A short palliative care experience: beginning to learn

Abstract

The Robert Wood Johnson Foundation issued grants to establish palliative care clinical learning opportunities for medical students. We developed a 1-week focused curriculum on palliative care that was embedded into the internal medicine clerkship. We examined the feasibility of a 1-week course incorporated into the medicine clerkship, and looked at knowledge and attitudinal changes in students who had completed the course. In 2000, the Liaison Committee on Medical Education (LCME) mandated that all medical schools ‘must’ teach about end-of-life care, yet few schools have developed a comprehensive educational programme during a 4-year curriculum. The relatively recent American Board of Medical Specialties designation of hospice and palliative care as a medical subspecialty in 11 medical practice areas adds further motivation for medical schools to develop palliative care training for medical students. An extensive needs analysis was completed and a 1-week, required, comprehensive palliative care curriculum was developed for all Year 3 medical students during a 1-year period. The core curriculum was developed with the help of the Medical College of Wisconsin’s Medical School Palliative Care Education Project and the End-of-Life Palliative Education Resource Center. It included direct in-patient and out-patient care, multidisciplinary rounds, reflection exercises and didactic teaching around the core clinical topics of hospice and palliative care, pain management, dyspnoea, nausea and vomiting, constipation, delirium, anorexia, and depression and anxiety. It also included faculty development on core palliative care topics and the teaching of these topics. The programme was implemented for 1 year with grant support. Students in the last 9 months of the embedded palliative care course evaluated the programme. Programme evaluation included a survey of attitudes towards palliative care and pre- and post-course measurements of knowledge learned. Mean scores on the knowledge tests before and after the course were compared. A total of 53 of 84 (63%) students completed both pre- and post-tests. Students felt that learning palliative care was important to their education (100%) and that it was feasible to incorporate into a medicine clerkship (93%). All students felt it was useful to learn about palliative care. When knowledge was measured, mean scores were 145 (of 230 total points) pre-course and 175 post-intervention. The difference between the means is significant (P < 0.01), demonstrating that students had learned from the course. In conclusion, a 1-week palliative care course embedded in a medicine clerkship is feasible and effective for learning. As a result of this pilot project, a required, independent, 1-week palliative care clerkship and palliative care elective were instituted at our medical school.