Training In Palliative Medicine Research Articles

Medical students’ knowledge on palliative care – a survey of teaching in Finland

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. In addition, students´ attitudes towards end-of-life (EOL) care issues were examined. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Students from these universities expressed less anxiety in facing EOL issues. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Anesthesiological Preoperative Interview with a Palliative Care Patient: A Simulation-Based Experiment Using Standardized Patients.

Background and Objectives: Anesthesiologists come into contact with patients under palliative care in different clinical settings. They also routinely encounter these patients in their primary field of work, the operating room. Patients receiving palliative care who are scheduled for surgery will pose unique challenges in perioperative management, often presenting with advanced disease and with different psychosocial and ethical issues. This study aims to evaluate whether anesthesiologists without specialty training in palliative medicine will spot perioperative challenges presented by patients under palliative care and address them adequately. Materials and Methods: In this study, we simulated a preoperative anesthesiological interview using standardized patients and anesthesiologists (specialists as well as trainees). The standardized patients were asked to represent a patient under palliative care in need of surgery because of a mechanical ileus. We conducted 32 interviews, dividing the anesthesiologists into two groups. In one group, the standardized patients were instructed to address four problems, i.e., use of a port catheter for anesthesia, nausea and vomiting, pain medication, and an advance directive including a limitation of treatment (DNR-order). In the other group, these problems were also present, but were not actively addressed by the standardized patients if not asked for. The interviews were recorded, transcribed, and then analyzed. Results: In most cases, the medical problems were spontaneously identified and discussed. In only a few cases, however, was a therapy recommendation made for improved symptom control. The advance directive was spontaneously discussed by only 3 of the 32 (9%) anesthesiologists. In another 16 cases, the advance directive was discussed at the request of the standardized patients. The limitation of treatment stayed in place in all cases, and the discussion of the advance directives remained short, with an average duration of just over 5 min. Conclusions: In this study, the complex problems of patients under palliative care are not sufficiently taken into account in a preoperative anesthesiological interview. To improve treatment of the medical problems, therapists who have palliative medicine expertise, should be involved in the perioperative medical care, ideally as a multi-professional team. The discussion about perioperative limitations of treatment should be held beforehand, for example, as part of a structured advanced care planning discussion.

Medical students’ knowledge on palliative care – a survey of teaching in Finland

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. In addition, students´ attitudes towards end-of-life (EOL) care issues were examined. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Students from these universities expressed less anxiety in facing EOL issues. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Top Ten Tips Palliative Care Clinicians Should Know Before Their Patient Undergoes Surgery.

Many seriously ill patients undergo surgical interventions. Palliative care clinicians may not be familiar with the nuances involved in perioperative care, however they can play a valuable role in enabling the delivery of patient-centered and goal-concordant perioperative care. The interval of time surrounding a surgical intervention is fraught with medical, psychosocial, and relational risks, many of which palliative care clinicians may be well-positioned to navigate. A perioperative palliative care consult may involve exploring gaps between clinician and patient expectations, facilitating continuity of symptom management or helping patients to designate a surrogate decision-maker before undergoing anesthesia. Palliative care clinicians may also be called upon to direct discussions around perioperative management of modified code status orders and to engage around the goal-concordance of proposed interventions. This article, written by a team of surgeons and anesthesiologists, many with subspecialty training in palliative medicine and/or ethics, offers ten tips to support palliative care clinicians and facilitate comprehensive discussion as they engage with patients and clinicians considering surgical interventions.

Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey

ContextOutpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training. ObjectivesCharacterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education. MethodsA cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March and July, 2023. ResultsOf 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows’ clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, P<0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, P<0.001). ConclusionOur survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.

Beyond the Labs: Need for Primary Palliative Medicine Training in an Internal Medicine Residency

Beyond the Labs: Need for Primary Palliative Medicine Training in an Internal Medicine Residency

Medical students’ knowledge on palliative care – a survey of teaching in Finland

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Basic Training in Palliative Medicine for Internal Medicine Residents: Pilot Testing of a Canadian Model in Switzerland.

In Switzerland, palliative care (PC) clinical training is well established at undergraduate and specialist postgraduate levels. However, postgraduate nonspecialist training curricula are less documented. A structured curriculum for nonspecialist rotation within internal medicine (IM) in specialized PC wards is lacking. To pilot two versions of a PC nonspecialist curriculum for IM residents in Swiss PC units. In the pilot phase, two curricula-short immersion (3-10 weeks, based on the University of Toronto's Internal-Medicine PC Rotation) and standard nonspecialist (11-18 weeks, based on the Canadian Society of Palliative Care Physician Competencies)-were assessed using a mixed-method online survey. One university and two nonuniversity sites participated. The analysis was descriptive. Five residents and eight supervisors of five training rotations (July-October 2023) responded. Overall, curriculum quality and feasibility (content and time) received positive ratings across all groups, with high satisfaction concerning organization, educational design, learning support, climate, experience, and facilities. Nonuniversity sites were generally rated more positively than university sites. Qualitative feedback paralleled these findings, highlighting the curriculum's relevance and fit with learners' needs and suggesting potential simplifications and more personalized planning. Establishing short and standard duration curricula for a PC program is viable and well received by nonspecialist trainees. Future implementation should concentrate on personalized learning objectives and streamlining the content and structure of the competencies. Cooperation within various training settings (university and regional hospitals) as well as on an international level (e.g., Canada-Switzerland) may further improve the quality of the proposed training formats.

Palliative Care in the Community: The Greek Version of the Supportive and Palliative Care Indicators Tool (SPICT™).

Systematic identification of persons with palliative care needs constitutes a major challenge for promoting palliative care in all levels of the health system, including primary care. The aim of this study was to translate, cross-culturally adapt, and content validate Supportive and Palliative Care Indicators Tool (SPICT) for use in the Greek primary care context. Secondary objectives were to probe the use of SPICT-GR in exemplary case vignettes, to discuss the clarity and comprehensibility of its content as well as the appropriateness, acceptability, and feasibility of the tool within the Greek primary care. The Greek translation and cross-cultural adaptation of SPICT™ followed World Health Organization recommendations for translation and adaptation of instruments. For this purpose a working group was set up consisting of 2 senior researchers, a primary care professional with postgraduate training in Palliative Medicine and a general practitioner (GP) with special interest in primary palliative care. Three focus groups comprised of health professionals (n = 23) working in primary care settings participated in the pilot testing phase. Participants also completed a questionnaire including rating their perceptions on tool's utility and feasibility as well as on the clarity and relevance of its items. Thematic analysis was used for focus groups discussions on how the tool was perceived and interpreted by health professionals in a Greek healthcare context and descriptive statistics for the quantitative analysis of the questionnaire data. The majority assessed the tool as useful (65%), considered its implementation in primary care as feasible (91%) and rated its items as "relevant" or "very relevant" and "clear" or "very clear." Three themes emerged from focus groups discussions: Guiding clinical practice and facilitating collaboration; promoting comprehensive care and awareness for palliative care; applicability in and suitability for primary care. SPICT-GR™ was identified as a practical and applicable tool for primary care, a source of guidance for the comprehensive identification of patients' palliative care needs, promoting awareness on palliative care and facilitating a shared language among health care professionals.

Defining Key Elements of a Clinical Experience in Hospice and Palliative Medicine for Medical Residents in the United States.

Training in hospice and palliative medicine (HPM) is essential for practicing internists, who routinely care for patients and families facing serious illness. Program directors and medical residents acknowledge the importance of palliative medicine skills, and trainees themselves desire more such training. The ACGME has also recognized the importance of HPM training for medical residents, establishing in its 2022 Common Program Requirements for Internal Medicine a new expectation that all residents have a clinical experience in HPM. However, internal medicine residencies vary significantly in their approach to teaching HPM skills, and what constitutes a useful clinical experience in HPM has not been well-described. In this perspective, we draw from the available literature and our experience as educators to propose 5 core elements for creating an optimal HPM experience for medical residents. These include practice with symptom management and communication in serious illness, exposure to interdisciplinary care, appreciation of the continuum of care settings for HPM delivery, and an understanding of the key principles of hospice care. We then describe the relevance of each element and offer educational strategies regarding how each can be achieved.

Narrative Medicine in Hospice and Palliative Care: A Longitudinal Fellowship Curriculum Pilot.

Growing evidence suggests that clinician exposure to narrative medicine (NM) may help bolster resilience and mitigate burnout. The value of formal longitudinal training in NM for hospice and palliative medicine (HPM) trainees remains understudied. A 1-year longitudinal NM curriculum for HPM fellows was pilot-tested for feasibility, acceptability, and exploratory impact. Six monthly 45-minute sessions included reading literature, reflective writing, and sharing creative work. Quantitative and qualitative data were collected through a pre-intervention survey and post-intervention survey administered immediately upon completion of the curriculum. Longitudinal impact was assessed with a post-intervention survey administered three months after completion of the curriculum. All HPM fellows (n = 6) attended at least 5/6 sessions during the 1-year pilot, suggesting intervention feasibility. Participant engagement and self-reported comfort with NM exercises supported intervention acceptability. Post-intervention, participants described the positive influence of NM practice on their clinical practice and stated an intention to integrate NM skills in their future HPM careers. Three months following the intervention, participants had a sustained increase in their comfort level with NM. All participants felt that the NM sessions had been relevant to their life as HPM fellows and anticipated using NM moving forward in their practice of HPM. This novel NM curriculum was feasible and acceptable to implement in a 1-year HPM fellowship. Longitudinal impact showed sustained increase in trainee comfort and interest in using NM in their future clinical practice.

„Der zeitliche Gesamtaufwand für den Hausarzt sinkt“: Die Sicht der Zuweisenden auf eine palliativmedizinische Tagesklinik

BackgroundPalliative day-care clinics (PDCCs) can complement inpatient and outpatient specialized palliative care. Some studies have shown improvements in the patients'́ symptoms, functional level and psychological well-being, while others have not. This study aimed to document the experience of referring physicians with PDCCs. MethodA postal questionnaire was sent to referring physicians between 11/2020 and 3/2021. The questionnaire included open and closed questions about professional background, symptom control, medical / psychosocial benefits for patients and challenges in the collaboration. Closed, 5-point scaled questions were analyzed descriptively with IBM SPSS Statistics 25®, open questions with a thematic content analysis using MAXQDA 2020®. ResultsOf the 96 referring physicians contacted, 76 questionnaires were returned (79%), 73 of which could be analyzed. Most referring physicians were general practitioners (57%), followed by oncologists (28%). 12% had completed further training in palliative medicine and had been working with patients with palliative care needs for an average of almost 19 years. On average, they had referred 24 patients (range 1–200) to a PDCC. 93% said that inpatient stays were delayed or avoided by PDCCs. 97% were of the opinion that their patients achieved a (great or rather great) benefit from medical treatment, and 96% thought that they benefited (to a great or rather great degree) from psychosocial treatment. 58% said that their own time spent with patients treated at the PDCC had decreased.In addition, a total of 227 open comments on challenges in cooperation, suggestions for optimization, reasons for referring patients and general wishes for PDCCs were analyzed. DiscussionThe high response rate to the questionnaires shows that PDCCs are of great importance to referring physicians. They consider the cooperation with PDCCs to be supportive and helpful for both themselves and their patients. ConclusionPDCCs make an important contribution to palliative care. Almost all respondents believe that treatment at a PDCC prevents or delays hospitalization.

A Survey of Clinicians Who Provide Aid in Dying.

Little is known about the identity and moral experience of clinicians who provide the option of aid in dying to terminally ill Americans. In May 2023 we distributed an email survey to clinicians registered for the American Clinician's Academy on Medical Aid in Dying listserv. Of the 72 clinicians who responded, 90% were of white race, 50% were over 60years old, and 47% had been in practice for over 20years. Most clinicians report practicing primary care (39%) or hospice/palliative care (33%); 25% of clinicians had training in palliative medicine. 22% described their practice as a specialized "aid-in-dying practice" and 26% either "rarely" or "never" cared for the terminally ill outside the context of aid in dying. A majority (56%) of clinicians were either affiliated with an independent practice or unaffiliated. Before they began aid-in-dying work, 26% of clinicians reported having felt "somewhat" or "very" morally conflicted; after having written an aid in dying prescription, 96% felt "hardly" or "not at all" conflicted. On average, clinicians felt that aid-in-dying laws balance protection of patients with access; 39% believed that the laws were "somewhat" or "overly" protective. Many responding clinicians report caring for patients considering aid in dying in specialized practices or otherwise in unaffiliated or independent practice. Clinicians report that providing aid in dying (and writing an aid-in-dying prescription) resulted in less reported moral conflict toward aid in dying.

Becoming a Palliative Care Physician During Surgical Residency

This Viewpoint describes the option of integrating hospice and palliative medicine training into surgical training.

Integrated dual training in palliative care and oncology

Fellowship training in Hospice and Palliative Medicine (HPM) and Hematology/Oncology (Hem/Onc) share common themes and roots in the holistic care of people living with cancer. As of 2021, approximately 630 physicians in the United States were board-certified in both HPM and Hem/Onc. There is increasing demand for an integrated fellowship pathway, and the inaugural integrated fellowship Match took place in 2022. We present the historical context of the overlap in HPM and Hem/Onc fellowship training, limitations of the standard training paradigm, and an overview of the recently developed integrated training pathway accredited by the Accreditation Council for Graduate Medical Education (ACGME). We explore applications of dual training in clinical care, program development, and research at the intersection of HPM and Hem/Onc. Finally, we consider challenges to the success and how best to assess the outcomes of this program. Integrated fellowship training in HPM and Hem/Onc is 1 avenue to develop a cohort of dual-trained physicians poised to effect broad cultural change in this important and evolving space. A subset of physicians with dual training has the potential to fill unmet needs by promoting enhanced patient-centered care, developing infrastructure for heightened collaboration between these distinct but closely related fields, and prioritizing research focused on advanced communication skills and symptom management for patients with cancer.

Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training.

Few individuals have fellowship training in both hospice and palliative medicine (HPM) and a surgical specialty including general surgery, general obstetrics and gynecology, or affiliated subspecialties. There is a paucity of data to explain why some surgeons choose to pursue HPM fellowship training. Identify facilitators and barriers to palliative medicine fellowship training among physicians from a surgical specialty. We conducted individual semistructured interviews with 17 surgeons who were also fellowship-trained in HPM. Interviews were recorded, transcribed, and thematic analysis was conducted to identify themes. Participants reported pivotal experiences-either positive exposure to palliative care or suboptimal surgical care experiences-as a key motivator for pursuing specialty palliative care training. Additionally, participants chose HPM training because they felt that practicing from a HPM perspective aligned with their personal care philosophy, and in some cases, offered professional opportunities to help achieve career goals. Participants reported encountering bias from both HPM and surgical faculty, and also found that some HPM fellowship programs did not accept surgical trainees. Surgeons also reported logistical concerns related to coordinating a one-year fellowship as a barrier to formal HPM training. Understanding the motivations of surgeons who pursue HPM training and identifying challenges to completing fellowship may inform solutions to expand surgeon representation in palliative care. Both HPM and surgical faculty should be educated on the benefits of specialty HPM training for surgical trainees and practicing surgeons. Further research should explore HPM fellowship best practices for welcoming and training surgeons and other underrepresented specialties.

Sacrifices

Sacrifices Efrat Lelkes I've always been goal-oriented. Since I was a teenager, I've known what my life would look five, ten years ahead of time. I went straight through—straight to college from high school, to medical school, through residency, fellowship, and to a junior faculty position in academia. I never stopped to ask if this was the right path for me, nor did I ask what I was missing throughout this path. For me, the honor of being in academia meant that I kept going without questioning. I theoretically knew that sacrifices were intrinsic to becoming a physician, especially a physician-scientist. But to be an academician, I believed, was what I was supposed to be, and thus I knew that I would sacrifice sleep, money, and a "normal life" for a long time. I just didn't realize that I would sacrifice myself. In my mid-thirties, I began to recognize that the life I had forged as a physician-scientist was destroying me. I hated being in the lab. I missed my patients. I spent my time away from work living a very unhealthy life. And so, abruptly, I left the lab and my career as a scientist, and I transitioned to being a full-time pediatric critical care physician. I did so with the belief that I was a failure. I did so without considering the need to care for myself and to truly ask what I needed. I just believed I needed to serve others. The pressure I put on myself was immense. I started to mistrust myself as a clinician. I started to make mistakes. I deeply despised myself. And then I broke. With severe depression and anxiety, post-traumatic stress disorder, and a need to run away, I left home for a year under the guise of further training in palliative medicine. It was the year that saved my life, and it was the year that I began to appreciate how much I had given up for this career. It was when I learned that academia was not life, and it was then that I learned what I truly wanted. I wanted a family. I had wasted so much time pretending that I didn't. No glory had been afforded—especially for young women in this world—to needing a companion. I was supposedly superhuman; I didn't need anyone else—whenever anyone asked what was wrong, I would defiantly aver that I was fine—and to suggest otherwise meant that I was a burden and useless. But, by my late thirties, after my year away, after starting to heal, I was learning otherwise. I wanted to belong and to connect. I wanted a partner. Just as much, I wanted to become a mom. So I entered the world of fertility, deciding to become a single mom by choice. My reproductive endocrinologist was remarkable, my friends and my family were supportive, and I felt courageous, proud, and ready. [End Page E16] And, just as I started this process alone, I fell in love for the first time. I met a man the same month I started to try to get pregnant through Intrauterine Insemination (IUI). The first cycle did not work. I was sad, and he supported me. The second cycle did not work, and I was relieved. He was as well. We were becoming part of each other's lives, and we were excited about the future. I chose to put motherhood aside to focus on us, in theory. But, in truth, it was hard not to think about it daily. I knew that I was getting to the end of my reproductive years. Though I wanted a fairy tale, and I wanted us to be together, the aching to be a mom would not subside. I tried to quash it, but it would bubble up, and it would explode. I should have listened to him when he told me he was not ready. We perhaps should have made different decisions about our relationship. But we were deeply in love, we believed in us, so we forged ahead. After an eternity of pressure by me—and pressure fueled by...

Awareness of Palliative Care among Healthcare Providers in Pakistan: A Survey

Objective: To assess the awareness of palliative care among healthcare providers in Pakistan.Study Design: Cross-sectional descriptive study.Place and Duration of Study: The study was conducted in healthcare providers from various healthcare setupsin Pakistan, from 20th March 2021 to 21st May 2021.Materials and Methods: A total of 134 responders from various hospitals answered a questionnaire-basedsurvey on the knowledge and palliative care practice among healthcare providers. The questionnaire was madeaccording to guidelines given By Shaheen Palliative Care Project, United Kingdom.For data collection, convenience sampling was used and to present distribution of responses percentages andfrequencies were used. Data were entered and analyzed using SPSS 17.Result: In 134 responders, about 128 (95.5%) responders were involved in palliative care, but only 55 (41.0%)were satisfied with palliative care given. Majority of responders 118 (88.0%) had idea regarding members ofpalliative care team. About 124 (73.4%) responders knew that, palliative care should start at the time ofdiagnosis and 123 (91.7%) gave correct response regarding the goal of palliative care. Most of the responders124 (92.5%) were convinced that palliative care should be the part of curriculum at all health care levels.Conclusion: Among healthcare providers across Pakistan, the majority have fair idea regarding palliative carebut a more than half of the responders were not satisfied with palliative care they are providing which is mainlydue to the lack in palliative medicine training. Palliative care should be the part of curriculum at all health carelevels with more online programs and workshops.&#x0D; How to cite this: Kashif S. Awareness of Palliative Care among Healthcare Providers in Pakistan: A Survey. 2022; 3(4): 174-177. doi: http://doi.org/10.37185/LnS.1.1.224&#x0D;

Surgeons’ perspectives on facilitators and barriers to fellowship training in hospice and palliative medicine (575)

<b>Objectives:</b> While there is a national shortage of Hospice and Palliative Medicine Providers (HPM), surgeons comprise only 2% of the HPM workforce. The current study sought to explore facilitators and barriers to HPM fellowship training from the perspective of surgeons with training in HPM and a surgical specialty. <b>Methods:</b> We conducted a qualitative study utilizing semi-structured interviews with HPM fellowship-trained surgeons. Data were recorded, transcribed, and coded. Descriptive statistics were used to summarize demographic data, and thematic analysis was used to identify themes in participant responses. <b>Results:</b> There were 17 participants, including general surgeons (<i>n</i>=5), surgical specialists (<i>n</i>=5), general obstetrician/gynecologists (<i>n</i>=3), and obstetrics/gynecology specialists (<i>n</i>=4). All participants described having pivotal experiences that highlighted deficits in patient care, their clinical skillset, and/or their personal or professional development. Participants or their mentors recognized that practicing through a palliative care lens aligned with the participant's personal and professional identity and could fill self-identified deficits in their skillsets. These pivotal experiences and the participants' internal alignment with the HPM practice ultimately drove their decision to pursue an HPM fellowship. Many participants experienced bias when considering HPM, which was either internal bias and doubt or external bias or discouragement that they experienced during conversations with their mentors, faculty, and peers. Additionally, many participants had to overcome logistical barriers to pursue an HPM fellowship, including financial concerns, moving with spouses/families, coordinating an additional surgical fellowship, and navigating an uncertain job market post-fellowship. Ultimately, all participants found solutions to these barriers (JB1) and felt satisfied with their decision to pursue HPM training. <b>Conclusions:</b> Our participants emphasized the importance of mentorship and exposure to HPM as key facilitators to pursuing HPM training. While many participants had to navigate bias and logistical barriers, they felt HPM fellowship was feasible for surgeons and ultimately led to more satisfying careers in their current practice. Highlighting the experiences of HPM-trained surgeons who have navigated this underrepresented career path may empower other surgeons to consider HPM fellowship training and expand surgeon representation in the HPM workforce. HPM and surgical specialty organizations should work to mitigate the cultural and structural barriers to HPM surgical training identified by our participants to facilitate the growth of this critical healthcare resource, the HPM trained surgeon. This will add value to surgical and HPM care for patients, improve primary and specialty palliative care education in surgery and HPM, and foster HPM-oriented research within the surgical specialties while simultaneously addressing a critical HPM workforce shortage.

Position paper on undergraduate Palliative Medicine education for doctors in South Africa.

BackgroundBasic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality.AimThis joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor.SettingPalliative Medicine programme leads and teachers from eight medical schools in South Africa.MethodsA survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers.ResultsResponses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum.ConclusionThrough mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).