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This project focuses on enhancing medical education on end-of-life care by identifying areas for improvement in the current curriculum and outlining strategies for effective implementation. The current curriculum is front-loaded with limited interaction with actual patients until the third and fourth years, resulting in sparse exposure to end-of-life education. The plan includes making first and second-year experiences more memorable, increasing EOL/palliative care education in the third year, offering diverse electives in the fourth year, and providing extracurricular opportunities for interested students. The strategies involve incorporating specific lectures, test questions, clinical skills sessions, palliative care consultation rounds, and extracurricular programs. A grant from AMSA and student involvement in the curriculum committee signal progress towards improving education on issues concerning the end of life at East Carolina University.
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EOL @ ECU Improving Education Pertaining to Issues Concerning the End of Life Benjamin Dieter East Carolina University Class of 2007
OBJECTIVES • Identify current EOL curriculum @ ECU • Identify areas that need improvement • Outline a strategy to effectively implement improvements
Current Curriculum • First Year (covered in two courses only) • Behavioral Sciences: two 30 minute lectures (“Death and Dying” and “Bereavement”) followed by one 60 minute small group discussion • Ethical and Social Issues in Medicine I: three small group topics • “Advanced Directives” • “Assisted Suicide, Active and Passive Euthanasia, and Palliative Care” • “Dying Issues as in Tolstoy’s ‘The Death of Ivan Illyich’”
How First Years Treat Ethics and Behavioral Science zzzzzzzzz
Current Curriculum • Second Year • Clinical Skills Course: three sessions, 6hrs total • “Grief and Depression” lecture followed by small group with standardized patient ‘Elderly Woman in the Office After the Sudden Death of Her Husband’ • Only one student interviews • “Giving Bad News” lecture followed by standardized patient small group with ‘Man Receiving News of Non-resectable Pancreatic Cancer’ • Only one student interviews • Viewing of “Wit” with group discussion
Current Curriculum • Second Year (continued) • Psychopathology – one session • 30 minute “Death and Dying” lecture followed by sixty minute small group discussion on the similarities and differences in the perspectives on dying and death among patients, family members, and physicians • Ethical and Social Issues in Medicine II – two sessions • “Conflict Over Life Sustaining Care: The Case of Terri Schiavo” • “Medical Futility”
Current Curriculum • Second Year (concluded) • Medical Pharmacology – two lectures • “Pain Management” and “Palliation” are covered in the Cancer Chemotherapy section
Current Curriculum • Third Year • Internal medicine rotation – one hour lunch session • 15 minute presentation followed by group discussion Getting Sparse...
Current Curriculum • Fourth Year • Medical Humanities elective “Death and Dying: Philosophical and Moral Issues” – one month long 5 hrs/wk for 4 weeks Party Time
Room for Improvement • Thoughts: • ECU’s curriculum is (understandably) front-loaded • No interaction with true patients until third and fourth year at which point specific EOL education exposure becomes sparse • Thus students will only be exposed if the clinicians they work with are skilled at addressing EOL issues/palliative care AND actively seek to involve students • This current state of affairs does not guarantee each student the appropriate tools to address EOL issues and palliative care as a first year intern
Room for Improvement • Specific areas to improve: • Make exposure in first and second year more memorable • Increase EOL/palliative care education experiences in third year • Offer more diverse electives in fourth year • Provide students interested in issues of Death and Dying access to extracurricular education
THE PLAN • Step 1: Making First and Second year Experiences Stick • Physiology lecture: “Physiologic changes as Death nears: Correlation with the stages of dying” • Neuroscience lecture: “Brain-Death and PVS: Definitions and their clinical implications” • Devote test questions to these lectures (make sure to mention them in the review session!) • Incorporate all students into SP experiences in clinical skills sessions on EOL issues
THE PLAN • Step 2: Focused EOL/Palliative Care educational experiences in the third year • Palliative Care Consult team rounds bimonthly while on medicine, family medicine, and pediatrics • Emphasis by clerkship directors to residents on student presence at family meetings and delivering bad news with residents
THE PLAN • Step 3: Offering more electives dealing with EOL/palliative care issues in the fourth year • New elective “Palliative Care and Hospice Care” has been suggested, but needs student interest
THE PLAN • Step 4: Offering extracurricular exposure to those interested • Volunteer Program with Local Hospices for those interested • Death and Dying Interest Group • Meet monthly to conduct various learning modules, view movies, and organize lunch lectures
THE PLAN • Also on the Horizon… • ECU has just received a $15,000 grant from AMSA to implement changes in our geriatrics curriculum • Two classmates and I have been chosen to sit on the curriculum committee to provide student voices during the meetings….
