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  1. Educating Future Physicians for Palliative/End of Life Care: EFPPEC Paul Daeninck MD MSc FRCPC Louise Hanvey BN MHA for the EFFPEC project team

  2. Topics • Need for Palliative Care • EFPPEC overview • Progress • Future work

  3. 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

  4. 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

  5. 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

  6. 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

  7. Canadians Expect It ! • “Quality End-of-life Care: The Right of Every Canadian” • Canadian Senate Report 2000/05 • Social responsibility of medical schools

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

  9. How Well Are We Preparing Our New Physicians?

  10. 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

  11. 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

  12. Palliative Care in Medical Schools Oneschuk D, et al. J Pall Care. 2004;20:32-37

  13. 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

  14. 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

  15. Palliative Medicine Training For Family Medicine Residents Oneschuk D, Bruera E. Pall Med 1998

  16. Palliative Care: Not Just About Dying & Death

  17. What can Palliative Care Offer? • Interdisciplinary Collaboration • Self-awareness / Reflection • Spiritual & Psychosocial Care • Experience of Suffering • Ethics • Complementary & Alternative Medicine

  18. 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

  19. Summary Messages • Patients need & want better EOL care • Students & residents need & want better EOL skills • Role models needed • Experiential learning opportunities

  20. Project Outline LH

  21. 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

  22. 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

  23. EFPPEC Project Team • Project Manager: • Louise Hanvey • Physician Leader: • Larry Librach • Administrative Assistant: • Jennifer Kavanagh

  24. 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

  25. EFPPEC Partners • Professional Partnerships • CASN • Canadian Ass’n of Faculties of Pharmacy • CAPPE • CASW • Professional Resource Groups • CSPCP • RCPSC/CFPC • MCC

  26. Philosophy • 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

  27. 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

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

  29. 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

  30. EFPPEC Objectives • Facilitate the introduction of palliative and EOLC questions in licensing/certification exams • Develop network of educators • Develop a resource of programs

  31. “Top down, bottom up”approach

  32. 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

  33. 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

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

  35. 1: Address & Manage Pain & Symptoms 2: Address Psychosocial & Spiritual Needs 3: Address End-of-life Decisions & Planning using Bioethical & Legal Frameworks

  36. 4: Communicate Effectively with Patients, Families, & Other Caregivers 5: Collaborate as a Member of an Interdisciplinary Team 6: Attend to Suffering

  37. Progress: Where are we at?

  38. 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

  39. 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

  40. Video Conferences • Two so far • Successful in getting people to share their successes and challenges • Facilitates communication • Not all teams involved as yet

  41. 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

  42. Learning Commons • Developed with the help of the Pallium Project • Website for sharing information and educational programs • Unique features • Forum • Searchable • Notification of subscribers

  43. Communications • Developing communication strategy: • Logo and branding • Website (www.efppec.ca) • Newsletters & other forms of regular communications with local teams • Symposia • Conference presentations & booths • Visits to university faculties

  44. Evaluation • 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

  45. 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

  46. 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

  47. 2007 Symposium • Planning underway • Likely in Fall, ? CHPCA Annual Meeting • Interprofessional meeting • Review of local team progress • Faculty development • Sustainability

  48. 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

  49. 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

  50. 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