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Teaching palliative medicine

Dmitry Kozhevnikov, Laura J Morrison, Matthew S Ellman
Background: The growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap. This paper describes the current state of SBME in training of PC skills...
2018: Advances in Medical Education and Practice
Nicola White, Priscilla Harries, Adam Jl Harris, Victoria Vickerstaff, Philip Lodge, Catherine McGowan, Ollie Minton, Christopher Tomlinson, Adrian Tookman, Fiona Reid, Patrick Stone
OBJECTIVES: To identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions. DESIGN: Prospective observational study and two cross-sectional online studies. SETTING: Phase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes...
November 25, 2018: BMJ Open
Poi Choo Hwee, Khoo Hwee Sing, Mervyn Koh Yong Hwang, Allyn Hum Yin Mei
OBJECTIVES: Junior doctors learn from the formal and informal curriculum. In a palliative care rotation, the informal curriculum may be useful in teaching attitudes like empathy and compassion. Our study aims to explore how the informal curriculum augments the formal curriculum of a palliative care rotation in shaping the professional development of a doctor. METHODS: We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents) who spent at least 2 months in a palliative care setting in a tertiary hospital or an inpatient hospice...
November 12, 2018: BMJ Supportive & Palliative Care
Maria Kolind Brask-Thomsen, Bodil Abild Jespersen, Mogens Grønvold, Per Sjøgren, Mette Asbjoern Neergaard
INTRODUCTION: Denmark has been ranked low regarding the extent of teaching in palliative care (PC) at medical schools although the Danish Health Authority recommends that all doctors have basic knowledge of PC. The aim of this study was to investigate the contents of and time spent on teaching in PC at the four Danish medical schools and to compare results with recommendations from the European Association of Palliative Care (EAPC). METHODS: Data were collected by examining university curricula, course catalogues, etc...
October 2018: Danish Medical Journal
Carlos Centeno, Thomas Sitte, Liliana de Lima, Sami Alsirafy, Eduardo Bruera, Mary Callaway, Kathleen Foley, Emmanuel Luyirika, Daniela Mosoiu, Katherine Pettus, Christina Puchalski, M R Rajagopal, Julianna Yong, Eduardo Garralda, John Y Rhee, Nunziata Comoretto
BACKGROUND: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC ("PAL-LIFE group"). DESIGN: Thirteen experts in PC advocacy participated in an online Delphi process...
October 2018: Journal of Palliative Medicine
Lowri Evans, Mark Taubert
OBJECTIVES: Both simulation and high-fidelity simulation involving manikins, clinical training suites, wards, computer programs and theatres have established themselves in medical undergraduate and postgraduate education. Popular among students, they have been shown to be effective learning tools. Contrasted with this is the potential risk to patients and their proxy associated with learning 'at the bedside', which can pose a real challenge in medical and palliative settings. The need for education and training methods that do not expose the patient to preventable communication blunders from less experienced practitioners is a priority...
September 25, 2018: BMJ Supportive & Palliative Care
R Voumard, E Rubli Truchard, L Benaroyo, G D Borasio, C Büla, R J Jox
In aging societies, the last phase of people's lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both specialties have to collaborate closely and geriatric palliative care (GPC) should be conceptualized as an interdisciplinary field of care and research based on the synergies of the two and an ethics of care.Major challenges characterizing the emerging field of GPC concern (1) the development of methodologically creative and ethically sound research to promote evidence-based care and teaching; (2) the promotion of responsible care and treatment decision making in the face of multiple complicating factors related to decisional capacity, communication and behavioural problems, extended disease trajectories and complex social contexts; (3) the implementation of coordinated, continuous care despite the increasing fragmentation, sectorization and specialization in health care...
September 20, 2018: BMC Geriatrics
Antonio Noguera, Deborah Bolognesi, Eduardo Garralda, Monica Beccaro, Aleksandra Kotlinska-Lemieszek, Carl Johan Furst, John Ellershaw, Frank Elsner, Agnes Csikos, Marilene Filbet, Guido Biasco, Carlos Centeno
BACKGROUND: In Europe in recent decades, university teaching of palliative medicine (PM) has evolved. In some countries it has been introduced as a compulsory subject in all medical schools, but in a majority of countries it remains an isolated subject at few universities. OBJECTIVE: To explore how PM has been introduced into the curricula and how it is currently being taught at different European universities. METHOD: Case study method using face-to-face semistructured interviews with experienced PM professors, comparing how they have developed PM undergraduate programs at their universities...
November 2018: Journal of Palliative Medicine
Constantin Shuster, Andrew Hurlburt, Terence Yung, Tony Wan, John A Staples, Penny Tam
BACKGROUND: Unplanned hospital readmissions are associated with increased patient mortality and health care costs, yet only a fraction are likely to be preventable. This study's objective was to identify preventable hospital readmissions of general internal medicine patients, and their common causes. METHODS: Patients who were discharged from the general internal medicine teaching service and readmitted to hospital within 28 days for 24 hours or more were recruited to the study; they were identified via the hospital electronic medical record system...
July 2018: Quality Management in Health Care
Omondi Michelle Atieno, Sylvia Opanga, Antony Martin, Amanj Kurdi, Brian Godman
BACKGROUND: Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare...
September 2018: Journal of Medical Economics
Rushad Patell, Alejandra Gutierrez, Natalie Lee, Kathleen Neuendorf
OBJECTIVE: To assess the impact of a 1-hour communication skills workshop highlighting the "ask more and summarize technique" (AMST) to teach residents an effective way to respond to emotionally charged questions. METHODS: From December 2015 to January 2017, residents on an inpatient oncology or palliative medicine rotation attended a mandatory 1-hour workshop on AMST involving a short introduction to the technique followed by skills practice. A survey (S1) was administered to the residents during the first session to assess their self-reported attitudes and practices...
October 2018: Journal of Palliative Care
Barbara A Head, Christian Davis Furman, Andrew M Lally, Kimberly Leake, Mark Pfeifer
BACKGROUND: Interprofessional Education (IPE) is an important component of medical education. Rotations with palliative care interdisciplinary teams (IDTs) provide an optimal environment for IPE and teaching teamwork skills. OBJECTIVE: Our objective was to assess the learning of senior medical students during a palliative care rotation. DESIGN: A constant comparison method based on grounded theory was used in this qualitative study. SETTING/SUBJECTS: Senior medical students completed a semi-structured reflective writing exercise after a required one-week palliative care clerkship...
May 2018: Journal of Palliative Medicine
Robert W Smith, Kerry Kuluski, Andrew P Costa, Samir K Sinha, Richard H Glazier, Alan Forster, Lianne Jeffs
OBJECTIVE: To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control...
December 12, 2017: BMJ Open
Zachary M Rossfeld, Dmitry Tumin, Lisa M Humphrey
OBJECTIVE: To describe our institutional experience with a four-week pediatric HPM elective rotation and its impact on residents' self-rated competencies. BACKGROUND: In the spirit of bolstering primary hospice and palliative medicine (HPM) skills of all pediatricians, it is unclear how best to teach pediatric HPM. An elective rotation during residency may serve this need. METHODS: An anonymous online survey was distributed to pediatric and internal medicine/pediatrics residents at a single, tertiary academic children's hospital...
February 2018: Journal of Palliative Medicine
Frank D Ferris, Shannon Y Moore, Mary V Callaway, Kathleen M Foley
The International Palliative Care Leadership Development Initiative (LDI) was a model demonstration project that aimed to expand the global network of palliative care leaders in low- and moderate-resource countries who are well positioned to apply their new leadership skills. Thirty-nine palliative medicine physicians from 25 countries successfully completed the two-year curriculum that included three thematic residential courses, mentorship, and site visits by senior global palliative care leaders and personal projects to apply their new leadership skills...
February 2018: Journal of Pain and Symptom Management
Alexandria Bear, Tucker Keuter, Jayshil J Patel
BACKGROUND: Providing accurate and valid prognostic information significantly influences end-of-life care. Disclosing a poor prognosis can be among the most difficult of physician responsibilities, thus having appropriate knowledge during training is crucial for appropriate prognostication. OBJECTIVE: To provide internal medicine (IM) house staff with a pre- and posteducational survey to determine their ability to accurately prognosticate 5 common end-stage diseases...
March 2018: American Journal of Hospice & Palliative Care
Juliet Jacobsen, Corinne Alexander Cole, Bethany-Rose Daubman, Debjani Banerji, Joseph A Greer, Karen O'Brien, Kathleen Doyle, Vicki A Jackson
BACKGROUND: We aim to address palliative care workforce shortages by teaching clinicians how to provide primary palliative care through peer coaching. INTERVENTION: We offered peer coaching to internal medicine residents and hospitalists (attendings, nurse practioners, and physician assistants). MEASURES: An audit of peer coaching encounters and coachee feedback to better understand the applicability of peer coaching in the inpatient setting to teach primary palliative care...
October 2017: Journal of Pain and Symptom Management
Emmanuel Tamchès, Lazare Benaroyo, Marc Antoine Bornet, Jean-Pierre Hornung, Gian Domenico Borasio
The optional course « Living facing death » is the result of an innovative educational approach jointly developed by CHUV's Palliative Care Service, Lausanne's School of Medicine, Medical Ethics Unit and the students' association « Doctors & Death ». It is intended for 3rd and 4th grade medical students and was inspired by previous experiences conducted at Harvard Medical School. Its primary objective is to help students to « take some distances ». A mixed quantitative/qualitative satisfaction questionnaire was administered to all participating students at the completion of the course...
May 24, 2017: Revue Médicale Suisse
Juho T Lehto, Kati Hakkarainen, Pirkko-Liisa Kellokumpu-Lehtinen, Tiina Saarto
BACKGROUND: Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. METHODS: We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations...
January 25, 2017: BMC Palliative Care
Stefan J Friedrichsdorf
Dr Stefan Friedrichsdorf speaks to Commissioning Editor Jade Parker: Stefan Friedrichsdorf, MD, is medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children's Hospitals and Clinics of Minnesota in Minneapolis/St Paul, MN, USA, home to one of the largest and most comprehensive programs of its kind in the country. The pain and palliative care program is devoted to control acute, chronic/complex and procedural pain for inpatients and outpatients in close collaboration with all pediatric subspecialties at Children's Minnesota...
May 2017: Pain Management
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