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Educating Future Physicians In Palliative And End Of Life Care Project: Successes & Challenges. Larry Librach MD,CCFP,FCFP Physician Leader EFPPEC W. Gifford Jones Professor Pain Control & Palliative Care University of Toronto.

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Educating future physicians in palliative and end of life care project successes challenges

Educating Future Physicians In Palliative And End Of Life Care Project:Successes & Challenges

Larry Librach MD,CCFP,FCFP

Physician Leader EFPPEC

W. Gifford Jones Professor Pain Control & Palliative Care

University of Toronto



Background
Background advances have made living easier and dying harder”

  • In 2003, Health Canada provided funding for a national education project for future physicians called EFPPEC

    • The project is heading into last 1 ½ years of its mandate

    • We gave a preliminary report 2 years ago


Project overall goal
Project Overall Goal advances have made living easier and dying harder”

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


Issues leading to the development of efppec

Issues Leading to the Development of EFPPEC advances have made living easier and dying harder”


The education work group of the canadian strategy on palliative end of life care
The Education Work Group of the Canadian Strategy on Palliative & End of Life Care

  • Interprofessional group

  • Identified core competencies for all health care professionals

  • Identified needs for education by surveys


End of life care needs of canadians
End of Life Care Needs of Canadians Palliative & End of Life Care

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

    Canadian Senate Report 2000 & 2005

  • Social responsibility of medical schools


Documented deficiencies in training future physicians
Documented Deficiencies In Training Future Physicians Palliative & End of Life Care

  • Oneschuk D, et al. The status of undergraduate palliative care education in Canada. J Pall Care. 2004;20:32-37

  • Noted lack of curriculum in all postgraduate residency programs


Palliative medicine
Palliative Medicine Palliative & End of Life Care

  • Recognition of palliative medicine as a specialty

    • Residency program

  • CSPCP

  • Academic expertise in education


All family physicians should be involved in providing palliative care

Not just Palliative Care specialists & teams Palliative & End of Life Care

Palliative care not just “at end”.

All Family Physicians Should Be Involved In Providing Palliative Care


The informal hidden curriculum
The Informal & Hidden Curriculum Palliative & End of Life Care

  • Influence of faculty as role models

    • Good & bad

  • Faculty behaviour & attitude influences residents

  • Implicit & explicit messages


The growth of palliative care
The Growth of Palliative Care Palliative & End of Life Care

  • More prominent organizations

    • CHPCS, QEOLCC

  • Norms of Practice

  • Regionalized care

    • Need to meet demands for PM physicians & care standards


Efppec structure

EFPPEC Structure Palliative & End of Life Care


Efppec partners
EFPPEC Partners Palliative & End of Life Care

  • AFMC is principal partner.

    • CHPCA is co-partner.

  • Health Canada funding

  • Office is located at CHPCA in Ottawa.


Efppec project team
EFPPEC Project Team Palliative & End of Life Care

  • Project Manager:

    • Louise Hanvey

  • Physician Leader:

    • Larry Librach

  • Administrative Assistant:

    • Jennifer Kavanagh


Efppec management committee
EFPPEC Management Committee Palliative & End of Life Care

  • Alan Neville (Chair)-McMaster University

  • Rob Wedel-U of Calgary

  • Hubert Marcoux- U of Laval

  • Paul Daeninck-U of Manitoba

  • Doreen Oneschuk-U of Alberta

  • Maryse Bouvette-MN

  • Sue Maskill-ACMC

  • Sharon Baxter-CHPCA

  • Gerard Yetman- Health Canada


Challenge integrate not usurp
Challenge: Palliative & End of Life CareIntegrate, Not Usurp

  • A curriculum that is already full.

  • Map out opportunities for integration

    Block SD et al. Journal of General Internal Medicine. 1998: 13(11):768-73,


Tasks status

Tasks & Status Palliative & End of Life Care


Enlist support of deans of all 17 medical schools
Enlist Support of Deans of All 17 Medical Schools Palliative & End of Life Care

  • Need for “top down” authorization

  • Easier than expected

    • AFMC accredits these schools & is sponsoring partner

    • All in favour and enthusiastic


Task 1 local team development

Task 1 Palliative & End of Life CareLocal Team Development


Background1
Background Palliative & End of Life Care

  • Every medical school has a somewhat different culture & blend of learning methods

  • Each school has curriculum that may have EOLC components that need to be identified

  • “Bottom up” approach


Tasks for local teams
Tasks for Local Teams Palliative & End of Life Care

  • Form an interprofessional team of educators

  • Identify team leader(s)

  • Implement a curriculum inventory tool & submit

  • Begin to integrate into curriculum committees & process for UG & PG

  • Attend first EFPPEC symposium


Results
Results Palliative & End of Life Care

  • All 17 have identified local teams & leaders

    • Most are very active

    • 3 are still struggling although getting more active

    • All teams are IP


Results1
Results Palliative & End of Life Care

  • Initial curriculum inventories done in the majority

    • 11 of 17

  • Good attendance at 1st symposium

  • Have established regular e-mail newsletters


Task 2 develop consensus on ug medicine basic competencies

Task 2 Palliative & End of Life CareDevelop Consensus on UG Medicine Basic Competencies


Background2
Background Palliative & End of Life Care

  • CSEOLC had developed core competencies

    • Used these to identify specific enabling competencies

    • Subjected these to national consensus building

      • PC, medical educators


Results of consensus building
Results of Consensus Building Palliative & End of Life Care

  • From a participant list of 327 medical educators, there were a total of 210 respondents, a response rate of 64.2%

  • Most items achieved consensus of around 90%

  • Changes suggested & incorporated


Ug medicine competencies
UG Medicine Competencies Palliative & End of Life Care

  • SEE HANDOUTS


Task 3 develop ug curriculum guidelines based on competencies

Task 3 Palliative & End of Life CareDevelop UG Curriculum Guidelines Based on Competencies


Background3
Background Palliative & End of Life Care

  • There had been a previous attempt at defining curriculum objectives in palliative / EOLC

    • Too long

    • Not the “right” time

  • Local & provincial efforts had started by consensus that a national document would carry more weight


Tasks
Tasks Palliative & End of Life Care

  • Work with the UG Education Committee of the CSPCP, the Ontario group & the Québec Groups from the medical schools to see if efforts could be combined

    • Incorporate competencies, enabling competencies & limited specific objectives

  • Get national consensus on the curriculum guideline


Results2
Results Palliative & End of Life Care

  • Almost two year project to meld the efforts of groups

  • Draft produced & subjected to national survey

    • Fewer responses in total but good input from educators

    • Changes have been made & penultimate draft being reviewed before translating & publishing


Further tasks
Further Tasks Palliative & End of Life Care

  • Ensure the Medical Council of Canada exams incorporate EOLC questions & OSCEs


Task 4 continuing professional development

Task 4 Palliative & End of Life CareContinuing Professional Development


Background4
Background Palliative & End of Life Care

  • Recognition that many PC educators not well integrated into system in their schools partly because of lack of training to be educators

  • Feedback from PC people indicating their need for education on teaching, evaluation, program development etc.

  • Expressed need for education forum in EOLC


Tasks1
Tasks Palliative & End of Life Care

  • Establish an annual EFPPEC Symposium dedicated to teaching & learning in PEOLC

    • Partnered with an organization

    • IPE in nature


Results3
Results Palliative & End of Life Care

  • 2 EFPPEC Symposia have been held in conjunction with the 5 partner Canadian Association of Medical Education

    • First devoted to opinion leader development

    • Second with workshops & progress reports


Results4
Results Palliative & End of Life Care

  • Videoconferences

    • 4 so far

    • Across Canada

    • Inexpensive

    • Allow sharing of experiences


Challenges
Challenges Palliative & End of Life Care

  • How can this be sustained?

    • Expensive if current model maintained

  • Where & when to have the meeting

    • Most PC educators not at CAME meeting


Solutions
Solutions Palliative & End of Life Care

  • Move the meeting as a preconference to the annual CHPCA conference

    • 2007 in Toronto

    • CSPCP as partner

  • Incorporate an education stream throughout CHPCA conference


Task 5 postgraduate competencies in peolc

Task 5 Palliative & End of Life CarePostgraduate Competencies in PEOLC


Background5
Background Palliative & End of Life Care

  • Get an initial buy-in (“top-down”)

  • 2 accrediting organizations for PGME

    • CFPC & RCPSC

    • Need to identify & incorporate any competencies, enabling competencies & objectives for each specialty

    • Rely on accreditation to ensure basic training


Background6
Background Palliative & End of Life Care

  • Some literature examples but little Canadian activity

  • Need to avoid overwhelming objectives

  • Need to target specialties who need enhanced knowledge

    • e.g. oncology


Tasks2
Tasks Palliative & End of Life Care

  • Work with CFPC

    • Already had made some changes

    • Develop specific objectives in format of 4 principles as well

    • Consensus building

  • Work with RCPSC

    • Establish specific objectives & do consensus building


Results family medicine

Results-Family Medicine Palliative & End of Life Care


Palliative care fm training
Palliative Care & FM Training Palliative & End of Life Care

  • From the most recent edition of the CFPC’s Standards for Accreditation of Residency Training Programs (The “Red Book”), the following section has been included:

  • “Palliative and End of Life Care

    • Residents must learn the skills, knowledge, and attitudes related to the management of physical, psychological, social and spiritual needs of dying patients and their families. Residents must be familiar with medical and societal attitudes towards death and dying.”


Common competencies for family medicine residents
Common Competencies for Family Medicine Residents Palliative & End of Life Care

  • SEE HANDOUT


Results cfpc
Results-CFPC Palliative & End of Life Care

  • Have achieved consensus

  • National working group of family medicine programs & educators working on curriculum guidelines


Results rcpsc
Results-RCPSC Palliative & End of Life Care

  • Initial meetings with RCPSC to discuss mechanisms

  • Draft enabling competencies & objectives for:

    • Core medicine

    • Critical care

  • Groups working on pediatrics, oncology, core surgery


Results rcpsc1
Results-RCPSC Palliative & End of Life Care

  • Will move on other specialites

  • Need to go to specialty committees for vetting & then we will do similar consensus building


Task 6 communications

Task 6 Palliative & End of Life CareCommunications


Background7
Background Palliative & End of Life Care

  • Need to enhance networking & publicize efforts

  • EFPPEC Project materials to be developed


Tasks3
Tasks Palliative & End of Life Care

  • Bilingual materials that are constantly reviewed

  • Develop system for sharing info across programs

  • Do presentations & publish


Results efppec communications strategy
Results Palliative & End of Life CareEFPPEC Communications Strategy

  • Materials

  • Website

  • Reaching out to offer help


Results learning commons
Results Palliative & End of Life CareLearning Commons

  • PALLIUM product

  • On-line resource of materials

    • Registry & editing functions

    • Search capacity

    • Notification capacity

  • On-line workspace for projects

  • Still working out glitches


Challenges1
Challenges Palliative & End of Life Care

  • Sustaining the Learning Commons & identifying host site


Task 7 sustainability

Task 7 Palliative & End of Life CareSustainability


Challenges2
Challenges Palliative & End of Life Care

  • What to do when the money runs out?

  • What about an IPE effort?

  • Is there a potential for further funding?

    • Source?

  • Monitoring of changes


Summary
Summary Palliative & End of Life Care

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

  • [email protected]


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