Six-Month Natural History of Hospitalized Medicare Beneficiaries With Heart Failure Referred for Hospice Care (S709)

Abstract

2. Identify opportunities to influence, initiate, maintain, and advance the practice and sustainability of palliative care within the changing healthcare environment. Background. In general, medical education in the US inadequately addresses end-of-life (EOL) care and palliative care. After a shift of focus post-Katrina, Tulane is placing a renewed emphasis on these important but difficult topics. Research Objectives. (1) Assess the current state of Tulane medical student interest in EOL education, (2) teach medical students basic EOL care competencies with an emphasis on confidence-building for addressing these topics, and (3) measure the impact of this pilot elective. Method. We designed an elective course open to 25 first-year medical students for approximately 9 total hours and implemented it in both the 2010-2011 and the 2011-2012 academic years. The elective utilized the expertise of Tulane’s palliative care specialist and other multidisciplinary specialists to combine creative, active-learning modules with published tools and techniques to explore the basics of hospice and palliative medicine. A survey was conducted to compare knowledge and confidence gained by participants compared to other first-year students. Result. Elective students showed a significant difference in their perceived knowledge of palliative care, hospice, and healthcare advanced directives (average score of 10.2 out of 15 for elective students vs. 8.8 for non-elective students; p < .01); this difference has been evident for 2 consecutive years. Additionally, participants indicated that their preparation to speak with a patient or their family about these topics increased more than non-participants (4.23 vs. 3.26; range from 1 ‘‘I’m now less prepared’’ to 5 ‘‘I am now much more prepared’’; p < .01). Conclusion. Well-timed, creative, and interactive teaching sessions can draw upon the energy and excitement of entering the first year of medical school to stimulate educational opportunities in EOL care. Implications for Research, Policy, or Practice. This student-initiated and low-cost elective opens the door to the complex ethical, social, and psychological situations that doctors will face with an aging population. The elective also increases students’ confidence to address these situations.