Improvements on the End of Life Care Curriculum at the University of Michigan Medical School

1. Improvements on the End of Life Care Curriculum at the University of Michigan Medical School William Cederquist (M2)

2. Lecture Outline • Part 1: A brief overview of the existing components of the End of Life Care curriculum • Part 2: The implementation of a formal network through which medical students can arranged field experiences with hospice and palliative care teams

3. Part 1: Current Curriculum Components: First year • Introduction to Hospice Care using the video “Letting Go: A Hospice Journey” • Recognize how personal experience will influence your attitude as a physician: video? “Journey of Death” • Learn how to identify and control non-pain symptoms at the end of life using a fictional case study: Hannah Rosen, a woman with metastatic breast cancer

4. Current Curriculum Components: Second year • Become familiar with the structure, purpose, and delivery of palliative care through a presentation by Adult Palliative Care Team and Pediatric Palliative Care Team • Understand how patients and families might express grief before, during and after a terminal illness with a lecture entitled “Grief and Loss” • Understand what constitutes pharmacologic and non-pharmacologic pain therapies (indications, side effects, dose equivalents, non-pharmacologic therapies)

5. Current Curriculum Components: Third year • Acquire skills for communicating with patients with life-threatening illness, and with their families. Standardized Patient Interview: “Breaking Bad News” • Recognize the importance of the doctor-patient relationship in making end-of-life decisions. Seminars in Medicine with video and discussion “Evan Mayday’s Good Death” • Recognize the importance of physician self-care with monthly Schwartz Rounds

6. Current Curriculum Components: Fourth year • Optional M4 hospice elective (1 month)

7. Part 2:Supplementing the curriculum • How can other medical students share the VITAS experience without having to come all the way to Florida? • A) Forge relationships with hospice and palliative care teams • B) Establish an M2 elective

8. Part 2a:Supplementing the curriculum • 1) Meet with medical director/team physician of the following groups: • Arbor Hospice • Hospice of Michigan • U of M Hospital Adult Palliative Care Consult Team • U of M Hospital Pediatric Palliative Care Consult Team • VA Hospital Palliative Care Team

9. Part 2a:Supplementing the curriculum • 2) Establish permanent contacts within the hospice/palliative care teams to allow students to follow interdisciplinary team members on a home visits. • 3) Launch the initiative with a lunch time lecture featuring interdisciplinary team members. Maintain those contacts long term through the End of Life Care Interest Group.

10. Part 2b: An M2 elective • In October of the M2 year two weeks are set aside for clinical experiences as part of the course “Clinical Foundations of Medicine.” • Each student chooses two electives, one for each week. Each elective is allotted 6 hours of time during the week.

11. Part 2b: An M2 elective (6 hours) • Midmorning lecture and lunch: 2 hours • Death Awareness Exercise (visualize Favorite place vs Final place) • What is hospice? Who is part of the interdisciplinary team? • When is hospice indicated? • Field visit: 4 hours • Field visit with hospice doctor, nurse, social worker or chaplain

12. Acknowlegments • The American Medical Student Association • The teams at VITAS Innovative Hospice Care especially Francine Samedy

13. Questions or comments?