A curriculum in palliative care for internal medicine housestaff: A pilot project

Abstract

Despite dramatic growth in the number of hospice programs over the past 15 years, palliative care skills and principles receive minimal attention in medical schools and residency training programs. Northwestern University Medical School and Northwestern Memorial Hospital have developed a program in palliative care education for internal medicine housestaff. Residents, working with a multidisciplinary team of hospice staff, have primary responsibility for the care of terminally ill patients in the home. An inpatient unit is available for acute care when needed. A formal lecture series on symptom management, accompanied by a bibliography and defined learning objectives, provides a guide to the clinical experience. Participating residents also attend seminars focusing on physicians' coping skills and attitudes toward death and dying. Evaluation of the program in its first year shows a definite perception of educational benefit by residents, and enthusiasm for continued involvement in palliative care.

Educating Medical Residents in End-of-Life Care: Insights from a Multicenter Survey

“…Education during residency training has been characterized as inadequate to meet the needs of dying patients and their families. [5][6][7][8][9] Surveys and self-ratings of medical and surgical residents have highlighted perceived deficiencies in EOL care in postgraduate training, [10][11][12] especially that related to symptom control, [13][14][15] communication, [13][14][15] and confidence in dealing with dying patients and their families. 15 In the United States, this has led to several initiatives to improve EOL care training to internal medicine residents.…”

Evidence of improved knowledge and skills after an elective rotation in a hospice and palliative care program for internal medicine residents

“…Educational efforts in undergraduate, graduate, postgraduate, and continuing medical education have been initiated. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The roots of contemporary physician education in palliative care lie in the modern hospice movement begun by Dame Cicely Saunders in England. From her observations of the care of terminally ill cancer patients in both an acute care hospital as well as an inpatient hospice run by a religious community, she formulated the concepts that led her to establish the first modern academic hospice.…”

Can a pain management and palliative care curriculum improve the opioid prescribing practices of medical residents?

“…The current literature does not yet offer a systematic way to measure whether interventions are effective at improving physician practices and/or patient outcomes in pain management 3,14 . Studies have shown that pain management education programs can change self‐perceptions of knowledge, skill, and comfort/confidence, as well as objective knowledge, including knowledge about the appropriate use of opioids 18,20–22 . However, measuring changes in the physician's self‐perceived or objective knowledge may not accurately indicate whether the educational intervention has altered his or her behavior 23,24 …”