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An Online Palliative and End of Life Care Course for Medical Students. Ilene Lewis, MS II University of California – Davis School of Medicine. Current Palliative and End of Life Care Curriculum in Medical Schools. AAMC = Association of American Medical Colleges

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An Online Palliative and End of Life Care Course for Medical Students

Ilene Lewis, MS II

University of California – Davis School of Medicine


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Current Palliative and End of Life Care Curriculum in Medical Schools

AAMC = Association of American Medical Colleges

Curriculum Directory: http://services.aamc.org/currdir/section4/start.cfm

NOTE: AAMC represents 125 allopathic medical schools accredited by the LCME (Liaison Committee on Medical Education) including 17 Canadian medical schools


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Current Palliative and End of Life Care Curriculum in Medical Schools

  • According to the AAMC Curriculum Directory, the following schools have clerkships for the Class of 2008:

    • SUNY-Downstate Medical Center COM

      • Primary Care II Clerkship in Geriatrics and Palliative Care Hours: 296, Weeks: 4

    • Ponce School of Medicine

      • Community Medicine and Geriatrics, Hours: 65

      • Geriatrics, Hours: 65

    • University of Miami School of Medicine

      • Geriatrics, Weeks: 4, with Psychiatry, Weeks: 2

      • Geriatrics, Weeks: 6


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Current Palliative and End of Life Care Curriculum at UC - Davis

  • Year 1 – Doctoring (Required Course)

    • Culture and Medicine

      • Spirituality

      • Death Awareness

      • Bereavement

    • Communication Skills

      • Breaking Bad News

    • Adult and Geriatric Development

      • Elder Abuse

      • Assigned home visits with a geriatric patient

        • ~ Monthly

        • Follow same patient all 4 years

    • Medical Ethics and the Law

    • Small Group Discussions

      • 2 different groups: Application of Medical Principles (AMP), and Doctoring small group

      • Each group meets once a week

      • Simulated patients, role playing, and learning issues are researched and presented to the groups


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Current Palliative and End of Life Care Curriculum at UC - Davis

  • Year 2 - Oncology (Required Course)

    • End of Life and Hospice Care Lecture

  • Year 4 – Elective Clerkships

    • Geriatrics in Community Health

    • Practicum in Care for the Terminally Ill

    • Law and Medicine (can be taken during any year)

      • Physician Assisted Suicide, Terminal Sedation, Medical Ethics, Pain Management


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Role of Online Curriculum Davis

  • Provide more focused and comprehensive preparation for caring for patients and families at the end of life

  • Provide continuity in presentations

  • Can be integrated into existing curriculum in the 1st and 2nd year


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Online Curriculum Proposal Davis

  • Required 2 year web based series of PowerPoint presentations and exercises on palliative and end of life care

  • Presentations will be designed by medical school faculty and will be ~ 50 min each

  • “Virtual Preceptors” will be available via e-mail to respond to student questions

  • Chat room available for students to communicate with each other

  • Each module will have a review of key points and suggested readings

  • Self-assessment quizzes will be provided for each module that will generate score reports to identify areas for review

  • Question Bank for each module

  • One final comprehensive examination after all modules are completed (90% is passing – able to retake until score is achieved)

  • Required evaluations of each module’s content


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Curriculum Materials and Resources Davis

  • Curriculum Materials:

    • Textbook/Syllabus

    • Pocket Guides

      • American Academy of Hospice and Palliative Medicine Guide

      • American Pain Society: Principles of Pain Management

      • Robert Buckman’s Communication Skills

      • Opioid Equianalgesic Card

  • Additional Resources:

    • Websites

    • Movies

    • Recommended Readings

    • Advance Directive Examples

    • Do-Not-Resuscitate Form


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Online Curriculum Format Davis

  • Modules will be based on American Board for Hospice and Palliative Medicine (ABHPM) Physician Credentialing Standards:

    • Non-Pain Symptom Management (30%)

    • Pain Management (25%)

    • Ethical and Legal Decision Making (8%)

    • Communication and Teamwork (7%)

    • Impending Death (7%)

    • Psychosocial and Spiritual Issues (7%)

    • Hospice and Palliative Approach to Care (6%)

    • Grief and Bereavement (5%)

    • Prognostication (5%)


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Online Curriculum Format Davis

  • Modules will be organized to reflect existing curriculum presentations

  • Deadlines for completing modules and self-assessment quizzes will correspond with the conclusion of existing lecture series on given topics


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Online Curriculum Format Davis

  • Generally:

    • Completed in Year 1: 20 Required Hours

      • Introduction to Palliative and End of Life Care (17%)

        • Includes Prognostication

      • Communication Skills (11%)

      • Ethical and Legal Decision Making (17%)

      • Psychosocial and Spiritual Issues (11%)

    • Completed in Year 2: 16 Required Hours

      • Non-Pain Symptom Management (14%)

      • Pain Management (17%)

      • Impending Death (14%)

        • Includes Grief and Bereavement


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Module 1: Introduction to Palliative and End of Life Care Davis

6 Required hours (including 1 hr self-assessment)

  • Defining Palliative and End of Life Care

  • Accessing End of Life Care Delivery Systems

  • Quality of Life Assessments and Prognostication

  • Specific Populations: Elderly, Substance Abusers, and Incarcerated

  • Pediatric Palliative and End of Life Care

  • Optional Exercises:

    • Death Attitude Survey

    • A Good Death Survey


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Module 2: Communication Skills Davis

4 Required hours (including 1 hr self-assessment)

  • Breaking Bad News

  • Confidentiality and Families

  • Working with an Interdisciplinary Team


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Module 3: Ethical and Legal Decision Making Davis

6 Required hours (including 1 hr self-assessment)

  • Informed Consent and Patient Rights

  • Advance Care Planning

  • Nutrition and Hydration in End of Life Care

  • Medical Procedures and Diagnostic Tests in End of Life Care

  • Physician Assisted Suicide and Terminal Sedation


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Module 4: Psychosocial and Spiritual Issues Davis

4 Required hours (including 1 hr self-assessment)

  • Psychosocial Responses

  • Culture and End of Life Care

  • Religious Beliefs and Practices

  • Optional Exercises:

    • Vignettes of Patients/Families speaking about their experiences

    • Scenarios – “choose your adventure” style


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Module 5: Non-Pain Symptom Management Davis

5 Required Hours (including 1 hr self-assessment)

  • Common Symptoms at the End of Life

    e.g. Fatigue, Incontinence, Cachexia, etc.

  • Respiratory Symptoms at the End of Life

  • Gastrointestinal Symptoms at the End of Life

  • Delirium, Agitation, and Depression


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Module 6: Pain Management Davis

6 Required Hours (including 1 hr self-assessment)

  • Acute and Chronic Pain

  • Pain Assessment

  • Pharmacologic Management of Pain

  • Non-Pharmacologic Management of Pain

  • Barriers to Pain Management


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Module 7: Impending Death Davis

5 Required Hours (including 1 hr self-assessment)

  • Signs of Impending Death

  • Symptom Management During Last Days of Life

  • Managing Caregiver Stress and Other Family Issues

  • The Grief Process

  • Optional Exercises:

    • Grief-Loss Inventory


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Implementation Goals Davis

  • Present to curriculum committee to secure support for project

  • Contact medical school faculty to prepare presentations/be virtual preceptors for project

  • Develop website design with programmer

  • Contact publishers/book suppliers for donations of curricular materials

  • Write grant proposal for future purchases of curricular materials


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