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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

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
“In some respects,
  • this century’s scientific and medical advances have made living easier and dying harder”
  • “Approaching Death”-The Institute of Medicine
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


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
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
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

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 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


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

5: Collaborate as a Member of an Interdisciplinary Team

6: Attend to Suffering

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
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