training or hospice-based clinical rotations.

IMPLICATIONS

Palliative care competencies are too complex and universally important to be relegated to a minimum of classroom time, random clinical exposures, and the hidden curriculum.

RECOMMENDATIONS

Given the reality of overstrained medical school curricula, developmentally appropriate, basic palliative care competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment.

End-of-Life and Palliative Care Curricula in U.S. Social Work Graduate Programs

Social workers have a high probability of relating to clients with terminal illnesses and their families. Yet, end-of-life education in U.S. graduate programs of social work has been somewhat limited. A recent guideline by the National Association of Social Workers (NASW) sets standards for social work practice in palliative and end-of-life care. This article presents the results of a 2012 survey of U.S. social work graduate programs to determine curricula offerings in end-of-life and palliative care. Results suggest that the majority of graduate social work programs are addressing the NASW guidelines; however, less than half of students participate in the offering(s).

Twenty-First Century End-of-Life Issues in Selected U.S. Professional Schools

Health professionals often relate to dying and death, but what does their professional training do to prepare them for these often stressful situations? With this question in mind, selected professional schools (medical, nursing, dental, child life, and veterinary) were surveyed to determine their emphasis on end-of-life issues in the 21st century. Return rates ranged from 71 to 100%. With the exception of dental schools, over 96% offer “something” on end-of-life issues. The lecture format and interdisciplinary background of the instructors frequently occur, with medical schools tending to be the most interdisciplinary. Topics covered vary, though attitudes toward death and dying, communication with the family and patient/owner of the animal, social and psychological contexts of dying, the experience of dying, and grief and bereavement are especially often addressed.