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Educating Future Physicians for Palliative/End of Life Care: EFPPEC. Paul Daeninck MD MSc FRCPC Louise Hanvey BN MHA for the EFFPEC project team. Topics. Need for Palliative Care EFPPEC overview Progress Future work. What do Patients & Families Want?. Competence Compassion

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Educating Future Physicians for Palliative/End of Life Care: EFPPEC

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Educating future physicians for palliative end of life care efppec

Educating Future Physicians for Palliative/End of Life Care: EFPPEC

Paul Daeninck MD MSc FRCPC

Louise Hanvey BN MHA

for the EFFPEC project team



  • Need for Palliative Care

  • EFPPEC overview

  • Progress

  • Future work

What do patients families want

What do Patients & Families Want?

  • Competence

  • Compassion

  • Pain and symptom management

  • Clear decision making

  • Preparation for death

  • Affirmation of the whole person

  • Steinhauser KE et al.

  • Ann Intern Med 2000;132:825-32

A good death patient perspectives

A Good Death:Patient Perspectives

  • 5 dimensions of a good death

    • Pain/symptom management

    • Avoiding prolongation of dying

    • Achieving a sense of control

    • Relieving burden on others

    • Strengthening relationships with loved ones

Singer PA et al JAMA 1999;281:163-8

End of life wishes seriously ill pts families

End of Life Wishes: Seriously Ill Pts & Families

  • Questionnaire of patients and families

  • N=440/160, cancer and chronic diseases

  • Trust and confidence in the doctors looking after you

  • Not to be kept alive on life support when there is little hope for a meaningful recovery

  • Information about your disease communicated to you by your doctor in an honest manner

  • To complete things and prepare for life’s end

CMAJ 2006:174; DOI:10.1503/cmaj050626

Growing needs

Growing needs

  • “Trends suggest that by 2010 cancer will be the leading cause of death in Canada”

  • Canadian Cancer Society

  • 2004

“By 2016, > 20% of population

will be 65 years or older”

Health Canada 2000

Canadians expect it

Canadians Expect It !

  • “Quality End-of-life Care: The Right of Every Canadian”

  • Canadian Senate Report 2000/05

  • Social responsibility of medical schools

Educating future physicians for palliative end of life care efppec

  • “In some respects,

  • this century’s scientific and medical advances have made living easier and dying harder”

  • “Approaching Death”-The Institute of Medicine

How well are we preparing our new physicians

How Well Are We Preparing Our New Physicians?

Palliative care in medical schools

Palliative Care in Medical Schools

  • None:3

  • Mandatory rotation:2

  • Elective only:11

  • Less than 5% (0%-15%) of students participate

n=16, 2001

Oneschuk D, et al. J Pall Care. 2004;20:32-37

Palliative care in medical schools1

Palliative Care in Medical Schools

  • “Integrated” in other sessions:6

  • Independent program:6

  • Supervised patient encounters:4

  • Mean # of hours: 11 (3-22)

  • Multidisciplinary faculty:3

n=16, 2001

Oneschuk D, et al. J Pall Care. 2004;20:32-37

Educating future physicians for palliative end of life care efppec

Palliative Care in Medical Schools

Oneschuk D, et al. J Pall Care. 2004;20:32-37

What do medical students want

What do Medical Students Want?

  • 83% of students favoured ↑ pall. care education

  • Oneschuk et al. J Palliat Med 2001

  • Exit surveys by AAMC/AFMC: medical students feel unprepared in the areas of palliative & EOL care

  • Direct or indirect experience with terminal illness increased their request for more palliative care

  • Oneschuk et al. J Palliat Med 2002;5:353-361

All specialties provide palliative care

All physicians during the course of their professional lives will be involved in caring for a patient with an incurable illness

Palliative care not just “at the end”

All Specialties Provide Palliative Care

Palliative medicine training for family medicine residents

Palliative Medicine Training For Family Medicine Residents

Oneschuk D, Bruera E. Pall Med 1998

Palliative care not just about dying death

Palliative Care: Not Just About Dying & Death

What can palliative care offer

What can Palliative Care Offer?

  • Interdisciplinary Collaboration

  • Self-awareness / Reflection

  • Spiritual & Psychosocial Care

  • Experience of Suffering

  • Ethics

  • Complementary & Alternative Medicine

Challenge integrate not usurp

A curriculum that is already full

Map out opportunities for integration

Block SD et al.

J Gen Int Med. 1998;13:768-73

Challenge: Integrate, not usurp

Summary messages

Summary Messages

  • Patients need & want better EOL care

  • Students & residents need & want better EOL skills

  • Role models needed

  • Experiential learning opportunities

Educating future physicians for palliative end of life care efppec

Project Outline


Project overall goal

Project Overall Goal

  • By the year 2008, all under-graduate medical students and the residents at Canada’s 17 Medical Schools will receive effective training in palliative and end-of-life care and will graduate with competencies in these areas

Efppec partners

EFPPEC Partners

  • Association of Faculties of Medicine Canada (AFMC) principal partner/CHPCA co-partner

  • Health Canada funding & close involvement of Canadian Strategy on Palliative/End of Life Care Working Group on Formal Caregiver Education

  • Office is located at CHPCA in Ottawa

Efppec project team

EFPPEC Project Team

  • Project Manager:

    • Louise Hanvey

  • Physician Leader:

    • Larry Librach

  • Administrative Assistant:

    • Jennifer Kavanagh

Efppec management committee

EFPPEC Management Committee

  • Alan Neville (Chair) - McMaster University

  • Paul Daeninck - U of Manitoba

  • Doreen Oneschuk - U of Alberta

  • Hubert Marcoux – Université Laval

  • Robert Wadel - U of Calgary

  • Maryse Bouvette - CASN

  • Sue Maskill - AFMC

  • Sharon Baxter - CHPCA

Efppec partners1

EFPPEC Partners

  • Professional Partnerships

    • CASN

    • Canadian Ass’n of Faculties of Pharmacy

    • CAPPE

    • CASW

  • Professional Resource Groups

    • CSPCP


    • MCC



  • Build on present state in medical schools by forming/facilitating local teams

  • Identify common competencies in EOLC and examine to those competencies

  • Assist in the development of curricula and clinical experiences

  • Evaluation is a key component

Efppec objectives

EFPPEC Objectives

  • Develop an interprofessional team (from various disciplines/specialties) at each university to identify gaps/opportunities related to palliative and EOLC at their university

  • Develop a strategy to address the gaps and implement the strategy

Educating future physicians for palliative end of life care efppec

EFPPEC Objectives

  • Support development of consensus-based palliative and EOLC common competencies for undergraduates in medicine and for postgraduate trainees in key clinical specialties

Efppec objectives1

EFPPEC Objectives

  • Facilitate introduction of curriculum based on common competencies for all undergraduate & clinical postgraduate trainees at each medical school

  • Empower faculty from various specialties to become palliative and EOLC mentors/role models

Efppec objectives2

EFPPEC Objectives

  • Facilitate the introduction of palliative and EOLC questions in licensing/certification exams

  • Develop network of educators

  • Develop a resource of programs

Top down bottom up approach

“Top down, bottom up”approach

Top down approach

Top Down Approach

  • All 17 deans in agreement

  • Certification colleges in agreement

    • accreditation of residency programs with a component of EOLC

  • AFMC will accredit medical schools with EOLC as component

Bottom up approach

Bottom Up Approach

  • National input and consensus

  • Local team formation

  • Interdisciplinary focus

  • Identification of local champions

  • Changes at the local university level

  • Assist in faculty development

Common competencies

Common Competencies

  • Competencies developed based on those of the Canadian Strategy on Palliative/End of Life Care Working Group on Formal Caregiver Education

1 address manage pain symptoms

1: Address & Manage Pain & Symptoms

2: Address Psychosocial & Spiritual Needs

3: Address End-of-life Decisions & Planning using Bioethical & Legal Frameworks

Educating future physicians for palliative end of life care efppec

4: Communicate Effectively with Patients, Families, & Other Caregivers

5: Collaborate as a Member of an Interdisciplinary Team

6: Attend to Suffering

Progress where are we at

Progress: Where are we at?

Local teams

Local Teams

  • Team leader identified at each med school

  • All but 3 medical schools active

  • Team leaders form interdisciplinary stakeholder teams to:

    • Familiarize them with the goals of EFFPEC

    • Inventory their local curricula in EOLC

    • Build consensus around the competencies

Local teams1

Local Teams

  • Project team to obtain relevant info from professional resources with feed back to local teams

  • Local teams to share info with others across Canada, e.g. effective programs, innovations

  • Local teams to enhance and deliver local EOLC curricula

Video conferences

Video Conferences

  • Two so far

  • Successful in getting people to share their successes and challenges

  • Facilitates communication

  • Not all teams involved as yet

University of mb team

University of MB Team

  • Local Leader: Dr. Marcelo Garcia

  • Team members identified

  • Local curriculum reviewed, gaps identified

  • Working with University to integrate

  • Presently have approx. 15 contact hrs

  • Related areas may double contact

  • Experiential learning electives possible

Learning commons

Learning Commons

  • Developed with the help of the Pallium Project

  • Website for sharing information and educational programs

  • Unique features

    • Forum

    • Searchable

    • Notification of subscribers



  • Developing communication strategy:

    • Logo and branding

    • Website (

    • Newsletters & other forms of regular communications with local teams

    • Symposia

    • Conference presentations & booths

    • Visits to university faculties



  • Instrumental evaluation

    • What has been accomplished so far at each of the identified nodal points

  • Quantitative & qualitative

  • Appropriate & realistic outcomes

  • Done in collaboration with Wilson Centre in Toronto

  • Final report to include outcomes

Faculty development

Faculty Development

  • Assess needs for faculty development and facilitate development of these resources

  • Hope to use local expertise

  • Challenging for several groups

  • Palliative care not yet full academic status

2006 symposium

2006 Symposium

  • Held in London ON in May

  • Meeting of the AFMC/CAME/CFPC/MCC/RCPSC

  • Over 80 attendees

  • Excellent exchange of ideas

  • Interprofessional presence

  • Priorities:

  • Faculty development

2007 symposium

2007 Symposium

  • Planning underway

  • Likely in Fall, ? CHPCA Annual Meeting

  • Interprofessional meeting

  • Review of local team progress

  • Faculty development

  • Sustainability

Undergraduate competencies

Undergraduate Competencies

  • Project team worked with Ontario and Quebec groups

  • A draft curriculum in place

  • Seeking consensus across country

  • Detailed enabling objectives

  • May add evaluation suggestions

Family medicine competencies

Family Medicine Competencies

  • Worked with CFPC to develop postgraduate training competencies

  • Approved by CFPC, linked to Four principles and CanMEDS

  • Will be incorporated into the Red Book, guidelines for program teaching

Specialty competencies

Specialty Competencies

  • Royal College Specialty Committees asked to develop competencies

  • Internal Medicine, Critical Care finished first draft

  • Surgery, Psychiatry, Pediatrics, Oncology currently in process

  • Meeting with RCPS Education Office

Educating future physicians for palliative end of life care efppec

Looking Ahead

What s next

What’s Next?

  • Royal College specialty competencies

  • Learning commons

  • Developing palliative / EOLC questions in licensing / certification exams

  • Working with accreditors

  • Interprofessional project funding

  • Individual schools

  • Sustainability



  • An ambitious 4 year project to introduce effective teaching in end of life care and produce physicians who are competent in this area

Educating future physicians for palliative end of life care efppec


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