Education and Palliative Care: A challenge for all disciplines

1. Education and Palliative Care: A challenge for all disciplines Jim Hallenbeck, MD Kelley Skeff, MD, PhD.

2. Working Assumptions • Historically, education focused on end-of-life (or palliative care) has been inadequate relative to need • Educational deficiencies not just physician issues • Also problems for nurses, social workers, psychologists, chaplains and pharmacists

3. Evidence Base • Physicians: Of 27 interns interviewed on Hospice rotation, only 1/27 recalled learning anything about pain in Med School* • Nurses: Of over 5000 pages of nursing textbook pages reviewed, constipation addressed on only 12 pages ** *Hallenbeck, **Ferrell

4. Educational Domains • Death and Dying in the USA • Pain Management • Non-Pain Symptom Management • Communication • Difficult Decisions • Psychosocial/Spiritual Care • Venues of Care, System Issues SFDC ELC (End-of-Life) Course

5. Palliative Care Fellowship Educational Domains •               Death and Dying in Society •               Physical symptoms               • Communication •              System Issues •               Ethics and Legal Issues •             Interprofessional Care •         Spirituality/Meaning •         Education •                Children and Palliative Care •         Research methodology

6. Barriers to Improved Education • Educational Inertia – ‘we’ve always done it this way’ • Competing vested interests • Cultural biases • In world of Medicine • In society at large • Arrogance/ignorance phenomenon

7. Weissman et al. Survey of Internal Medicine residents and faculty Ignorance… Mean % Correct

8. Despite minimal differences in knowledge… Arrogance • Interns admitted knowledge and skill deficits and were concerned about their competency = TENSION • Residents and faculty less concerned about ability to practice and teach palliative care • Many faculty – What ME worry?

10. Like a battery… Learning requires TENSION to work So where’s the tension in the learner?

11. Tension – Overt and Covert • Overt tension – what people verbally identify as the problem • Covert tension – unspoken, sometimes unconscious tension

12. Dealing with Tension • When tension is overt • Learners open to learning new knowledge and skills • When tension is covert • Attitude objectives are primary, especially – • Making covert tension overt

13. Good news • Clinicians become clinicians for the right reasons – they want to help people • Both clinicians and lay public are bothered by the current state of affairs in healthcare – i.e. tension exists for positive change • Many new exiting educational opportunities for training in end-of-life care exist

14. Educational Opportunities • EPEC (educating physicians about end-of-life care) • ELNEC (end-of-life nursing education consortium) • ELC (end-of-life care) Stanford course • VA Palliative Care Network/Learning Center at: http://vaww.webboard.med.va.gov:8040/~eol

15. A Canary in a Coal Mine • Most of the important educational issues in end-of-life care are important in ‘non-end-of-life’ care • Comfort • Respect • Good Communication It is not just the imminently dying who wish to be as comfortable as possible in their illnesses and who wish to be treated with respect