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Palliative Care Skills. 2 ° Expert skills Palliative Care Consultants / Teams. Palliative Medicine Specialists. 2006 ABMS recognized subspecialty 10 of the 24 parent boards 12 month US fellowship, > 71 graduates. Class of 2011 - 2012.

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Palliative care skills

Palliative Care Skills...

2°Expert skillsPalliative CareConsultants /Teams


Palliative medicine specialists
Palliative Medicine Specialists

  • 2006 ABMS recognized subspecialty

    • 10 of the 24 parent boards

  • 12 month US fellowship, > 71 graduates

Class of 2011 - 2012


2006 palliative medicine recognized as subspecialty by american board of medical specialties
2006 – Palliative Medicine Recognized as Subspecialty by American Boardof Medical Specialties

  • 1 year Fellowship orExperiential qualification( 2006 – 2013 only)

    • Oversight: American Committee Graduate Medical Education

    • Accreditation: American Academy of Family Practice

  • Certification exam

    • Multiple choice

    • ABIM: American Board of Internal Medicine


10 sponsoring specialties
10 Sponsoring Specialties American Board

Internal Medicine

Physical Medicine & Rehab

Psychiatry & Neurology

Radiology (XRT)

Emergency Medicine

Pediatrics

Surgery

OB / GYN

Family Medicine

Anesthesiology

Hospice

and

Palliative Medicine


Next steps
Next Steps American Board

  • Clinical

    • Competencies

    • Outcomes

  • Teaching skills

    • Presentation

    • Facilitation

    • Bedside mentorship

  • Leadership skills

  • Research project


360 evaluation
360° Evaluation American Board

  • Patient and family care

  • Medical knowledge

  • Practice-based learning and improvement

  • Communication and interpersonal skills related to process of providing care

  • Professionalism

  • System based practice


Ipm us fellows employment
IPM US Fellows Employment American Board

7 San Diego

10 Los Angeles

1 Hawaii

1 New Zealand


10 sponsoring specialties1
10 Sponsoring Specialties American Board

Internal Medicine

Physical Medicine & Rehab

Psychiatry & Neurology

Radiology (XRT)

Emergency Medicine

Pediatrics

Surgery

OB / GYN

Family Medicine

Anesthesiology

Hospice

and

Palliative Medicine


Palliative care skills

Palliative Medicine Fellowship… American Board

Developing Clinical Capacity


Hypothesis
Hypothesis American Board

Training palliative medicine specialists will advance palliative care delivery and increase opioid consumption


Int l p alliative medicine fellowship
Int’l American BoardPalliative Medicine Fellowship

  • Over 24 - 36 months

    • 4 – 6 months at San Diego Hospice

    • 2 visit by IPMFaculty in-country

    • Competency-based

    • Practical bedside mentorship, not observership


International fellows
International Fellows American Board


Pilot 11 int l fellow graduates
Pilot: 11 Int’l Fellow Graduates American Board

  • Demonstrated competencies to IPM faculty

    • All recognized as consultants

    • 3 Jordan

    • 2 Georgia

    • 2 Mongolia

    • 1 Slovenia

    • 1 Spain

    • 2 Vietnam


King hussein cancer center jordan
King Hussein Cancer Center Jordan American Board

  • 2 fellow graduates  consultants


King hussein cancer center jordan1
King Hussein Cancer Center Jordan American Board

  • Built palliative care program

    • 2 palliative medicine consultants

    • > 50 staff

    • 10-bed inpatient unit ( of 140 beds )

    • Inpatient consults

    • Ambulatory outpatient clinics

    • Homecare

    • Saw > 2,000 patients in 5 years ( since October 2004 )


Khcc pall care growth

New Patients American Board

KHCCPallCareGrowth

Length of Stay


Khcc outpatient opioid consumption
KHCC Outpatient Opioid Consumption American Board

2004 - 2.7 kg 2006 - 5.3 kg 2008 - 6.2 kg


Jordan opioid consumption
Jordan Opioid American BoardConsumption

INCB 1980-2008 Morphine Use in Jordan ( mg / capita )

≈ 11.8 kg

4x 

≈ 2.9 kg


Urska lunder ljubljana slovenia
Urska Lunder American BoardLjubljana, Slovenia

  • Medical Director, Palliative Care, Golnik Hospital

    • 19 bed unit, consultation service, home care

  • MoH Pilot Pathway Project - 3 regions

  • Teaching extensively

    • Faculty European School of Oncology

  • European Union Research on EOL

  • IPM Leadership Development Initiative


Gantuya tserendorj ulaanbaatar mongolia
Gantuya Tserendorj American BoardUlaanbaatar, Mongolia

  • Medical Director, Palliative Care, National Cancer Center

    • 16 bed unit, consultation service, outpatient clinics

  • MoH agreed to pay for PC services

  • Teaching regularly across Mongolia

  • Member Board of Directors new Foundation of First Lady of Mongolia dedicated to vaccination & palliative care


Mongolia june 2009
Mongolia June 2009 American Board


Reach of 11 fellows
Reach of 11 Fellows American Board

Direct: If each cares / influences careof 1,000 pts / yr, for 30 yr

Patients Lives Each Touched11 Fellows 30,000330,000 + families

Indirect: Teaching, research, advocacy


Next step
Next Step American Board

  • Expanded international pilot project

    • NCI R25E grant 2011 – 2015

    • 20 Fellows

      • Cyprus 2 Ghana 2 Tanzania 2

      • Egypt 1 ( + 1 ) Italy 1 ( + 1 ) Uganda 2

      • Georgia 3 Peru 1

    • Others… Brazil, Colombia, Rwanda ?

  • US pilot project

    • Address workforce shortage


Palliative care skills

Growing Global Leaders… American BoardAdvancing Palliative Care


Cohort 2 23 leaders 10 mentors
Cohort 2: American Board23 Leaders, 10 Mentors

Romania

2 Mongolia

Serbia

Nepal

Armenia

Turkey

Albania

Bangladesh

Guatemala

4 India

2 Vietnam

Nigeria

Colombia

Uganda

Kenya

Brazil

South Africa

Argentina


Cohort 2 23 leaders 10 mentors1
Cohort 2: American Board23 Leaders, 10 Mentors

Sweden

Canada

UK

Germany

Belgium

USA

India

Uganda

Australia

Argentina


5 practices of exemplary leaders
5 Practices of Exemplary Leaders… American Board

  • Model the way

  • Inspire a shared vision

  • Challenge the process

  • Enable others to act

  • Encourage the heart


Niche over 2 years
Niche… Over 2 years American Board

Develop Individual Development Plan ( IDP )

  • Build leadership skills ( self )

    • Residential courses - curriculum

    • Coaching

  • Apply leadership skills inpractical palliative care activities

    • Mentorship by senior palliative care leaders

  • Advancepalliative care capacitylocally, regionally, globally


Foster leadership skills
Foster Leadership Skills American Board


Attitudes about leadership
Attitudes about Leadership American Board

Positive

Negative

p = 0.0005

p = 0.05

Before

Retrospective

After


Leadership core skills
Leadership Core Skills American Board

All p < 0.003

Regional /International

Organizational

Self


Sample outcomes to date

Sample outcomes American Boardto date…


Palliative care activities latin america
Palliative Care Activities… American BoardLatin America

  • New PC undergraduate medical education curriculum 2 universities

  • Beginning interdisciplinary post-graduate courses

  • Improving PC E-learning course for doctors & nurses


Palliative care activities czech republic
Palliative Care Activities… American BoardCzech Republic

  • Regular multi-disciplinary meetings in Cancer Institute,  referrals

  • New website for Czech Society of Palliative Care

  • Palliative medicine recognized as new medical specialty


Palliative care activities africa
Palliative Care Activities… American BoardAfrica

  • Integrating PC into medical, nursing & dental schools

  • Integrate palliative care in 10 hospitals in country

  • Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies


Palliative care activities vietnam
Palliative Care Activities… American BoardVietnam

  • First Dept. PC Ho Chi Minh Cancer Center

    • Beginning home care

  • New PC unit Hanoi

  • Vietnamese E-learning in PC


International scholar in residence dr staffan lundstr m stockholm sweden
International American BoardScholar-in-ResidenceDr. Staffan LundströmStockholm, Sweden


International reach 2003 2015
International Reach 2003 – 2015 American Board

Patients Participants Each Lives

  • Presentations > 10,000 100 1 M

  • Courses > 500 2000 1 M

  • Fellows 11 + 20 10,000+ .3 M+

  • Leaders 19 + 23 10,000+ .4 M+

    > 2,7 M+


Key message

Key Message American Board

A consistent, planned approach to education interventions and evaluation over 5-10 years changesbehaviors and the experiences ofpatients and families, organizations and societies


Mohammad bushnaq at end of fellowship
Mohammad Bushnaq American Boardat End of Fellowship…

“ Overall, I can say it very clear that: my experience with palliative care not only changed my career, but also the way I am looking to the life, the way I communicating with people,the way I am trying to understand others, and how you can be a happy person by working for noble ideas…


Mohammad bushnaq
…Mohammad Bushnaq American Board

“ I truly believe that palliative care is NOT limited to terminally ill patients, or even for sick person; but also it is the answer for all people on earth, for nations as a language to replace the language of conflict between nations we hear everyday in the media.


Call to action in sweden
Call to Action in Sweden American Board

  • Education

    • Standardized curricula

      • Trainees - students, residents

      • Practicing professionals

    • Specialty recognition

      • Fellowship training


Palliative care skills

“ The standards of practice we create American Boardand the people we trainwill look after uswhen it’s our turn to receive care… ”Will Sweden be ready ?


Palliative care skills

You must be the change you want to see in the world American Board

Gandhi

www.PalliativeMed.org www.IPCRC.net