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Transforming health care globally… through palliative care

Transforming health care globally… through palliative care. www.PalliativeMed.org www.IPCRC.net. Challenges in Teaching Palliative Medicine. Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicine at San Diego Hospice University of California San Diego

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Transforming health care globally… through palliative care

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  1. Transforming health care globally… through palliative care www.PalliativeMed.org www.IPCRC.net

  2. Challenges in Teaching Palliative Medicine Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicineat San Diego Hospice University of California San Diego University of Toronto

  3. Objective…A Road Map to Build Palliative Care Capacity in Sweden through education…

  4. Call to Action… Train ALL healthcare professionalsto provide palliative care…

  5. Dixon 6: Goals of Education & Implementation • Awareness / Attitudes • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization / SocietyIncrease palliative care capacity Dixon J. Evaluation and the Health Professions, 1978Ferris et al. Knowledge Insufficient for Change, 2001

  6. How will you teach…?

  7. How People Learn • Memory:Short  intermediate  long-term • 3 major facts / hour • Information retention per unit time • 10 minutes new information • 2 minutes rest to process it

  8. Principles of Learning in Healthcare • Practical • Participatory • Multiple demands Hank Slotnick, PhD, North Dakota

  9. Reading / Online Retention ? • Awareness / Attitudes • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization/Society

  10. Lectures Retention ? • Awareness / Attitudes Lectures 10 % • Knowledge • Skills • Behavior Change Experience • Patient / Family • Organization/Society

  11. Group Learning Retention ? • Awareness / Attitudes Lectures 10 % • Knowledge Small-group Cases 25 % • Skills Role-play 35 % • Behavior Change Experience • Patient / Family • Organization/Society

  12. Effective presentations‘ theater ’ • Movement • Body • Hands • Voice • Tone • Volume • Speed • Eye contact • Minimize distractions

  13. Who will you teach…?

  14. Palliative Care Skills... 1°Advanced SkillsCariology,Geriatrics,Oncology,Etc. 2°Expert skillsPalliative CareConsultants /Teams 1° Basic SkillsAll HealthcareProfessionals 3°AcademicPalliative Care

  15. Interdisciplinary Care Nurse Spiritual counselor Volunteer Family Psychologist Physician PATIENT Pharmacist Community Social worker Physical therapist Bereavement counselor

  16. What will you teach…?

  17. PC Skills... 1° Basic SkillsAll HealthcareProfessionals

  18. ‘ Buzz ’ Groups • 1 – 2 • 1 – 2

  19. General Doctors ?

  20. 1999

  21. EPEC 1999 • National consensus of 280 ethics, hospice, palliative care experts • Linda Emanuel, Principal Aim: To teach all physicians and other members of the interdisciplinary team the core skills of palliative care Not intended to make every clinician a palliative care expert

  22. EPEC 1999 • 4 plenary sessions • 12 modules • Open, train-the-trainer model • Widely accepted • Standard of practice ‘ inside ’

  23. First 15 Months in the USARobinson K, Sutton S, von Gunten CFet al, J of Palliative Medicine 2004 • Sample 200 of first 585 trainers touched • 120,000 professionals in 15 months • Estimated patients & families affected

  24. US Palliative Medicine Specialists • > 3.000 certified specialists • 80 % started training with EPEC

  25. End-of-LifeNursing Education Consortium Curriculum…

  26. Nurses ?

  27. ELNEC – Nursing Curricula, 2002 Oncology Version:Open Adaptable Reproducible Google:ELNEC

  28. Palliative Care Skills... 1°Advanced SkillsCariology,Geriatrics,Oncology,Etc.

  29. Doctors seeing Advance Illnesses ?

  30. 2007 The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  31. EPEC-O 2007 • National consensus of > 80 oncology experts Aim: To teach all oncologists and other members of the interdisciplinary cancer care team the advanced skills of palliative care Not intended to make every oncologista palliative care expert

  32. Multiple Issues that Cause Suffering

  33. Core Skills for Providing Palliative Care

  34. EPEC-O 2007 • 32 modules - 3 plenaries, 2 how to teach • Syllabus, slides • Open, adaptable • Video vignettes • Teaching strategies • Annotated bibliography • Hyperlinks to references online

  35. 2007 • Free CD / DVD • American Society of Clinical Oncology ( ASCO ) provides education credits • Online modules • Translations • Spanish • Ukrainian • www.IPCRC.net

  36. IPM Interdisciplinary Curriculum Will you translate any of these curricula ?

  37. A multi-yeareducation strategy to build palliative care capacity... www.PalliativeMed.org www.IPCRC.net

  38. Time ( yr ) 3 5 7 9 11 Sensitization Courses ( Basic & Advanced ) Visiting Scholars ( Expert Identification ) Fellowships ( Experts ) Leadership ( Leaders ) Scholars in Residence ( Education & Research )

  39. Nursing & Medical Trainees Nursing students • 9 schools UCSD Medical students Residents • Family practice • Internal medicine • Psychiatry Experiential ‘ bedside training ’ • Observational visits • Structured program • Electives

  40. PC in Curricula / Exams • In US Boards • In several specialty exams • 10 % of Medical Oncology Exam

  41. Physicians Practicingin San Diego • 10 % trained at UCSD School of Medicine • 33 % did their medical residency in San Diego

  42. Practicing Clinicians • Continuing education – optional or compulsory ? • In California • To get a new license, since 2002, obligatory to demonstrate training in palliative / end-of-life care • To renew license in 2006, 12 hours education in pain & palliative care ( AB 487 )

  43. Conference Presentations • Oncology • Cardiology • Geriatrics • Elder Care • Nephrology

  44. Many Domestic & International Partners

  45. In-Country Courses 3-5 day, 2 & 3 week 2004 – Jordan 32 2005 – Jordan 72 2006 – Mongolia 75 2007 – Jordan 50 Georgia 50 Mexico 75 2008 – Georgia – 75 Vietnam 75 Saudi Arabia 150 2009 – Ukraine 95 Egypt 105 Slovenia 50 2010 – Ukraine 36 Salzburg 40 MECC 50 2011 – Georgia 75 Vietnam 100 Cyprus 55 Turkey 52

  46. First dose of oral morphine – Al Basheer Hospital

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