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Educating Future Physicians In Palliative And End Of Life Care Project: Successes & Challenges. Larry Librach MD,CCFP,FCFP Physician Leader EFPPEC W. Gifford Jones Professor Pain Control & Palliative Care University of Toronto.

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educating future physicians in palliative and end of life care project successes challenges

Educating Future Physicians In Palliative And End Of Life Care Project:Successes & Challenges

Larry Librach MD,CCFP,FCFP

Physician Leader EFPPEC

W. Gifford Jones Professor Pain Control & Palliative Care

University of Toronto

“In some respects, this century’s scientific and medical advances have made living easier and dying harder”

“Approaching Death”-The Institute of Medicine

  • In 2003, Health Canada provided funding for a national education project for future physicians called EFPPEC
    • The project is heading into last 1 ½ years of its mandate
    • We gave a preliminary report 2 years ago
project overall goal
Project Overall Goal
  • By the year 2008, all undergraduate medical students and the residents at Canada’s 17 Medical Schools will be receiving effective training in palliative and end-of-life care and will graduate with competencies in these areas.
the education work group of the canadian strategy on palliative end of life care
The Education Work Group of the Canadian Strategy on Palliative & End of Life Care
  • Interprofessional group
  • Identified core competencies for all health care professionals
  • Identified needs for education by surveys
end of life care needs of canadians
End of Life Care Needs of Canadians
  • “Quality End-of-life Care: The Right of Every Canadian”

Canadian Senate Report 2000 & 2005

  • Social responsibility of medical schools
documented deficiencies in training future physicians
Documented Deficiencies In Training Future Physicians
  • Oneschuk D, et al. The status of undergraduate palliative care education in Canada. J Pall Care. 2004;20:32-37
  • Noted lack of curriculum in all postgraduate residency programs
palliative medicine
Palliative Medicine
  • Recognition of palliative medicine as a specialty
    • Residency program
  • Academic expertise in education
the informal hidden curriculum
The Informal & Hidden Curriculum
  • Influence of faculty as role models
    • Good & bad
  • Faculty behaviour & attitude influences residents
  • Implicit & explicit messages
the growth of palliative care
The Growth of Palliative Care
  • More prominent organizations
  • Norms of Practice
  • Regionalized care
    • Need to meet demands for PM physicians & care standards
efppec partners
EFPPEC Partners
  • AFMC is principal partner.
    • CHPCA is co-partner.
  • Health Canada funding
  • 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
  • Rob Wedel-U of Calgary
  • Hubert Marcoux- U of Laval
  • Paul Daeninck-U of Manitoba
  • Doreen Oneschuk-U of Alberta
  • Maryse Bouvette-MN
  • Sue Maskill-ACMC
  • Sharon Baxter-CHPCA
  • Gerard Yetman- Health Canada
challenge integrate not usurp
Challenge: Integrate, Not Usurp
  • A curriculum that is already full.
  • Map out opportunities for integration

Block SD et al. Journal of General Internal Medicine. 1998: 13(11):768-73,

enlist support of deans of all 17 medical schools
Enlist Support of Deans of All 17 Medical Schools
  • Need for “top down” authorization
  • Easier than expected
    • AFMC accredits these schools & is sponsoring partner
    • All in favour and enthusiastic
  • Every medical school has a somewhat different culture & blend of learning methods
  • Each school has curriculum that may have EOLC components that need to be identified
  • “Bottom up” approach
tasks for local teams
Tasks for Local Teams
  • Form an interprofessional team of educators
  • Identify team leader(s)
  • Implement a curriculum inventory tool & submit
  • Begin to integrate into curriculum committees & process for UG & PG
  • Attend first EFPPEC symposium
  • All 17 have identified local teams & leaders
    • Most are very active
    • 3 are still struggling although getting more active
    • All teams are IP
  • Initial curriculum inventories done in the majority
    • 11 of 17
  • Good attendance at 1st symposium
  • Have established regular e-mail newsletters
  • CSEOLC had developed core competencies
    • Used these to identify specific enabling competencies
    • Subjected these to national consensus building
      • PC, medical educators
results of consensus building
Results of Consensus Building
  • From a participant list of 327 medical educators, there were a total of 210 respondents, a response rate of 64.2%
  • Most items achieved consensus of around 90%
  • Changes suggested & incorporated
  • There had been a previous attempt at defining curriculum objectives in palliative / EOLC
    • Too long
    • Not the “right” time
  • Local & provincial efforts had started by consensus that a national document would carry more weight
  • Work with the UG Education Committee of the CSPCP, the Ontario group & the Québec Groups from the medical schools to see if efforts could be combined
    • Incorporate competencies, enabling competencies & limited specific objectives
  • Get national consensus on the curriculum guideline
  • Almost two year project to meld the efforts of groups
  • Draft produced & subjected to national survey
    • Fewer responses in total but good input from educators
    • Changes have been made & penultimate draft being reviewed before translating & publishing
further tasks
Further Tasks
  • Ensure the Medical Council of Canada exams incorporate EOLC questions & OSCEs
  • Recognition that many PC educators not well integrated into system in their schools partly because of lack of training to be educators
  • Feedback from PC people indicating their need for education on teaching, evaluation, program development etc.
  • Expressed need for education forum in EOLC
  • Establish an annual EFPPEC Symposium dedicated to teaching & learning in PEOLC
    • Partnered with an organization
    • IPE in nature
  • 2 EFPPEC Symposia have been held in conjunction with the 5 partner Canadian Association of Medical Education
    • First devoted to opinion leader development
    • Second with workshops & progress reports
  • Videoconferences
    • 4 so far
    • Across Canada
    • Inexpensive
    • Allow sharing of experiences
  • How can this be sustained?
    • Expensive if current model maintained
  • Where & when to have the meeting
    • Most PC educators not at CAME meeting
  • Move the meeting as a preconference to the annual CHPCA conference
    • 2007 in Toronto
    • CSPCP as partner
  • Incorporate an education stream throughout CHPCA conference
  • Get an initial buy-in (“top-down”)
  • 2 accrediting organizations for PGME
    • CFPC & RCPSC
    • Need to identify & incorporate any competencies, enabling competencies & objectives for each specialty
    • Rely on accreditation to ensure basic training
  • Some literature examples but little Canadian activity
  • Need to avoid overwhelming objectives
  • Need to target specialties who need enhanced knowledge
    • e.g. oncology
  • Work with CFPC
    • Already had made some changes
    • Develop specific objectives in format of 4 principles as well
    • Consensus building
  • Work with RCPSC
    • Establish specific objectives & do consensus building
palliative care fm training
Palliative Care & FM Training
  • From the most recent edition of the CFPC’s Standards for Accreditation of Residency Training Programs (The “Red Book”), the following section has been included:
  • “Palliative and End of Life Care
    • Residents must learn the skills, knowledge, and attitudes related to the management of physical, psychological, social and spiritual needs of dying patients and their families. Residents must be familiar with medical and societal attitudes towards death and dying.”
results cfpc
  • Have achieved consensus
  • National working group of family medicine programs & educators working on curriculum guidelines
results rcpsc
  • Initial meetings with RCPSC to discuss mechanisms
  • Draft enabling competencies & objectives for:
    • Core medicine
    • Critical care
  • Groups working on pediatrics, oncology, core surgery
results rcpsc1
  • Will move on other specialites
  • Need to go to specialty committees for vetting & then we will do similar consensus building
  • Need to enhance networking & publicize efforts
  • EFPPEC Project materials to be developed
  • Bilingual materials that are constantly reviewed
  • Develop system for sharing info across programs
  • Do presentations & publish
results efppec communications strategy
ResultsEFPPEC Communications Strategy
  • Materials
  • Website
  • Reaching out to offer help
results learning commons
ResultsLearning Commons
  • PALLIUM product
  • On-line resource of materials
    • Registry & editing functions
    • Search capacity
    • Notification capacity
  • On-line workspace for projects
  • Still working out glitches
  • Sustaining the Learning Commons & identifying host site
  • What to do when the money runs out?
  • What about an IPE effort?
  • Is there a potential for further funding?
    • Source?
  • Monitoring of changes
  • An ambitious 4 year project to introduce effective teaching in end of life care and produce physicians who are competent in this area