Professional Education
Education in palliative care is often tangential to curricula in medical, nursing, and other
health sciences schools, leaving many medical professionals unprepared to meet the needs of patients
with life-limiting illness and those at the end of life. For the past several decades, curriculum time,
faculty prestige, and research money have typically flowed largely toward cure-oriented science and technology and
hospital-based care,
neglecting the needs of incurable and dying patients and their families. A 1991 survey of 111
U.S. medical schools revealed that 12 schools offered no formal instruction in death and dying.
Death and dying was taught in lectures or modules as part of another course in 82% of schools.
It was taught as a separate course in only 18% of schools. It is, therefore,
not surprising that at both the medical school and residency levels data consistently reveal that
these programs inadequately prepare students and residents to: 1) discuss end-of-life decisions with
patients and families; 2) manage pain and many other common symptoms near the end of life; 3) address
psychological and spiritual issues related to death and dying.
The goal of palliative care education is for trainees in all health professions to
acquire the knowledge, skills, and attitudes required for compassionate, technically
proficient, culturally appropriate care to patients and families with advanced, life-threatening
illness. Educators have begun to develop authoritative guidelines and model curricula for
end-of-life care, and there is now a growing body of resources to assist training programs
and faculty in preparing today's health professions students to provide palliative care.
The Institute works with a variety of departments, schools, and centers at the University of
Pittsburgh to enhance and improve the education of providers across disciplines and at all levels
of training. The Institute mentors and encourages students in nursing, medicine, social work,
and pharmacy to participate in research, clinical, and educational programs, as well as to
choose careers in Palliative Medicine. By combining academic and community-based resources,
the Institute is equipped to improve education and to mentor and train healthcare professionals
of all disciplines in order to promote their abilities to manage the care of a growing population
of seriously ill and dying patients.
The Institute is a national leader in curriculum innovation in medical education for palliative
care. For example, with significant grant support from the National Cancer Institute, it has
introduced new required and elective experiences in end-of-life care for medical students, residents,
and subspecialty fellows at the University of Pittsburgh School of Medicine. Institute faculty members
have also contributed to the creation of highly regarded national programs in communications skills
training for oncologists.
Past Accomplishments
- Medical School Education & Curriculum Development:
First and Second Years: A four-year grant from the National Cancer Institute
enabled new content related to palliative medicine and end-of-life care to be developed
and added to the University of Pittsburgh's required medical school curriculum in the
first and second years of medical school. Through lecture material and problem-based
learning, all students are now exposed to the basic science knowledge underlying the
management of common symptoms of advanced disease, and to the principles of effective
doctor-patient communication about bad news and advance care planning.
Current Programs & Initiatives
- Medical School Education & Curriculum Development:
"Nothing I have learned this year in the basic sciences will leave an impression on me as this
experience...I feel that I have a framework now with which to approach the issues of terminal
disease, the dying patient, the surviving family members, palliation, and bereavement."
University of Pittsburgh Medical Student
First Year: Learning from Patients with Life-Threatening Illness is an elective course,
which gives first-year medical students the opportunity to learn directly from patients and families what
it is like to deal with life-threatening illness. Students get to know a particular patient and family
in depth by making a series of home visits throughout the semester, allowing them to form meaningful
relationships, over time in the patient's own home, with people who are facing the physical, social,
psychological and spiritual issues of life-threatening illness, anticipated death, and bereavement.
Third Year: With a four-year grant from the National Cancer Institute, David Barnard, Director
of the Institute, specialists in Palliative Care from UPMC, and experts in educational design
are utilizing web-based educational technologies to deliver "just-in-time" palliative care
learning materials to medical students in all required clinical rotations. Students who record
patient encounters in electronic learning logs will automatically be offered immediate email
delivery of palliative care instructional material specifically relevant to the patient's diagnosis
or current clinical problem. Similar material will also be sent automatically to the student's
faculty and resident preceptors to facilitate bedside learning on palliative care topics at the
time of the student's greatest "need to know." Major objectives of this project are to improve
graduating medical students' (1) knowledge of core end-of-life tasks, (2) attitudes toward end-of-life
care, (3) emotional comfort with dying patients, (4) satisfaction with their end-of-life instruction,
and (5) feeling of preparedness to provide end-of-life care at the level of a medical intern.
Fourth Year: An elective in Palliative Medicine offers a structured four-week clinical rotation to
increase students' awareness, knowledge, and clinical skills when dealing with terminally ill patients
and their families. Under supervision of palliative care staff, students see patients in hospitals,
outpatient clinics, and patients' homes. The core content covered includes: advance care planning/Do-Not-Resuscitate
orders; communicating bad news; pain and symptom management; responding to spiritual and existential concerns; family
support; managing comfort in the last hours of life; bereavement follow-up; and working with multidisciplinary teams.
- Post-Graduate Medical Education
"This fellowship has opened my eyes to the possibility of really being able to make a difference in the last
days of a patient's life. Palliative care and Hospice involve compassionate social work that patients and their
families need. I've realized how hard it may be to communicate with people who don't know a lot about the health
care system. It is our job as social workers to help break down the technical language and make sure the patients
and families understand exactly what the medical professionals are telling them. It can be very rewarding work
to really support and advocate for the patient and their families at the end of the patient's life."
Jill Iszkula, Recipient of the Evelyn Amdur Palliative Care Social Work Fellowship
Residency: Residents in Medicine, Family Practice, and Psychiatry spend varying lengths of time in clinical training on the
palliative care service seeing patients and developing treatment plans under the supervision of palliative medicine faculty.
Palliative care faculty also provides an annual lecture series on core palliative care topics for the Medicine and Family
Practice residency programs.
Fellowship:
- Senator H. John Heinz III Fellowship in Palliative Medicine: This two-year fellowship, generously
funded by The Heinz Endowments, prepares fellows for an academic career in the growing field of
Palliative Medicine with a focus on clinical research. Upon completion of the program, fellows
have the skills necessary to succeed as independent physician investigators. For further information and to apply, please contact Paige Hepple
at jph29@pitt.edu
or apply online at www.dgim.pitt.edu/FellowApp/fellowship_app.aspx
- Lecture Series: Fellows in Critical Care Medicine and Hematology-Oncology attend annual
lecture series in palliative care, with the option of additional time rounding on the palliative care service.
Geriatric Fellows also participate in a two
or four-week block in palliative care as part of their clinical training.
- Onco-Talk: This program is co-directed by Institute faculty member Bob Arnold, MD
and funded by the National Cancer Institute. It is administered by colleagues at the University of Washington, Seattle and uses intensive retreats designed
to train Oncology Fellows in communication skills related to the care of patients with advanced disease.
- Social Work Education:
- Evelyn Amdur Palliative Care Social Work Fellowship: Social workers, with their expertise
in the psychological and social aspects of illness, family dynamics, and community resources, are critical
members of the palliative care team. This fellowship provides an intensive, one-month internship in palliative
care social work for University of Pittsburgh social work students under the guidance of one of the nation's
leading academic palliative care programs.
For more information or an application call the Institute to Enhance Palliative Care at 412-692-4884
|
