educating future physicians for palliative/end of life care: efppec paul daeninck md msc frcpc...
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Educating Future Physicians for Palliative/End of Life Care:
EFPPEC
Paul Daeninck MD MSc FRCPC
Louise Hanvey BN MHA
for the EFFPEC project team
TopicsNeed for Palliative Care
EFPPEC overview
Progress
Future work
What do Patients & Families Want?
CompetenceCompassionPain and symptom managementClear decision makingPreparation for deathAffirmation of the whole person
Steinhauser KE et al. Ann Intern Med 2000;132:825-32
A Good Death:Patient Perspectives
5 dimensions of a good deathPain/symptom managementAvoiding prolongation of dyingAchieving a sense of controlRelieving burden on othersStrengthening relationships with
loved onesSinger PA et al JAMA 1999;281:163-8
End of Life Wishes: Seriously Ill Pts & Families
Questionnaire of patients and families
N=440/160, cancer and chronic diseasesTrust and confidence in the doctors looking after you
Not to be kept alive on life support when there is little hope for a meaningful recovery
Information about your disease communicated to you by your doctor in an honest manner
To complete things and prepare for life’s end
CMAJ 2006:174; DOI:10.1503/cmaj050626
Growing needs“Trends suggest that by 2010 cancer will be the leading cause of death in Canada”
Canadian Cancer Society
2004“By 2016, > 20% of population
will be 65 years or older”
Health Canada 2000
Canadians Expect It !
“Quality End-of-life Care: The Right of Every Canadian”
Canadian Senate Report 2000/05
Social responsibility of medical schools
“In some respects,
this century’s scientific and medical advances have made living easier and dying harder”
“Approaching Death”-The Institute of Medicine
How Well Are We Preparing Our New
Physicians?
Palliative Care in Medical Schools
None: 3
Mandatory rotation: 2
Elective only: 11
Less than 5% (0%-15%) of students participate
Oneschuk D, et al. J Pall Care. 2004;20:32-37
n=16, 2001
“Integrated” in other sessions: 6
Independent program: 6
Supervised patient encounters: 4
Mean # of hours: 11 (3-22)
Multidisciplinary faculty: 3
Oneschuk D, et al. J Pall Care. 2004;20:32-37
n=16, 2001
Palliative Care in Medical Schools
Exposure Year # of Med Schools
One 8 (50%)
Two 12 (75%)
Three 6 (38%)
Four 5 (31%)
Palliative Care in Medical Schools
Oneschuk D, et al. J Pall Care. 2004;20:32-37
What do Medical Students Want?
83% of students favoured ↑ pall. care educationOneschuk et al. J Palliat Med 2001
Exit surveys by AAMC/AFMC: medical students feel unprepared in the areas of palliative & EOL care
Direct or indirect experience with terminal illness increased their request for more palliative care
Oneschuk et al. J Palliat Med 2002;5:353-361
All Specialties Provide Palliative Care
All physicians during the course of their professional lives will be involved in caring for a patient with an incurable illnessPalliative care not just “at the end”
Palliative Medicine Training For Family Medicine Residents
Oneschuk D, Bruera E. Pall Med 1998
Mandatory rotation in palliative care? 5/16
Median length of rotation 2 wks
Elective time in palliative care for family medicine residents
16/16
Median length of rotation 3 1/2 wks
Median number of residents participating
10%
Specific faculty positions for palliative medicine
9/16
Palliative Care: Not Just About Dying & Death
What can Palliative Care Offer?
Interdisciplinary Collaboration
Self-awareness / Reflection
Spiritual & Psychosocial Care
Experience of Suffering
Ethics
Complementary & Alternative Medicine
Challenge: Integrate, not usurp
A curriculum that is already full
Map out opportunities for integration
Block SD et al.
J Gen Int Med. 1998;13:768-73
Summary Messages
Patients need & want better EOL care
Students & residents need & want better EOL skills
Role models needed
Experiential learning opportunities
LH
Project Outline
Project Overall Goal
By the year 2008, all under-graduate medical students and the residents at Canada’s 17 Medical Schools will receive effective training in palliative and end-of-life care and will graduate with competencies in these areas
EFPPEC PartnersAssociation of Faculties of Medicine Canada
(AFMC) principal partner/CHPCA co-partner
Health Canada funding & close involvement of Canadian Strategy on Palliative/End of Life Care Working Group on Formal Caregiver Education
Office is located at CHPCA in Ottawa
EFPPEC Project Team
Project Manager:
Louise Hanvey
Physician Leader:
Larry Librach
Administrative Assistant:
Jennifer Kavanagh
EFPPEC Management Committee
Alan Neville (Chair) - McMaster UniversityPaul Daeninck - U of ManitobaDoreen Oneschuk - U of AlbertaHubert Marcoux – Université LavalRobert Wadel - U of CalgaryMaryse Bouvette - CASNSue Maskill - AFMCSharon Baxter - CHPCA
EFPPEC Partners Professional Partnerships
CASNCanadian Ass’n of Faculties of PharmacyCAPPECASW
Professional Resource GroupsCSPCPRCPSC/CFPCMCC
PhilosophyBuild on present state in medical
schools by forming/facilitating local teams
Identify common competencies in EOLC and examine to those competencies
Assist in the development of curricula and clinical experiences
Evaluation is a key component
EFPPEC Objectives
Develop an interprofessional team (from various disciplines/specialties) at each university to identify gaps/opportunities related to palliative and EOLC at their university
Develop a strategy to address the gaps and implement the strategy
Support development of consensus-based palliative and EOLC common competencies for undergraduates in medicine and for postgraduate trainees in key clinical specialties
EFPPEC Objectives
Facilitate introduction of curriculum based on common competencies for all undergraduate & clinical postgraduate trainees at each medical school
Empower faculty from various specialties to become palliative and EOLC mentors/role models
EFPPEC Objectives
Facilitate the introduction of palliative and EOLC questions in licensing/certification exams
Develop network of educators
Develop a resource of programs
EFPPEC Objectives
“Top down, bottom up”approach
Top Down Approach
All 17 deans in agreement
Certification colleges in agreement
accreditation of residency programs with a component of EOLC
AFMC will accredit medical schools with EOLC as component
Bottom Up Approach
National input and consensus
Local team formation
Interdisciplinary focus
Identification of local champions
Changes at the local university level
Assist in faculty development
Common Competencies
Competencies developed based on those of the Canadian Strategy on Palliative/End of Life Care Working Group on Formal Caregiver Education
1: Address & Manage Pain & Symptoms
2: Address Psychosocial & Spiritual Needs
3: Address End-of-life Decisions & Planning using Bioethical & Legal
Frameworks
5: Collaborate as a Member of an Interdisciplinary Team
6: Attend to Suffering
4: Communicate Effectively with Patients, Families, & Other Caregivers
Progress: Where are
we at?
Local TeamsTeam leader identified at each med schoolAll but 3 medical schools activeTeam leaders form interdisciplinary
stakeholder teams to:Familiarize them with the goals of EFFPECInventory their local curricula in EOLCBuild consensus around the competencies
Local TeamsProject team to obtain relevant info from
professional resources with feed back to local teams
Local teams to share info with others across Canada, e.g. effective programs, innovations
Local teams to enhance and deliver local EOLC curricula
Video Conferences
Two so far
Successful in getting people to share their successes and challenges
Facilitates communication
Not all teams involved as yet
University of MB TeamLocal Leader: Dr. Marcelo Garcia
Team members identified
Local curriculum reviewed, gaps identified
Working with University to integrate
Presently have approx. 15 contact hrs
Related areas may double contact
Experiential learning electives possible
Learning CommonsDeveloped with the help of the Pallium
ProjectWebsite for sharing information and
educational programsUnique features
ForumSearchableNotification of subscribers
CommunicationsDeveloping communication strategy:
Logo and branding
Website (www.efppec.ca)Newsletters & other forms of regular
communications with local teamsSymposiaConference presentations & boothsVisits to university faculties
EvaluationInstrumental evaluation
What has been accomplished so far at each of the identified nodal points
Quantitative & qualitative
Appropriate & realistic outcomes
Done in collaboration with Wilson Centre in Toronto
Final report to include outcomes
Faculty Development
Assess needs for faculty development and facilitate development of these resources
Hope to use local expertise
Challenging for several groups
Palliative care not yet full academic status
2006 SymposiumHeld in London ON in May
Meeting of the AFMC/CAME/CFPC/MCC/RCPSC
Over 80 attendees
Excellent exchange of ideas
Interprofessional presence
Priorities:
Faculty development
2007 SymposiumPlanning underway
Likely in Fall, ? CHPCA Annual Meeting
Interprofessional meeting
Review of local team progress
Faculty development
Sustainability
Undergraduate Competencies
Project team worked with Ontario and Quebec groups
A draft curriculum in place
Seeking consensus across country
Detailed enabling objectives
May add evaluation suggestions
Family Medicine Competencies
Worked with CFPC to develop postgraduate training competencies
Approved by CFPC, linked to Four principles and CanMEDS
Will be incorporated into the Red Book, guidelines for program teaching
Specialty Competencies
Royal College Specialty Committees asked to develop competencies
Internal Medicine, Critical Care finished first draft
Surgery, Psychiatry, Pediatrics, Oncology currently in process
Meeting with RCPS Education Office
Looking Ahead
What’s Next?Royal College specialty competenciesLearning commons Developing palliative / EOLC questions
in licensing / certification exams Working with accreditorsInterprofessional project fundingIndividual schoolsSustainability
Summary
An ambitious 4 year project to introduce effective teaching in end of life care and produce physicians who are competent in this area
Questions?