Expanding Education about End of Life Care 2008 AMSA EOL Fellowship

1. Expanding Education about End of Life Care2008 AMSA EOL Fellowship Katie Burton-Wang Case Western Reserve University School of Medicine Class of 2011

2. Outline • Current curriculum • What’s missing • What works • Project goals • Project implementation

3. Current Curriculum • Foundations of Clinical Medicine: longitudinal • Patient-based programs • Communication in Medicine • Tuesday seminars • Weekly during years 1 and 2 • Monthly during year 3 • Physical Diagnosis • Goal: Facilitate transformation from student to doctor, focusing on the doctor/patient relationship, on the roles of physicians in systems and in society, on professionalism and leadership, and on clinical skills.

4. Current Curriculum: EOL • Goal: Students will explore attitudes, knowledge, and skills for physicians to effectively address issues of death and dying • Year 1 • 1 day observing a freestanding hospice unit • Year 2 • 2 sessions devoted to EOL issues

5. Current Curriculum: EOL • Small group discussions • Personal experiences and beliefs • May address culture, advance directives, spirituality, origins of hospice and palliative care • Large group discussions • Palliative care vs. hospice, family experiences with hospice • Skills practice • Breaking bad news, creating a living will, transitioning from curative to palliative care, eliciting patient concerns and beliefs about death/dying

6. What’s Missing? • Personal reflection about our own beliefs about death and dying • Hospice knowledge • e.g. interdisciplinary teams; Medicare • Specific information about advance directives • Integration of clinical and academic learning objectives • e.g. symptoms at end of life; pain management • Ethical concerns at the end of life

7. What Works • Establishing meaningful connection to the patients, families, and hospice team • Learning alongside motivated peers with shared interests and diverse backgrounds • Working in small groups • Applying knowledge in different contexts

8. Project Goals • Increase awareness and understanding of hospice and palliative care • Provide opportunities for in-depth clinical exposure to patients, families, and the hospice team • Encourage personal reflection about death and mortality • Help students address difficult topics • Improve integration with the biomedical curriculum

9. Project Implementation: Phase I • Goal: Enhance current curriculum • Videotaped sessions with standardized patients • Student shadowing of hospice teams • Panel on cultural and religious beliefs about death/dying • Small group discussion about ethics of EOL care

10. Project Implementation: Phase II • Goal: Develop 6-week elective on EOL care • Shadowing of hospice teams (longitudinal) • Small group sessions to complement clinical experience • Hospice team • Pain management • Activities to help students address beliefs/attitudes about death and mortality • Concept of the good death/dying well • Meet with families to learn about caregiver burden • Meet with doctors to discuss how death affects their practice

11. Thank you!