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Hotz KG, Silverstein A, Dalgo A. Novel Integration of a Health Equity Immersion Curriculum in Medical Training. J Med Humanit 2024; 45:193-199. [PMID: 38504033 DOI: 10.1007/s10912-023-09839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/21/2024]
Abstract
Health disparities education is an integral and required part of medical professional training, and yet existing curricula often fail to effectively denaturalize injustice or empower learners to advocate for change. We discuss a novel collaborative intervention that weds the health humanities to the field of health equity. We draw from the health humanities an intentional focus retraining provider imaginations by centering patient narratives; from the field of health equity, we draw the linkage between stigmatized social identities and health disparities. We describe a longitudinal health equity curriculum for the Hospice and Palliative Medicine fellowship in Memphis, Tennessee, to give trainees exposure to the concept of structural violence and how it affects clinical care. The curriculum was developed in partnership with humanities and social sciences faculty who staff a Health Equity academic program at a small liberal arts college in Memphis. This curriculum has been implemented for the past four years in support of 22 hospice and palliative medicine fellows. Group debriefs and a mixed methods survey have revealed widespread and lasting impact towards understanding health equity concepts, enhanced communication and treatment of patients, and empowerment to address the broader needs and policies affecting patients and the communities in which they live. Ultimately, we model an educational initiative that integrates equity across the full scope of healthcare practice and equips learners with skills for sustaining compassionate practices, focusing on equity-oriented, person-centered care across the full scope of healthcare practice.
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Affiliation(s)
- Kendra G Hotz
- Health Equity Program, Rhodes College, Memphis, TN, USA
| | - Allison Silverstein
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Austin Dalgo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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Schukow C, Alawy B. Advocating for Training in End-Of-Life Conversations With Seriously Ill Patients During Residency. Am J Hosp Palliat Care 2024; 41:726-729. [PMID: 37845789 DOI: 10.1177/10499091231208388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
According to section IV.B.1.e of common residency program requirements from the Accreditation Council for Graduate Medical Education (ACGME), "[r]esidents must learn to communicate with patients and families to partner with them to assess their care goals, including, when appropriate, end-of-care [EOL] goals". EOL conversations are frequently appropriate for patients suffering from serious, life-threatening diseases (ie, terminal illness) or otherwise chronic health conditions with poor disease trajectories. These conversations are often followed with services and care from palliative medicine or hospice specialists depending on patients' projected prognoses (ie, 6 months or less). The focus of this patient-centered care, then, is on relieving patient and caregiver suffering, establishing clear treatment goals, and managing the physical, psychosocial, and spiritual burdens of disease. Although palliative medicine and hospice care have been shown to reduce health care costs and improve the overall care of patients who require these services, recent literature still suggests a gap in training programs being able to provide effective, educational strategies to their trainees regarding the appropriate and competent delivery of EOL conversations. Herein, this commentary will provide a discussion on what EOL is, palliative vs hospice care indications, and address current literature regarding EOL exposure within training programs while offering our personal insight and advocacy on the manner.
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Affiliation(s)
- Casey Schukow
- Department of Pathology, Corewell Health's Beaumont Hospital, Royal Oak, MI, USA
| | - Bilal Alawy
- Department of Graduate Medical Education, ProMedica Monroe Regional Hospital, Monroe, MI, USA
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3
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Sherry DR, Patell R, Han HJ, Dodge LE, Braun IM, Buss MK. Palliative Medicine Fellows' Discussions, Perceptions, and Training Regarding Medical Cannabis. J Pain Symptom Manage 2024; 67:471-477.e6. [PMID: 38417464 DOI: 10.1016/j.jpainsymman.2024.02.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/01/2024]
Abstract
CONTEXT Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms. OBJECTIVES We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to counsel patients about medical cannabis. METHODS A previously validated questionnaire was adapted for HPM fellows. Domains included fellows' practices recommending cannabis and their knowledge of its effectiveness and risks compared with standard treatments. U.S. HPM fellowships were sent surveys in 2022 and 2023. RESULTS Forty six programs participated, 123 fellows responded (response rate of 42%) including 69% female; 55% White, and 28% Asian. Of respondents, 65% reported receiving formal training regarding medical cannabis; 57% reported discussing medical cannabis with over five patients; 23% recommended medical cannabis to more than five patients in the preceding year. Only 19%, however, felt sufficiently informed to issue cannabis-related recommendations. HPM fellows with prior training were not more likely to feel sufficiently informed to discuss cannabis (RR: 1.17; 95% CI: 0.82-1.66) or to recommend cannabis to patients (RR: 2.05, 95% CI: 0.89-4.71). Fellows rate cannabis as equally or more effective than conventional treatments for the following symptoms: anorexia/cachexia (63%), nausea/vomiting (43%), pain (25%), and neuropathic pain (21%). CONCLUSION Most HPM fellows report formal training in the use of medical cannabis. Over half of trainees reported discussing medical cannabis with patients, but few considered themselves sufficiently informed to make cannabis-related clinical recommendations. These results suggest both a need for expanded high-quality evidence for medical cannabis in palliative care and for improved formal education for HPM fellows.
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Affiliation(s)
- Dylan R Sherry
- Fox Chase Cancer Center (D.R.S.), Temple University Health System, Philadelphia, Pennsylvania, USA.
| | - Rushad Patell
- Beth Israel Deaconess Medical Center (R.P., H.J.H., L.E.D.), Harvard Medical School, Boston, Massachusetts, USA
| | - Harry J Han
- Beth Israel Deaconess Medical Center (R.P., H.J.H., L.E.D.), Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Dodge
- Beth Israel Deaconess Medical Center (R.P., H.J.H., L.E.D.), Harvard Medical School, Boston, Massachusetts, USA
| | - Ilana M Braun
- Dana Farber Cancer Institute, Harvard Medical School (I.M.B.), Boston, Massachusetts, USA
| | - Mary K Buss
- Tufts Medical Center, Tufts University School of Medicine (M.K.B.), Boston, Massachusetts, USA
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Goett R, Lyou J, Willoughby LR, Markwalter DW, Gorgas DL, Southerland LT. Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model. West J Emerg Med 2024; 25:213-220. [PMID: 38596921 PMCID: PMC11000566 DOI: 10.5811/westjem.18448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/20/2023] [Accepted: 01/12/2023] [Indexed: 04/11/2024] Open
Abstract
Background Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list. Methods Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members. Results The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care). Conclusion The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.
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Affiliation(s)
- Rebecca Goett
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | - Jason Lyou
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Lauren R. Willoughby
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Daniel W. Markwalter
- University of North Carolina School of Medicine, Department of Emergency Medicine, Chapel Hill, North Carolina
- University of North Carolina School of Medicine, UNC Palliative Care Program, Chapel Hill, North Carolina
| | - Diane L. Gorgas
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| | - Lauren T. Southerland
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
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Lawton AJ, deLima Thomas J, Doyle K, Rosenberg L. Something Lost and Something Gained: Navigating the Bedside Teaching Role as a Hospice and Palliative Medicine Educator. J Palliat Med 2024; 27:279-282. [PMID: 37433215 DOI: 10.1089/jpm.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Hospice and palliative medicine (HPM) educators must often give up the satisfaction of working one-on-one with patients, to allow learners the opportunity to practice key communication skills and form their own therapeutic bonds with patients. Though the loss of that primary relationship with patients may feel challenging, educators may find new opportunity for professional impact and satisfaction by investing in their relationship with learners. This case discussion explores the challenges of bedside teaching in HPM, including the educator's looser connection with patients, need to withhold their own communication skills, and decision of when to interject into a trainee-patient conversation. We then propose strategies to help educators find renewed professional fulfillment in the teacher-learner relationship. By partnering intentionally with learners before, during, and after shared visits, inviting informal reflection between encounters, and preserving independent clinical time, we believe educators may cultivate a more sustainable and meaningful clinical teaching practice.
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Affiliation(s)
- Andrew J Lawton
- Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jane deLima Thomas
- Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Doyle
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leah Rosenberg
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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DeCarli K, Rodenbach R, Sedhom R, Von Roenn J, Ketterer B. Integrated dual training in palliative care and oncology. Curr Probl Cancer 2023; 47:101012. [PMID: 37714796 DOI: 10.1016/j.currproblcancer.2023.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 09/17/2023]
Abstract
Fellowship training in Hospice and Palliative Medicine (HPM) and Hematology/Oncology (Hem/Onc) share common themes and roots in the holistic care of people living with cancer. As of 2021, approximately 630 physicians in the United States were board-certified in both HPM and Hem/Onc. There is increasing demand for an integrated fellowship pathway, and the inaugural integrated fellowship Match took place in 2022. We present the historical context of the overlap in HPM and Hem/Onc fellowship training, limitations of the standard training paradigm, and an overview of the recently developed integrated training pathway accredited by the Accreditation Council for Graduate Medical Education (ACGME). We explore applications of dual training in clinical care, program development, and research at the intersection of HPM and Hem/Onc. Finally, we consider challenges to the success and how best to assess the outcomes of this program. Integrated fellowship training in HPM and Hem/Onc is 1 avenue to develop a cohort of dual-trained physicians poised to effect broad cultural change in this important and evolving space. A subset of physicians with dual training has the potential to fill unmet needs by promoting enhanced patient-centered care, developing infrastructure for heightened collaboration between these distinct but closely related fields, and prioritizing research focused on advanced communication skills and symptom management for patients with cancer.
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Affiliation(s)
- Kathryn DeCarli
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence RI.
| | | | - Ramy Sedhom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania, Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jamie Von Roenn
- American Society of Clinical Oncology, VP Education, Science and Professional Development, Alexandria, VA.
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Shalev D, Ekwebelem MI, Brody LA, Callahan ME, Singh N, Reid MC. Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors. J Pain Symptom Manage 2023; 66:310-319. [PMID: 37442531 PMCID: PMC10528591 DOI: 10.1016/j.jpainsymman.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT Psychological and psychiatric care is a core domain of palliative care. Despite a high burden of mental health comorbidity among individuals with serious illness, the Accreditation Council of Graduate Medical Education gives little guidance about training hospice and palliative medicine (HPM) fellows in this domain of care. Currently, there is a lack of empiric data on HPM physician fellowship training in mental health topics. OBJECTIVES To characterize HPM physician fellowship training practices in the psychological and psychiatric aspects of palliative care. METHODS A cross-sectional survey study querying HPM fellowship training directors nationally. RESULTS A total of 95 programs participated (51% response rate). A total of 98% programs offered didactics on mental health topics. Topics universally deemed as important by program directors were commonly taught, but there was variability in both the perceived importance and the didactic coverage of several topics. Only 15% of programs offered core rotations in psychiatry. Most programs offered psychiatry electives, but such electives were only rarely utilized by fellows. Interdisciplinary team (IDT) rounds infrequently included doctoral mental health clinicians. CONCLUSIONS Beyond a few commonly identified and taught key topics, there is variability in clinical and didactic exposure to mental health training among HPM fellowships. Standardizing key learning objectives and guiding educators in how to achieve these objectives could improve the preparedness of the physician workforce in HPM to meet the mental health needs of patients with serious illness.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry (D.S), Weill Cornell Medicine, New York, New York, USA.
| | - Maureen I Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Lilla A Brody
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - Mary E Callahan
- Department of Medicine (M.E.C), Columbia University Irving Medical Center, New York, New York, USA
| | - Navendra Singh
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S, M.E, L.B, N.S, M.C.R), Weill Cornell Medicine, New York, New York, USA
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8
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Bassette E, Salyer C, McCammon S, Veazey Brooks J, Spoozak L. Value of Hospice and Palliative Medicine Fellowship After Surgical Training: Bridging the Gap for Improved Patient Care. Am J Hosp Palliat Care 2023; 40:711-719. [PMID: 36154697 DOI: 10.1177/10499091221128966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Surgeons comprise 2% of HPM-trained physicians. Little is known about the perceived value of HPM training to the surgeon or medical community. We aim to demonstrate the value of HPM fellowship training to surgeons and surgical practice from the point of view of HPM fellowship trained surgeons. Design: A qualitative analysis was performed using semi-structured zoom interviews that elicited the lived experiences of HPM trained surgeons. Data was analyzed using descriptive statistics and thematic analysis. Setting: Researchers were from the University of Kansas School of Medicine and the University of Alabama at Birmingham. Participants were trained and worked across the United States in a variety of settings. Participants: Eligibility included training in general surgery, obstetrics and gynecology, or affiliated subspecialties and completion of a 1-year HPM fellowship. Results: 17 interviews were performed. Several themes emerged regarding the transformative value of HPM training to their medical and surgical practice: (1) Learning to apply shared decision making and goal-concordant care to surgical decision making, and (2) Decreasing personal bias in medical decision making, and (3) Enabling wellness in surgeons. Two themes emerged regarding the perceived value to both the surgical community and the HPM community: (1) Value of the HPM Fellowship Trained Surgeon to the Surgical Community, and (2) Value of the HPM Fellowship Trained Surgeon to the HPM Community. All study participants valued their HPM training and felt highly valued by the healthcare team. Conclusion: HPM trained surgeons are highly valued on the healthcare team and improve patient-centered surgical care.
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Affiliation(s)
- Emma Bassette
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Chelsea Salyer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Susan McCammon
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas, USA
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
- Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas, USA
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Liantonio J, Tapper CX, Danielewicz M, Spina E, Javier NM. A Call for the Creation of LGBTQ+ Competencies for Hospice and Palliative Medicine (HPM) Fellowship Programs. J Pain Symptom Manage 2023; 65:e381-e385. [PMID: 36563866 DOI: 10.1016/j.jpainsymman.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT LGBTQ+ people and their families have unique needs, concerns, and issues when navigating serious illness. OBJECTIVES To develop curricular milestones and an educational framework for hospice and palliative medicine (HPM) fellowship programs to meet the needs of this community. METHODS A working group has developed a plan for the inclusion of LGBTQ+ competencies in HPM fellowship programs, utilizing input from an AAHPM Special Interest Group (SIG) at a national meeting. DISCUSSION Learning to provide culturally competent care is essential for all HPM providers. Our group recommends specific clinical training competencies with plans to pilot them in upcoming academic years. Creating curricular recommendations will help guide fellowship programs education in the care of LGBTQ+ patients with serious illness.
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Affiliation(s)
- John Liantonio
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania.
| | - Corey X Tapper
- Johns Hopkins University School of Medicine (C.T.), Baltimore, Maryland
| | - Michael Danielewicz
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania
| | - Elizabeth Spina
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital (J.L., M.D., E.S.), Philadelphia, Pennsylvania
| | - Noelle M Javier
- Icahn School of Medicine at Mount Sinai (N.M.J.), New York, New York
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Finlay EE, Goodlev ER, Biewald MA, Skavinski KA, Sinclair CT. An Educational Needs Assessment for Outpatient Palliative Care Clinicians. J Palliat Med 2022; 26:464-471. [PMID: 36260354 DOI: 10.1089/jpm.2022.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: As the field of palliative medicine continues to grow in community-based settings, outpatient palliative care clinics have become an important site for providing upstream palliative care to patients and families. It is unclear whether current training models, focused predominantly on the inpatient setting, adequately prepare clinicians for outpatient palliative care practice. Methods: We performed an online educational needs assessment survey of physicians and advanced practice providers working in outpatient palliative care clinics. Survey questions focused on the importance of specific palliative care knowledge, skills, and attitudes in outpatient practice using the Accreditation Council of Graduate Medical Education Hospice and Palliative Medicine (HPM) curricular milestones to guide survey development. We also explored clinician perception of training adequacy and current educational needs relevant to outpatient practice. Results: One hundred sixty-four clinicians, including 122 (74.4%) physicians, 32 (19.5%) nurse practitioners, and 8 (4.9%) physician assistants, completed our survey. Clinicians had a median of 10 years of HPM experience and 6 years of outpatient experience. We identified two main areas of perceived knowledge or skill deficit: navigating insurance and prior authorizations and co-management of pain and opioid use disorder. Conclusion: Addressing gaps in education and preparedness for outpatient practice is essential to improve clinician competence and efficiency as well as patient care, safety, and care coordination. This study identifies practice management and opioid stewardship as potential targets for educational interventions. The development of curricula related to these outpatient skills may improve clinicians' ability to provide safe, patient-centered care with confidence.
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Affiliation(s)
- Esme E Finlay
- Department of Medicine, Division of Palliative Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Eric R Goodlev
- Department of Medicine, Division of Palliative Care, Einstein Healthcare Network (Einstein Medical Center Montgomery), Norristown, Pennsylvania, USA
| | - Mollie A Biewald
- Department of Medicine, Division of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York. USA
| | - Kira A Skavinski
- Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego Health, La Jolla, California, USA
| | - Christian T Sinclair
- Department of Medicine, Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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11
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Bassette E, Salyer C, McCammon S, Brooks JV, Spoozak L. Hospice and Palliative Medicine Fellowship after Surgical Training: A Roadmap to the Future of Surgical Palliative Care. J Surg Educ 2022; 79:1177-1187. [PMID: 35662536 DOI: 10.1016/j.jsurg.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/17/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeons comprise only 2% of Hospice and Palliative Medicine (HPM) board-certified physicians. Little is known about the motivations of individuals who pursue this combined training or the perceived benefits of this pathway. This study aimed to capture the pathways and experiences of HPM fellowship trained surgeons and to establish recommendations for surgical trainees who may benefit from HPM fellowship training. DESIGN A qualitative study was designed using semi-structured zoom interviews that elicited experiences of HPM trained surgeons. Data was analyzed using descriptive statistics and thematic analysis. SETTING Researchers were from the University of Kansas School of Medicine and the University of Alabama at Birmingham. Participants were trained and worked across the United States in a variety of settings. PARTICIPANTS Eligibility included completion of a 1-year HPM fellowship and training in general surgery, general obstetrics and gynecology, or affiliated subspecialties. RESULTS Seventeen interviews were conducted. All participants expressed satisfaction with their HPM fellowship training. Four themes emerged as recommendations for surgeons to pursue HPM fellowship training: 1) a commitment to joining the HPM workforce, 2) becoming ambassadors for HPM and surgical culture change, 3) desire for advanced communication and symptom management skills at the specialist level, and 4) specialist level HPM skills may enhance surgical career. CONCLUSIONS HPM fellowship training is achievable through multiple pathways for surgeons from a variety of training backgrounds.
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Affiliation(s)
- Emma Bassette
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Chelsea Salyer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Susan McCammon
- Department of Otolaryngology, University of Alabama School of Medicine, Birmingham, Alabama; Department of Internal Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama School of Medicine, Birmingham, Alabama
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, Kansas; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, Kansas.
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12
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Moyer KM, Verbeck N, Barnett MD, Denney-Koelsch EM, Ajayi T, Humphrey LM, Malhotra S, Ragsdale L, Waldman ED, Gustin JL. A National Survey to Guide Pediatric Curricula for Hospice and Palliative Medicine Fellows. J Pain Symptom Manage 2022; 64:e165-e171. [PMID: 35523388 DOI: 10.1016/j.jpainsymman.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen M Moyer
- Hospice and Community Care (K.M.M.), Lancaster, Pennsylvania, USA.
| | - Nicole Verbeck
- The Ohio State University College of Medicine (N.V.), Columbus, Ohio, USA
| | - Michael D Barnett
- University of Alabama at Birmingham (M.D.B.), Birmingham, Alabama, USA
| | | | - Toluwalase Ajayi
- Scripps Health and Rady Children's Hospital (T.A.), San Diego, California, USA
| | - Lisa M Humphrey
- Nationwide Children's Hospital (L.M.H.), Columbus, Ohio, USA
| | - Sonia Malhotra
- Tulane University School of Medicine and Louisiana State University School of Medicine (S.M.), New Orleans, Los Angeles, USA
| | - Lindsay Ragsdale
- University of Kentucky College of Medicine (L.R.), Lexington, Kentucky, USA
| | - Elisha D Waldman
- Northwestern University School of Medicine / Ann & Robert H. Lurie Children's Hospital of Chicago (E.D.W.), Chicago, Illinois, USA
| | - Jillian L Gustin
- The Ohio State University Wexner Medical Center (J.L.G.), Columbus, Ohio, USA
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Burger H, Krause R, Blanchard C, Ambler J, Ganca L, Barnard A, Meiring M, Ratshikana-Moloko M, Brits H, Brand T, Scott M, Mabuza L, Bac M, Zele-Mqonci N, Yogeswaran P, Gwyther L. Position paper on undergraduate Palliative Medicine education for doctors in South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 35924627 PMCID: PMC9350482 DOI: 10.4102/phcfm.v14i1.3202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality. Aim This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor. Setting Palliative Medicine programme leads and teachers from eight medical schools in South Africa. Methods A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers. Results Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum. Conclusion Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).
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Affiliation(s)
- Henriette Burger
- Division of Radiation Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Division of Radiation Oncology, Tygerberg Academic Hospital, Cape Town.
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14
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Goh S, Wong RSM, Quah ELY, Chua KZY, Lim WQ, Ng ADR, Tan XH, Kow CS, Teo YH, Lim EG, Pisupati A, Chong EJX, Kamal NHA, Tan LHE, Tay KT, Ong YT, Chiam M, Lee ASI, Chin AMC, Mason S, Krishna LKR. Mentoring in palliative medicine in the time of covid-19: a systematic scoping review : Mentoring programs during COVID-19. BMC Med Educ 2022; 22:359. [PMID: 35545787 PMCID: PMC9094135 DOI: 10.1186/s12909-022-03409-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program. METHODS A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles. RESULTS Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA's Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP's structured virtual and near-peer mentoring process complement IPT's accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program. CONCLUSION This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.
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Affiliation(s)
- Sherill Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Aubrey Ding Rui Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eleanor Jia Xin Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Nur Haidah Ahmad Kamal
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD6, Centre for Translational Medicine, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore
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Affiliation(s)
- Nickolas Fouladpour
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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16
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Chua IS, Fratt E, Ho JJ, Roldan CS, Gundersen DA, Childers J. Primary Addiction Medicine Skills for Hospice and Palliative Medicine Physicians: A Modified Delphi Study. J Pain Symptom Manage 2021; 62:720-729. [PMID: 33677071 DOI: 10.1016/j.jpainsymman.2021.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023]
Abstract
CONTEXT Hospice and palliative medicine (HPM) physicians frequently care for patients with substance use disorders (SUDs), but there is no consensus on which primary addiction medicine (AM) skills are essential. OBJECTIVES Identify key primary AM skills that physicians should acquire during an ACGME-accredited HPM fellowship program. METHODS A modified Delphi study consisting of 18 experts on SUD in HPM and medical education. A literature review and expert input identified initial AM skills. In three Delphi rounds, participants rated each skill on a nine-point scale from "not at all important to include" to "crucial to include." We calculated medians (IQRs), analyzed panelists' comments, and grouped skills using the RAND / UCLA appropriateness method. RESULTS Among 62 proposed AM skills, 53 skills were rated as appropriate to include (38 of which achieved agreement), and nine skills were rated as uncertain. AM skills most relevant to HPM included 1) defining chemical coping, median 8.5 (IQR 2); 2) balancing life expectancy with risks of opioid use for patients with SUD, 9 (IQR 0); 3) explaining best practices to dispose unused opioids postmortem, 8 (IQR 2); 4) managing pain for hospice patients with SUD, 9 (IQR 0.75); and 5) partnering with hospice to manage patients on methadone and buprenorphine, 9 (IQR 2). Experts did not achieve consensus on whether HPM physicians should be encouraged to learn to prescribe buprenorphine for patients with opioid use disorder, 6 (IQR 3). CONCLUSION HPM fellowships should consider incorporating the primary AM skills identified in this study in their curricula.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Ellie Fratt
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - J Janet Ho
- Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Claudia S Roldan
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA; Section for Treatment, Research, and Education in Addiction Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA
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17
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Brooks FA, Tolchin DW. Extending the Depth and Breadth of Physiatry Care: Five Strategies for Residents to Develop a Foundation in Hospice and Palliative Medicine. Am J Phys Med Rehabil 2021; 100:e144-e146. [PMID: 33496440 DOI: 10.1097/phm.0000000000001708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Hospice and palliative medicine is one of seven accredited fellowship subspecialties available to graduates of physical medicine and rehabilitation residency programs. Hospice and palliative medicine and physical medicine and rehabilitation share many of the same principles and practices, and physical medicine and rehabilitation residency training can be excellent preparation for hospice and palliative medicine fellowship. However, unlike the other six physical medicine and rehabilitation subspecialties, there is currently no requirement for hospice and palliative medicine training during physical medicine and rehabilitation residency. As a result, physical medicine and rehabilitation residents may encounter limited hospice and palliative medicine exposure or education, and lack explicit opportunities to develop the basic set of palliative care symptom management and communication tools that can be applied across the spectrum of physiatry care. Here, we provide five strategies that residents can use within their own programs to develop knowledge and experience in hospice and palliative medicine.
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Affiliation(s)
- Forrest A Brooks
- From Rusk Rehabilitation, New York University Grossman School of Medicine, New York City, New York (FAB); Harvard Medical School, Boston, Massachusetts (DWT); and Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (DWT)
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18
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Abstract
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.
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Affiliation(s)
- Alexandra C Istl
- Division of Surgical Oncology, Johns Hopkins Hospital, Blalock 684, 600 North Wolfe Street, Baltimore, MD 21287, USA. https://twitter.com/AllyIstl
| | - Fabian M Johnston
- Division of Surgical Oncology, Johns Hopkins Hospital, Blalock 684, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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19
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Bell LF, Livingston J, Arnold RM, Schenker Y, Kelsey RC, Ivonye C, October TW. Lack of Exposure to Palliative Care Training for Black Residents: A Study of Schools With Highest and Lowest Percentages of Black Enrollment. J Pain Symptom Manage 2021; 61:1023-1027. [PMID: 33189856 DOI: 10.1016/j.jpainsymman.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 01/03/2023]
Abstract
CONTEXT The palliative medicine workforce lacks racial diversity with <5% of specialty Hospice and Palliative Medicine (HPM) fellows identifying as black. Little is known about black trainees' exposure to palliative care during their medical education. OBJECTIVES To describe palliative care training for black students during medical school, residency, and fellowship training. METHODS We conducted a cross-sectional descriptive study using Internet searches and phone communication in September 2019. We evaluated 24 medical schools in three predetermined categories: historically black colleges and universities (HBCUs; N = 4) and non-under-represented minority-serving institutions with the highest (N = 10) and lowest (N = 10) percentages of black medical students. Training opportunities were determined based on the presence of a course, clerkship, or rotation in the medical school and residency curricula, a specialty HPM fellowship program, and specialty palliative care consult service at affiliated teaching hospitals. RESULTS None of the four HBCUs with a medical school offered a palliative care course or clerkship, rotation during residency, or specialty HPM fellowship program. Three of four HBCUs were affiliated with a hospital that had a palliative care consult service. Institutions with the highest black enrollment were less likely to offer palliative care rotations during internal medicine (P = 0.046) or family medicine (P = 0.019) residency training than those with the lowest black enrollment. CONCLUSION Residents at schools with the highest black medical student enrollment lack access to palliative care training opportunities. Efforts to reduce health disparities and underrepresentation in palliative care must begin with providing palliative-focused training to physicians from under-represented minority backgrounds.
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Affiliation(s)
- Lindsay F Bell
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics and Palliative Research Center (PaRC), University of Pittsburgh, Pennsylvania, USA.
| | - Jessica Livingston
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics and Palliative Research Center (PaRC), University of Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics and Palliative Research Center (PaRC), University of Pittsburgh, Pennsylvania, USA
| | - Riba C Kelsey
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Chinedu Ivonye
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tessie W October
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA; The George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
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20
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Morrison LJ, Periyakoil VS, Arnold RM, Tucker R, Chittenden E, Sanchez-Reilly S, Carey EC. Launching the Next Steps to Improve Hospice and Palliative Medicine Fellow Performance Assessment: A Look Back to the Initial Toolkit of Assessment Methods. J Pain Symptom Manage 2021; 61:613-627. [PMID: 33091584 PMCID: PMC7569474 DOI: 10.1016/j.jpainsymman.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Education leaders in hospice and palliative medicine (HPM) have long acknowledged the challenge of fellow performance assessment and the need for HPM-specific fellow assessment tools. In 2010, and in alignment with the Accreditation Council for Graduate Medical Education's (ACGME's) directive toward competency-based medical education, the national HPM Competencies Workgroup curated a set of assessment tools, the HPM Toolkit of Assessment Methods. The Toolkit has been a resource for HPM fellowship directors in evolving practical, multifaceted fellow assessment strategies. Now, as American Academy of Hospice and Palliative Medicine plans for a national workgroup in 2020 to define current HPM fellow assessment methods and to propose strategies to strengthen and standardize future assessment, the Toolkit provides a strong base from which to launch. However, the field learned important lessons from the 2010 Workgroup about the consensus process, gaps in areas of assessment, opportunities to address gaps with new or adapted tools, and limitations in implementing the Toolkit over time in terms of tracking, accessibility, and dissemination. This article describes the development of the Toolkit, including recommended tools and methods for assessment within each ACGME competency domain, and links the lessons learned to recommendations for the 2020 workgroup to consider in creating the next HPM assessment strategy and toolkit. Effective implementation will be crucial in supporting fellows to reach independent practice, which will further strengthen the field and workforce to provide the highest quality patient and family-centered care in serious illness. This will require an inspired, committed effort from the HPM community, which we enthusiastically anticipate.
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Affiliation(s)
- Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Rodney Tucker
- University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, Alabama, USA
| | - Eva Chittenden
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra Sanchez-Reilly
- Department of Medicine, University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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21
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Abstract
ABSTRACT Physiatrists care for patients and families with complex medical needs, and primary palliative care is an important part of the comprehensive rehabilitation care plan. Palliative care improves patient and family quality of life and reduces healthcare costs. Clinical care guidelines for several physiatry patient populations now include the provision of palliative care.Current Accreditation Council for Graduate Medical Education physiatry residency program requirements include foundational palliative care skills. Similarly, current clinical palliative care practice guidelines enumerate standards that apply to the rehabilitation setting. However, there is a dearth of literature on the current state of palliative care training within physiatry programs, and hospice and palliative medicine remains one of the least subscribed physiatry subspecialties.In this article, we describe palliative care, highlight existing literature on palliative care needs within physiatry patient populations, and identify a core physiatry-palliative care skillset. We look both within physiatry and across other specialties to guide recommendations for palliative care education within physiatry residency programs. We also describe opportunities for post-residency fellowship training in hospice and palliative medicine.
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Affiliation(s)
- Michelle Brassil
- From the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (MB); Vanderbilt University Medical Center, Nashville, Tennessee (VG-K); and Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts (DWT)
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22
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Willemsen AM, Paal P, Zhang S, Mason S, Elsner F. Chinese medical teachers' cultural attitudes influence palliative care education: a qualitative study. BMC Palliat Care 2021; 20:14. [PMID: 33435961 PMCID: PMC7805147 DOI: 10.1186/s12904-020-00707-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China. METHODS We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied. RESULTS Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China. CONCLUSIONS According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.
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Affiliation(s)
- Antonia M. Willemsen
- Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Piret Paal
- Institute of Nursing Science, Paracelsus Medical University, Salzburg, Austria
| | - Silja Zhang
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Stephen Mason
- Marie Curie Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Frank Elsner
- Faculty of Medicine, Department of Palliative Care, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
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Glass M, Rana S, Coghlan R, Lerner ZI, Harrison JD, Stoltenberg M, Namukwaya E, Humphreys J. Global Palliative Care Education in the Time of COVID-19. J Pain Symptom Manage 2020; 60:e14-e19. [PMID: 32717367 PMCID: PMC7380234 DOI: 10.1016/j.jpainsymman.2020.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/06/2020] [Accepted: 07/18/2020] [Indexed: 11/18/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S.; and two international PC programs in Uganda and India. GPEC offers U.S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating in-the Resilience Inspiration Storytelling Empathy Project-and discuss positive outcomes of the project.
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Affiliation(s)
- Marcia Glass
- Tulane University School of Medicine, New Orleans, USA.
| | | | - Rachel Coghlan
- Centre for Humanitarian Leadership, Deakin University, Melbourne, Australia
| | - Zachary I Lerner
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
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Barnett MD, Buckholz G, Christensen A, Hwang J, Johnston CB, Landzaat L, Lupu D, Morrison LJ, Okon T, Radwany S, Yang H, Edgar L, Gustin J. Development of Subspecialty-Specific Reporting Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S. J Pain Symptom Manage 2020; 60:151-157. [PMID: 31988020 DOI: 10.1016/j.jpainsymman.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for internal medicine subspecialties in 2014 but quickly recognized that they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts used an iterative consensus building process between December 2017 and February 2019 to draft new RMs and create a supplemental guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators. Program directors, program coordinators, and designated institutional officers were contacted directly to solicit feedback. Most respondents agreed or strongly agreed that each RM represented a realistic progression of knowledge, skills, and behaviors, and that the set of milestones adequately discriminated between meaningful levels of competency. Similarly, respondents felt that the supplemental guide was a useful resource. The result is a set of carefully developed and broadly vetted RMs that represent a progression of development for HPM physicians during one year of clinical fellowship training.
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Affiliation(s)
| | - Gary Buckholz
- University of California San Diego, La Jolla, California, USA
| | | | - Jennifer Hwang
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Lindy Landzaat
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dale Lupu
- George Washington University, Washington, District of Columbia, USA
| | | | | | - Steven Radwany
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly Yang
- Scripps Health, San Diego, California, USA
| | - Laura Edgar
- The Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
| | - Jillian Gustin
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Gryschek G, Cecilio-Fernandes D, Mason S, de Carvalho-Filho MA. Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese. BMJ Open 2020; 10:e034567. [PMID: 32601112 PMCID: PMC7328756 DOI: 10.1136/bmjopen-2019-034567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/10/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care for dying patients. Palliative care education should be an urgent concern for all medical schools all around the world, including Latin America and Brazil. Advances in palliative care education require robust assessment tools for constant evaluation and improvement of educational programmes. Bandura's social cognitive theory proposes that active learning processes are mediated by self-efficacy and associated outcome expectancies, both crucial elements of developing new behaviour. The Self-Efficacy in Palliative Care (SEPC) and Thanatophobia Scales were developed using Bandura's theory to assess the outcomes of palliative care training. OBJECTIVES We aimed to translate and validate these scales for Brazilian Portuguese to generate data on how well doctors are being prepared to meet the needs of their patients. DESIGN Cross-sectional study. SETTING One Brazilian medical school. PARTICIPANTS Third-year medical students. METHODS The authors translated the scales following the European Organisation for Research and Treatment of Cancer's recommendations and examined their psychometric properties using data collected from a sample of 111 students in a Brazilian medical school in 2017. RESULTS The Brazilian versions of SEPC and Thanatophobia Scales showed good psychometric properties, including confirmatory factor analysis, replicating the original factors (factor range: 0.51-0.90), and acceptable values of reliability (Cronbach's alpha: 0.82-0.97 and composite reliability: 0.82-0.96). Additionally, the Brazilian versions of the scales showed concurrent validity, demonstrated through a significant negative correlation. CONCLUSIONS The Brazilian version of the scales may be used to assess the impact of current undergraduate training and identify areas for improvement within palliative care educational programmes. The data generated allow Brazilian researchers to join international conversations on this topic and educators to develop tailored pedagogical approaches.
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Affiliation(s)
- Guilherme Gryschek
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Stephen Mason
- Research and Development Division, Marie Curie Palliative Care Institute Liverpool, Liverpool, UK
| | - Marco Antonio de Carvalho-Filho
- Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
- Department of Health Sciences, Center for Educational Development and Research in Health Professions, University of Groningen, Groningen, The Netherlands
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Whitla L, Devins M, Molloy EJ, Twomey M, O'Reilly M, Balfe J. Children's Palliative Care; the identified Learning Needs of Paediatricians. Ir Med J 2020; 113:95. [PMID: 32816430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aim To determine baseline learning needs of Paediatricians in Ireland when caring for children with palliative care needs. Methods A questionnaire based online survey was conducted. Results One hundred and fourteen paediatricians responded to the survey, the majority were Specialist Registrars but almost half were consultant paediatricians (46% n=52). Most had never had formal education in the paediatric palliative care (57% n=48). Areas of future training that were ranked as important or highly important (percentage of respondents) included: pain management (98% n=81), management of the dying child (96% n=80), palliative care resources (95%n=79), advanced care planning (95% n=79) and communication skills (86% n=71). Those surveyed were asked to comment on the challenges of recent clinical interactions, on analysis three overarching themes emerged; best interests of the child, inadequate training and confidence and co-ordinating care. Conclusion This survey highlights the learning needs of paediatricians and will inform the development of meaningful education sessions for doctors.
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Affiliation(s)
- L Whitla
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - M Devins
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
- Palliative Medicine, Coombe Women and Infant's University Hospital, Dublin, Ireland
| | - E J Molloy
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
- Discipline of Paediatrics and Child Health, the University of Dublin Trinity College, Ireland
- Department of Neonatology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - M Twomey
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - M O'Reilly
- Department of Paediatric Palliative Care, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - J Balfe
- Department of Neurodisability and Developmental Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
- Discipline of Paediatrics and Child Health, the University of Dublin Trinity College, Ireland
- LauraLynn Children's Hospice, Dublin, Ireland
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Beeley LJ, Winfield S, Adams D. Making the most of a palliative care experience. BMJ 2020; 368:l6893. [PMID: 32047027 DOI: 10.1136/bmj.l6893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yeow ME, Chen E. Ventilator Withdrawal in Anticipation of Death: The Simulation Lab as an Educational Tool in Palliative Medicine. J Pain Symptom Manage 2020; 59:165-171. [PMID: 31610274 DOI: 10.1016/j.jpainsymman.2019.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022]
Abstract
Simulation is a growing model of education in many medical disciplines. Withdrawal of mechanical ventilation is an important skill set for palliative medicine practitioners who must be facile with a variety of end-of-life scenarios and is well suited to the simulation laboratory. We describe a novel approach using high-fidelity simulation to design a curriculum to teach Hospice & Palliative Medicine fellows the practical aspects of managing a compassionate terminal extubation. This simulation session aims to equip palliative fellows with a knowledge base of respiratory physiology and mechanical ventilation as well as the practical experience of performing a terminal extubation. We designed a three-hour simulation session which includes a one-hour didactic followed by two hours of simulation, with four cases that focus on different teaching points regarding symptom management and practical aspects of removing the endotracheal tube. The session was designed as an annual session for Hospice & Palliative Medicine fellows in our region during a collaborative educational conference. Based on feedback, the session is scheduled for the beginning of the academic year and each fellow is given the opportunity to physically remove the endotracheal tube. Simulation can be effectively used to teach practical and complex bedside skills such as withdrawal of mechanical ventilation to palliative medicine trainees. This method of teaching could be expanded to teach other advanced hospice and palliative care skills.
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Affiliation(s)
- Mei-Ean Yeow
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Elaine Chen
- Division of Pulmonary & Critical Care Medicine and Section of Palliative Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Andersen S, Stentoft D, Emmersen J, Rasmussen S, Birkelund S, Nøhr S. Contention over undergraduate medical curriculum content. Int J Med Educ 2019; 10:230-231. [PMID: 31859263 PMCID: PMC7246117 DOI: 10.5116/ijme.5de7.7516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Stig Andersen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Denmark
| | - Diana Stentoft
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | | | - Sten Rasmussen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Denmark
| | - Svend Birkelund
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Susanne Nøhr
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Denmark
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Alt-Epping B, Scherg A. Decision-making towards the end of life - in which way does clinical and ethical reasoning enter QB 13 in palliative medicine? GMS J Med Educ 2019; 36:Doc82. [PMID: 31844654 PMCID: PMC6905365 DOI: 10.3205/zma001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/20/2018] [Accepted: 11/23/2018] [Indexed: 06/10/2023]
Affiliation(s)
- Bernd Alt-Epping
- Universitätsmedizin Göttingen, Klinik für Palliativmedizin, Göttingen, Germany
- Deutsche Gesellschaft für Palliativmedizin, AG Bildung, Berlin, Germany
| | - Alexandra Scherg
- Deutsche Gesellschaft für Palliativmedizin, AG Bildung, Berlin, Germany
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Langworthy K. A Junior Doctor's Perspective on Oncology and Palliative Medicine Education in Western Australia: Comparison Between Graduation and Completion of Internship. J Cancer Educ 2019; 34:1038-1041. [PMID: 30706325 DOI: 10.1007/s13187-019-1479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer is a leading cause of death in Australia and is also the leading cause of disease burden as survivorship continues to improve. Given the prevalence of oncology patients in the community, it is likely to be a condition encountered by every junior doctor. Despite this oncology and in conjunction with that, palliative care has not been a core component of medical curriculum until recently. This means that the junior doctor experience is often complicated by lack of knowledge, poor understanding of the disease process, treatment options and complications and therefore makes managing these patients complicated and often an uncessarily stressful process. This reflective article explores current issues in cancer education, a reflection and comparison between pre- and post-internship experience and offers some potential solutions to these issues.
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Affiliation(s)
- Kristyn Langworthy
- Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia.
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Abstract
Objective The early integration of palliative care into standard cancer treatment has become a global standard. The Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) has been conducted in Japan, and previous studies have reported that the PEACE workshop was able to improve various palliative care skills of participants. However, whether or not the effects of the program are long-lasting and if the program consequently changed physicians' practice with regard to lung cancer patients have been unclear. Methods Web-based surveys, including the palliative care knowledge test (PEACE-Q), the Palliative Care self-reported Practice Scale (PCPS), and the Palliative Care Difficulties Scale (PCDS), were conducted among lung cancer physicians in Japan. The differences in the survey results between participants and non-participants of the PEACE workshop were examined. Results Among 923 respondents (455 respiratory physicians, 345 pulmonary surgeons, and 123 others), 519 had participated in the PEACE workshop. The total PEACE-Q score was significantly higher in the PEACE workshop participants than in non-participants (28.0 versus 24.5, p<0.0001). The score was significantly higher in respiratory physicians than in pulmonary surgeons (27.4 versus 25.5). The total PCPS and PCDS scores were also significantly better in workshop participants than in non-participants (71.8 versus 67.1 and 34.3 versus 36.9, respectively), although some domains of PCDS were similar between the groups. Conclusion The PEACE program improved the knowledge and practices with regard to palliative care and resolved difficulties associated therewith among lung cancer physicians. In regions where palliative care specialists are insufficient, such educational programs may be effective.
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Affiliation(s)
- Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Japan
| | - Keiko Tanaka
- Department of Palliative Care, Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, Yamaguchi-Ube Medical Center, Japan
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Internal Medicine, Jichi Medical University, Japan
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Gustin JL, Yang HB, Radwany SM, Okon TR, Morrison LJ, Levine SK, Hwang JM, Buckholz GT, Barnett MD, Verbeck N, Landzaat LH. Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S. J Pain Symptom Manage 2019; 57:1009-1017.e6. [PMID: 30790721 DOI: 10.1016/j.jpainsymman.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education. OBJECTIVES The objective of this study was to develop and vet CMs for HPM fellowships in the U.S. METHODS A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings. CONCLUSION A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.
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Affiliation(s)
- Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, Hospice and Palliative Medicine Fellowship Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Holly B Yang
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship Program, Scripps Health, San Diego, California, USA
| | - Steven M Radwany
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tomasz R Okon
- Marshfield Clinic Palliative Medicine Fellowship, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Laura J Morrison
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stacie K Levine
- Palliative Medicine Programs, University of Chicago, Chicago, Illinois, USA
| | - Jennifer M Hwang
- Pediatric Advanced Care Team and Hospice and Palliative Medicine Fellowship, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | | | - Nicole Verbeck
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Krishna L, Toh YP, Mason S, Kanesvaran R. Mentoring stages: A study of undergraduate mentoring in palliative medicine in Singapore. PLoS One 2019; 14:e0214643. [PMID: 31017941 PMCID: PMC6481808 DOI: 10.1371/journal.pone.0214643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mentoring nurtures a mentee's personal and professional development. Yet conflation of mentoring approaches and a failure to contend with mentoring's nature makes it difficult to study mentoring processes and relationships. This study aims to understand of mentee experiences in the Palliative Medicine Initiative (PMI). The PMI uses a consistent mentoring approach amongst a homogeneous mentee population offers a unique opportunity to circumnavigate conflation of practices and the limitations posed by mentoring's nature. The data will advance understanding of mentoring processes. METHODS Sixteen mentees discussed their PMI experiences in individual face-to-face audio-recorded interviews. The two themes identified from thematic analysis of interview transcripts were the stages of mentoring and communication. RESULTS The 6 stages of mentoring are the 'pre-mentoring stage', 'initial research meetings', 'data gathering', 'review of initial findings, 'manuscript preparation" and 'reflections'. These subthemes sketch the progression of mentees from being dependent on the mentor for support and guidance, to an independent learner with capacity and willingness to mentor others. Each subtheme is described as stages in the mentoring process (mentoring stages) given their association with a specific phase of the research process. Mentoring processes also pivot on effective communication which are influenced by the mentor's characteristics and the nature of mentoring interactions. CONCLUSION Mentoring relationships evolve in stages to ensure particular competencies are met before mentees progress to the next part of their mentoring process. Progress is dependent upon effective communication and support from the mentor and appropriate and timely adaptations to the mentoring approach to meet the mentee's needs and goals. Adaptations to the mentoring structure are informed by effective and holistic evaluation of the mentoring process and the mentor's and mentee's abilities, goals and situations. These findings underline the need to review and redesign the way assessments of the mentoring process are constructed and how mentoring programs are structured.
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Affiliation(s)
- Lalit Krishna
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- Duke- NUS Medical School, Singapore, Singapore
| | - Ying Pin Toh
- National University Hospital Singapore, Department of Family Medicine, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Affiliation(s)
- Zachary S Sager
- New England Geriatric Research, Education, and Clinical Center, Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts
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Carey EC, Paniagua M, Morrison LJ, Levine SK, Klick JC, Buckholz GT, Rotella J, Bruno J, Liao S, Arnold RM. Palliative Care Competencies and Readiness for Independent Practice: A Report on the American Academy of Hospice and Palliative Medicine Review of the U.S. Medical Licensing Step Examinations. J Pain Symptom Manage 2018; 56:371-378. [PMID: 29935969 DOI: 10.1016/j.jpainsymman.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT It is unknown whether the palliative care (PC) content tested in the U.S. Medical Licensing Examination (USMLE) step examinations reflects the consensus-developed PC competencies. OBJECTIVES To review the USMLE step examinations to determine whether they test the PC knowledge necessary for graduating medical students and residents applying for licensure. METHODS Eight PC physicians reviewed three complete examination forms and a focused 509-item bundle of multiple-choice questions (MCQs) identified by the USMLE content outline as potentially assessing PC content. Reviewers determined MCQs to be PC items if the patient was seriously ill and PC knowledge was required to answer correctly. PC items' competency domains were determined using reference domains from PC subspecialty consensus competencies. RESULTS Reviewers analyzed 1090 MCQs and identified 242 (22%) as PC items. PC items were identified in each step examination. Patients in PC items were mostly males (62.8%), older than 65 years (62%), and diagnosed with cancer (43.6%). Only 6.6% and 6.2%, respectively, had end-stage heart disease or multimorbid illness. Fifty-one percent of PC items addressed ethics (31%) or communication (19.8%), focusing on patient autonomy, surrogate decision makers, or conflict between decision makers. Pain and symptom management was assessed in 28.5% of PC items, and one-third of those addressed addiction or substance use disorder. CONCLUSION We identified PC content in each step examination. However, heart disease and multimorbidity were under-represented in PC items relative to their prevalence. In addition, there was heavy overlap with ethics, a focus on conflict in assessing communication skills, and emphasis on addiction when testing pain management. Our findings highlight opportunities to enhance testing of clinical PC skills essential for all licensed physicians practicing medicine.
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Affiliation(s)
- Elise C Carey
- Center for Palliative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
| | - Miguel Paniagua
- Test Materials and Development, National Board of Medical Examiners, Philadelphia, Pennsylvania, USA; Palliative Care Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura J Morrison
- Department of Medicine, Yale Palliative Care Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stacie K Levine
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeffrey C Klick
- Pediatric Palliative Care Program, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Gary T Buckholz
- Doris Howell Palliative Care Service, University of California, San Diego, California, USA
| | - Joseph Rotella
- American Academy of Hospice and Palliative Medicine, Chicago, Illinois, USA
| | - Julie Bruno
- American Academy of Hospice and Palliative Medicine, Chicago, Illinois, USA
| | - Solomon Liao
- Department of Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Robert M Arnold
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Abstract
BACKGROUND Making particular use of Shale's analysis, this paper discusses the notion of leadership in the context of palliative medicine. Whilst offering a critical perspective, I build on the philosophy of palliative care offered by Randall and Downie and suggest that the normative structure of this medical speciality has certain distinctive features, particularly when compared to that of medicine more generally. I discuss this in terms of palliative medicine's distinctive morality or ethos, albeit one that should still be seen in terms of medical morality or the ethos of medicine. MAIN TEXT I argue that, in the context of multi-disciplinary teamwork, the particular ethos of palliative medicine means that healthcare professionals who work within this speciality are presented with distinct opportunities for leadership and the dissemination of the moral and ethical norms that guide their practice. I expand on the nature of this opportunity by further engaging with Shale's work on leadership in medicine, and by more fully articulating the notion of moral ethos in medicine and its relation to the more formal notion of medical ethics. Finally, and with reference to the idea of medical education as both on going and as an apprenticeship, I suggest that moral and ethical leadership in palliative medicine may have an inherently educational quality and a distinctively pedagogical dimension. CONCLUSIONS The nature of palliative medicine is such that it often involves caring for patients who are still receiving treatment from other specialists. Whilst this can create tension, it also provides an opportunity for palliative care professionals to disseminate the philosophy that underpins their practice, and to offer leadership with regard to the moral and ethical challenges that arise in the context of End of Life Care.
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Affiliation(s)
- Nathan Emmerich
- Visiting Research Fellow, School of History, Anthropology, Politics and Philosophy, Queen's University Belfast, Belfast, UK.
- Endcare Research Fellow, Institute of Ethics, Dublin City University, Dublin, Ireland.
- The Medical School, Australian National University, Canberra, Australia.
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Akthar AS, Hellekson CD, Ganai S, Hahn OM, Maggiore RJ, Cohen EE, Posner MC, Chmura SJ, Howard AR, Golden DW. Interdisciplinary Oncology Education: a National Survey of Trainees and Program Directors in the United States. J Cancer Educ 2018; 33:622-626. [PMID: 27873183 DOI: 10.1007/s13187-016-1139-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Oncologists must have a strong understanding of collaborating specialties in order to deliver optimal cancer care. The objective of this study was to quantify current interdisciplinary oncology education among oncology training programs across the USA, identify effective teaching modalities, and assess communication skills training. Web-based surveys were sent to oncology trainees and program directors (PDs) across the USA on April 1, 2013 and October 8, 2013, respectively. Question responses were Yes/No, five-point Likert scales (1 = not at all, 2 = somewhat, 3 = moderately, 4 = quite, 5 = extremely), or free response. Respondents included the following (trainees/PDs): 254/55 medical oncology, 160/42 surgical oncology, 102/24 radiation oncology, and 41/20 hospice and palliative medicine (HPM). Trainees consistently reported lower rates of interdisciplinary education for each specialty compared with PDs as follows: medical oncology 57 vs. 77% (p < 0.01), surgical oncology 30 vs. 44% (p < 0.01), radiation oncology 70 vs. 89% (p < 0.01), geriatric oncology 19 vs. 30% (p < 0.01), and HPM 55 vs. 74% (p < 0.01). The predominant teaching method used (lectures vs. rotations vs. tumor board attendance vs. workshop vs. other) varied according to which discipline was being taught. The usefulness of each teaching method was rated statistically different by trainees for learning about select disciplines. Furthermore, statistically significant differences were found between PDs and trainees for the perceived usefulness of several teaching modalities. This study highlights a deficiency of interdisciplinary education among oncology training programs in the USA. Efforts to increase interdisciplinary education opportunities during training may ultimately translate into improved collaboration and quality of cancer care.
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Affiliation(s)
- Adil S Akthar
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Christopher D Hellekson
- University of North Dakota School of Medicine, 1301 N Columbia Rd, Grand Forks, ND, 58203, USA
| | - Sabha Ganai
- Department of Surgery, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA
| | - Olwen M Hahn
- Section of Hematology/Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Ronald J Maggiore
- Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Ezra E Cohen
- University of California at San Diego Moores Cancer Center, 3855 Health Sciences Dr., La Jolla, CA, 92093, USA
| | - Mitchell C Posner
- Department of Surgery, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Andrew R Howard
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, 5758 South Maryland Avenue MC 9006, Chicago, IL, 60637, USA.
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Lupu D, Quigley L, Mehfoud N, Salsberg ES. The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up? J Pain Symptom Manage 2018; 55:1216-1223. [PMID: 29410071 DOI: 10.1016/j.jpainsymman.2018.01.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/30/2022]
Abstract
CONTEXT The need for hospice and palliative care is growing rapidly as the population increases and ages and as both hospice and palliative care become more accepted. Hospice and palliative medicine (HPM) is a relatively new physician specialty, currently training 325 new fellows annually. Given the time needed to increase the supply of specialty-trained physicians, it is important to assess future needs to guide planning for future training capacity. OBJECTIVES We modeled the need for and supply of specialist HPM physicians through the year 2040 to determine whether training capacity should continue growing. METHODS To create a benchmark for need, we used a population-based approach to look at the current geographic distribution of the HPM physician supply. To model future supply, we calculated the annual change in current supply by adding newly trained physicians and subtracting physicians leaving the labor force. RESULTS The current U.S. supply of HPM specialists is 13.35 per 100,000 adults 65 and older. This ratio varies greatly across the country. Using alternate assumptions for future supply and demand, we project that need in 2040 will range from 10,640 to almost 24,000 HPM specialist physicians. Supply will range from 8100 to 19,000. CONCLUSION Current training capacity is insufficient to keep up with population growth and demand for services. HPM fellowships would need to grow from the current 325 graduates annually to between 500 and 600 per year by 2030 to assure sufficient physician workforce for hospice and palliative care services given current service provision patterns.
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Affiliation(s)
- Dale Lupu
- Center for Aging, Health & Humanities, George Washington University School of Nursing, Washington, District of Columbia, USA.
| | - Leo Quigley
- George Washington University School of Nursing & Health Workforce Institute, Washington, District of Columbia, USA
| | - Nicholas Mehfoud
- George Washington University School of Nursing & Health Workforce Institute, Washington, District of Columbia, USA
| | - Edward S Salsberg
- George Washington University School of Nursing & Health Workforce Institute, Washington, District of Columbia, USA
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Affiliation(s)
- Leah B Rosenberg
- Division of Geriatrics and Palliative Care, Massachusetts General Hospital, Boston, Massachusetts
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Landzaat LH, Barnett MD, Buckholz GT, Gustin JL, Hwang JM, Levine SK, Okon TR, Radwany SM, Yang HB, Encandela J, Morrison LJ. Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States. J Pain Symptom Manage 2017; 54:609-616.e1. [PMID: 28729009 DOI: 10.1016/j.jpainsymman.2017.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
CONTEXT Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be "entrusted" to practice without supervision. A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define Hospice and Palliative Medicine (HPM) EPAs. OBJECTIVE The objective of this study was to describe the development of a set of consensus EPAs for HPM fellowship training in the United States. METHODS A set of HPM EPAs was developed through an iterative consensus process involving an expert workgroup, vetting at a national meeting with HPM educators, and an electronic survey from a national registry of 3550 HPM physicians. Vetting feedback was reviewed, and survey data were statistically analyzed. Final EPA revisions followed from the multisource feedback. RESULTS Through the iterative consensus process, a set of 17 HPM EPAs was created, detailed, and revised. In the national survey, 362 HPM specialists responded (10%), including 58 of 126 fellowship program directors (46%). Respondents indicated that the set of 17 EPAs well represented the core activities of HPM physician practice (mean 4.72 on a five-point Likert scale) and considered all EPAs to either be "essential" or "important" with none of the EPAs ranking "neither essential, nor important." CONCLUSIONS A set of 17 EPAs was developed using national input of practicing physicians and program directors and an iterative expert workgroup consensus process. The workgroup anticipates that EPAs can assist fellowship directors with strengthening competency-based training curricula.
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Affiliation(s)
- Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | | | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | - Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer M Hwang
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Steven M Radwany
- Summa Health and Northeast Ohio Medical University, Akron, Ohio, USA
| | - Holly B Yang
- University of California San Diego/Scripps Health, Scripps Health San Diego, California, USA
| | - John Encandela
- Teaching and Learning Center Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Abstract
Palliative care, an important interdisciplinary care modality, is not just for the terminally ill. The Institute of Medicine calls the improvement of end-of-life care a national priority. Developing a culture of ongoing integration of topics such as palliative care into a patient-focused care curriculum would be a lasting and important contribution from professional development educators. J Contin Educ Nurs. 2016;47(11):487-489.
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Prazak KA. Introduction of Virtual Patient Software to Enhance Physician Assistant Student Knowledge in Palliative Medicine. J Allied Health 2017; 46:e71-e76. [PMID: 29202167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this project was to infuse palliative medicine and end-of-life care creatively into physician assistant (PA) education. METHODS Nine second-year PA students volunteered to participate in this quasi-experimental, pretest-posttest pilot study. Students initially completed an anonymous survey evaluating seven domains of knowledge in palliative medicine coupled with a self-assessment in competence. Virtual patient software was then used to simulate clinical encounters that addressed major palliative care domains. Upon completion of these cases, the same survey, with the addition of three questions about their own personal feelings, was administered. RESULTS Overall response was positive in regard to improved knowledge and the virtual patient experience. After completion of the cases, students rated their self-assessed skills higher in all domains than prior to completing the cases. Factual knowledge scores showed a slight but not significant improvement, with an average pre-survey score of 4.56 and post-survey score of 4.67. DISCUSSION Using virtual patient software can be a way of infusing palliative medicine and end-of-life care into PA education. These encounters can then be modified to include interprofessional encounters within the health professions.
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Affiliation(s)
- Kristine A Prazak
- Physician Assistant Studies, New York Institute of Technology, Northern Boulevard, Riland Building, Suite 352, Old Westbury, NY 11568, USA. Tel 516-686-4019.
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Axelsson B, Sallerfors B, Furst CJ. [Place of residence determines the palliative care resources and quality. Efforts to increase the competence are needed]. Lakartidningen 2016; 113:D4FM. [PMID: 27898141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Access to palliative care is unequally distributed across Sweden and thus does not meet the needs. The holistic perspective of palliative care is sometimes contrasted with the usual medical focus on organ failure and disease. Palliative consultation teams provide specialist palliative care competencies for staff caring for patients in primary care, nursing homes and in hospitals. Efforts to increase knowledge and skills in palliative care is needed at undergraduate university level and through postgraduate and specialist training. Well organized cooperation between municipalities, county councils and primary care is crucial for patients in the final stages of life.
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Affiliation(s)
- Bertil Axelsson
- Storsjögläntans palliativa enhet - Kirurgkliniken Östersund, Sweden Storsjögläntans palliativa enhet - Kirurgkliniken Östersund, Sweden
| | - Bengt Sallerfors
- Palliativt Utvecklingscentrum vid Region Skåne och Lunds Universitet - Lund, Sweden Palliativt Utvecklingscentrum - Lund, Sweden
| | - Carl Johan Furst
- Palliativt Utvecklingscentrum - Lund, Sweden Palliativt Utvecklingscentrum - Lund, Sweden
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Sizova ZM, Nevzorova DV, Beloborodova AV, Abuzarova GR, Sonkina AA, Tyazhelnikov AA, Zakharova VL. [ACTUAL QUESTIONS OF TEACHING PALLIATIVE CARE IN A SYSTEM OF FURTHER PROFESSIONAL EDUCATION.]. Anesteziol Reanimatol 2016; 61:260-263. [PMID: 29470891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In response to the introduction ofpalliative care as a new kind of medical care in Russian Federation (Federal law No.323 from 21.11.2011), Russian Federation Health Ministry has taskedfurther educational institutions with teaching doctors about this new kind of care. I.M Sechenov First Moscow State Medical University has answered this plea in 2015 by introducing a new course focused on palliative care. The program of education was prepared in accordance with rec- ommendations of World Health Organization (WHO) and European Association for Palliative Care (EAPC). A special attention was paid to the pain relief communication skills and organization ofpalliative care for adults in ambulatory and stationary treatment. The program integrates different teaching methods including eLearning, trainings on pain relief and practical trainings on communication skills for interaction with palliative patients and their relatives using the technology of <<standardized patient>>.
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DiBiasio E. Palliative and End-of-Life Care Education Among Alpert Medical School Students. R I Med J (2013) 2016; 99:20-25. [PMID: 27035135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Doctors in almost every branch of medicine encounter patients who are dying or have serious illnesses. Numerous studies, however, indicate that the education of physicians does not adequately prepare them for such patients. We aimed to characterize the current training of Alpert Medical School (AMS) students on palliative and end-of-life care using a cross-sectional, web-administered survey. We discovered less than half of Alpert Medical School students have worked with dying patients, and almost a quarter of graduating medical students did not feel prepared to palliate common symptoms including pain, nausea, shortness of breath, and anxiety. We also found that exposure to dying individuals was significantly associated with many symptom management skills and more favorable attitudes toward palliative medicine. We therefore recommend that palliative care skills, which are relevant to all future physicians regardless of specialty, be incorporated throughout the AMS curriculum, and that more students be exposed to patients at end-of-life.
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Arnold BL, Lloyd LS, von Gunten CF. Physicians' Reflections on Death and Dying on Completion of a Palliative Medicine Fellowship. J Pain Symptom Manage 2016; 51:633-9. [PMID: 26433134 DOI: 10.1016/j.jpainsymman.2015.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 08/05/2015] [Accepted: 09/15/2015] [Indexed: 11/20/2022]
Abstract
CONTEXT Patient and family dissatisfaction may result when they are not satisfied with the physician/patient interaction, although the physician may feel he/she worked hard to provide information to the patient and family. New approaches to visual analysis can (1) identify significant insights from physicians' personal and clinical experiences in providing compassionate palliative care and end-of-life care and (2) provide an effective and practical vehicle for communicating with patients, their families, and other professional caregivers. OBJECTIVES To elucidate palliative physicians' core experiences with their patients' dying and death. METHODS A qualitative visual analysis was conducted on 75 images created by physicians completing a one year palliative medicine fellowship. These images are part of a larger personal reflections narratives database of images, text, and auditory projects prepared by students, interns, and fellows completing training in palliative care at a large hospice provider. Participation in the personal reflections project is a required part of the training program, with the goal of blending clinical competencies with lived experiences of caring for the dying. RESULTS Two categories of visual metaphors underlying the images were identified, with both expressing the relationship and transitional dynamics of life and death: portraits (n = 30, 40%) and nature (n = 45, 60%). Conventional images representing anxiety, pain, or other dimensions of suffering commonly associated with death and dying were virtually absent (n = 2, 0.03%). CONCLUSION We propose the communication of positive, hopeful, even peaceful perceptions of death and dying was likely the result of effective personal and professional skills gained through physicians' clinical experiences during the fellowship.
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Affiliation(s)
| | - Linda S Lloyd
- Public Health Consultant, San Diego, California, USA
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Affiliation(s)
- Daniel Shalev
- Department of Psychiatry, New York Presbyterian-Columbia University; and New York State Psychiatric Institute, New York, New York
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49
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Decker D. Early adopter. Minn Med 2016; 99:22-23. [PMID: 26897891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Bell H. Misunderstood specialty. Minn Med 2016; 99:10-17. [PMID: 26897888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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