Palliative Care Initiative Palliative Care Student Rotations: Curriculum Overview.
Transforming health care globally… through palliative care
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Transcript of Transforming health care globally… through palliative care
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Transforming health care globally… through palliative care
www.PalliativeMed.org www.IPCRC.net
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Challenges in Teaching Palliative Medicine
Frank D. Ferris, MD, FAAHPM, FAACEInstitute for Palliative Medicine
at San Diego HospiceUniversity of California San Diego
University of Toronto
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Objective…A Road Map
to Build Palliative Care Capacity
in Sweden through education…
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Call to Action…
Train ALL healthcare professionals
to provide palliative care…
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Dixon 6: Goals of Education & Implementation
1. Awareness / Attitudes2. Knowledge3. Skills4. BehaviorChange Experience5. Patient / Family6. Organization / Society
Increase palliative care capacityDixon J. Evaluation and the Health Professions, 1978Ferris et al. Knowledge Insufficient for Change, 2001
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How will you teach…?
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How People Learn• Memory:
Short intermediate long-term• 3 major facts / hour• Information retention per unit time
10 minutes new information2 minutes rest to process it
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Principles of Learning in Healthcare
• Practical• Participatory
• Multiple demands
Hank Slotnick, PhD, North Dakota
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Reading / OnlineRetention ?
1. Awareness / Attitudes
2. Knowledge3. Skills4. Behavior
Change Experience5. Patient / Family6. Organization/Society
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LecturesRetention ?
1. Awareness / Attitudes
Lectures 10 %2. Knowledge
3. Skills
4. BehaviorChange Experience
5. Patient / Family6. Organization/Society
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Group LearningRetention ?
1. Awareness / Attitudes
Lectures 10 %2. Knowledge
Small-group Cases 25 %3. Skills
Role-play 35 %4. Behavior
Change Experience5. Patient / Family6. Organization/Society
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Effective presentations‘ theater ’
• MovementBodyHands
• VoiceToneVolumeSpeed
• Eye contact• Minimize distractions
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Who will you teach…?
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1° Basic Skills
All HealthcareProfessionals
1°Advanced Skills
Cariology,Geriatrics,Oncology,
Etc.
2°Expert skills
Palliative CareConsultants /
Teams
3°Academic
Palliative Care
Palliative Care Skills...
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Community
VolunteerSpiritual counselor
Nurse
Bereavementcounselor
Physicaltherapist
Pharmacist
Physician Psychologist
Socialworker
Family
PATIENT
Interdisciplinary Care
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What will you teach…?
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PC Skills...
1° Basic Skills
All HealthcareProfessionals
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‘ Buzz ’ Groups• 1 – 2 • 1 – 2
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General Doctors ?
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1999
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EPEC 1999• National consensus of 280 ethics,
hospice, palliative care expertsLinda Emanuel, Principal
Aim: To teach all physicians and other members of the interdisciplinary
team the core skills of palliative care
Not intended to make every clinician a palliative care expert
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EPEC 1999
• 4 plenary sessions• 12 modules• Open, train-the-trainer model• Widely accepted• Standard of practice ‘ inside ’
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First 15 Months in the USARobinson K, Sutton S, von Gunten CF
et al, J of Palliative Medicine 2004
• Sample 200 of first 585 trainers touched• 120,000 professionals in 15 months• Estimated patients & families affected
Per Clinician Per Clinician 585 CliniciansPatients / Day Patients / Year Patients / Year
10 2.4 K 1.4 M100 24 K 14 M
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US Palliative Medicine Specialists
• > 3.000 certified specialists• 80 % started training with EPEC
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End-of-LifeNursing
Education Consortium
Curriculum…
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Nurses ?
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ELNEC – Nursing Curricula, 2002
Oncology Version:
OpenAdaptable
Reproducible
Google:ELNEC
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Palliative Care Skills...
1°Advanced Skills
Cariology,Geriatrics,Oncology,
Etc.
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Doctors seeing Advance Illnesses ?
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The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
Education in Palliative and End-of-life Care - Oncology
The
ProjectEPEC-OTM
2007
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EPEC-O 2007
• National consensus of > 80 oncology experts
Aim: To teach all oncologists and other members of the
interdisciplinary cancer care team the advanced skills of palliative care
Not intended to make every oncologista palliative care expert
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Multiple Issues that Cause Suffering
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Core Skills for Providing Palliative Care
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EPEC-O 2007
• 32 modules - 3 plenaries, 2 how to teachSyllabus, slides
Open, adaptableVideo vignettesTeaching strategiesAnnotated bibliographyHyperlinks to references online
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2007 • Free CD / DVD• American Society
of Clinical Oncology ( ASCO ) provides education credits
• Online modules• Translations
SpanishUkrainian
• www.IPCRC.net
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IPM Interdisciplinary
Curriculum
Will you translate any of these curricula ?
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A multi-yeareducation strategy to build palliative care
capacity...
www.PalliativeMed.org www.IPCRC.net
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Time ( yr ) 3 5 7 9 11
Sensitization
Courses ( Basic & Advanced )
Visiting Scholars ( Expert Identification )
Fellowships ( Experts )
Leadership ( Leaders )
Scholars in Residence ( Education & Research )
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Nursing & Medical Trainees
Nursing students
• 9 schoolsUCSD Medical
studentsResidents
• Family practice
• Internal medicine
• Psychiatry
Experiential ‘ bedside training ’
• Observational visits• Structured program• Electives
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PC in Curricula / Exams• In US Boards• In several specialty exams
10 % of Medical Oncology Exam
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Physicians Practicingin San Diego
• 10 % trained at UCSD School of Medicine
• 33 % did their medical residency in San Diego
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Practicing Clinicians• Continuing education – optional or
compulsory ?• In California
To get a new license, since 2002, obligatory to demonstrate training in palliative / end-of-life care
To renew license in 2006, 12 hours education in pain & palliative care ( AB 487 )
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Conference Presentations• Oncology• Cardiology• Geriatrics• Elder Care• Nephrology
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Many Domestic & International Partners
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In-Country Courses 3-5 day, 2 & 3 week
2004 – Jordan 322005 – Jordan 722006 – Mongolia 752007 – Jordan 50
Georgia 50 Mexico 75
2008 – Georgia – 75 Vietnam 75 Saudi Arabia 150
2009 – Ukraine 95 Egypt 105 Slovenia 50
2010 – Ukraine 36 Salzburg 40 MECC 50
2011 – Georgia 75 Vietnam 100 Cyprus 55 Turkey 52
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First dose of oral morphine – Al Basheer Hospital
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1-week Classroom vs. 3-weeks Bedside Training
2 Open Society Institute ( OSI ) Courses, Salzburg
• 1 week ( 5 days )• Classroom
Interactive didactic
2 Jordan Courses, Amman, Jordan
• 3 weeks ( 15 days )• 1 week classroom
Interactive didactic• 2 weeks bedside
training
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P < 0.001
P < 0.001
P < 0.001
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Day 1 After Course
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Day 1 After Course
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Jordanian Physician…
“During the first week [ in the classroom ] I felt that I will not benefit… and it will not do any change in my practice.
BUT, after starting practical session a huge and unexpected change happened… I will do every efforts I have to practice this knowledge in my real life.”
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1st International Palliative Medicine Physician