2015; Volume 16, No 11, November
Featured Article
Teaching palliative care to medical students: A gratifying and stimulating experience
Dr. Roberto Wenk is a member of the IAHPC Board of Directors and a past Chair. As a physician and the Director of the Programa Argentino de Medicina Paliativa-Fundación FEMEBA, Argentina, he has combined care of patients and families with graduate teaching for many years. Here, Roberto explains how they planned and delivered an undergraduate medical curriculum that is changing students’ attitudes to caring for patients and families affected by life-limiting illness.
In 2009, the authorities of the Austral University, Argentina, invited us to develop palliative care as an optional subject in the undergraduate medical curriculum. The goal was to give students a basic package of knowledge, skills and attitudes for caring for patients with life-limiting diseases and their families.
The medical career pathway takes six years and most students follow this with a further period of training, or ‘residency’. The target students are from the 4th, 5th and 6th years and have the option to choose one of the following optional subjects: Palliative Care, Molecular Medicine or Public Health. The palliative care curriculum has three main educational goals: symptom control, ethical principles and basic communication skills. The total length of the activity is 46 hours spread over seven weeks. The content is delivered through five classroom-based lessons, and two obligatory clinical visits to palliative care services. The mandatory hours allocated for classroom time and clinical visits were three hours; evaluations and educational material are available online.
Undergraduate palliative care education: Classroom-based lesson
The palliative care undergraduate curriculum
- Lesson one: What is Palliative Care? Suffering. Communication
- Lessons two and three: Symptoms: pain, delirium, dyspnea, constipation, nausea and vomiting
- Lesson four: Limitation of therapeutic effort. End of life. Palliative sedation
- Lesson five: Miscellaneous topics
- Two visits to palliative care services with ambulatory and inpatient activity
- 15 hours of theoretic activity (five classes of three hours)
- 15 hours of personal study (one hour for each hour of theoretical activity)
- Six hours of clinical activity (two visits of three hours)
- Six hours of revision (0.5 hour per hour of clinical activity)
- Four hours of reading (one hour for every five pages of mandatory study material – approximately 20 pages)
- Evaluation: essay questions (answers of 400 words maximum) to evaluate the student’s perceptions and feelings about the experience.
In 2010, we started with a teacher-centered, content-based education model but since the second cycle (2011) we have made the following modifications.
We have matched the content to the expected tasks and situations that students will face after completion of their medical training. For example, because students do not have direct access to patients during a residency we shifted from focusing mainly on clinical competencies to displaying complex situations that are common in palliative care.
We have moved to a learner-centered education model with small group discussions. Initially triggered by short, virtual clinical cases, discussions now start with three to six-minute clips of selected films providing experiences of uncontrolled symptoms, poor communication, suffering, etc.
Results of five cycles of activity were positive (evaluation of period 2010-2013 is published 1) and although this brief exposure to palliative care is insufficient to produce great and enduring changes, we are confident that it has changed students’ attitudes toward patients with life-limiting diseases and their families.
So what makes us feel gratified and stimulated?
- The fact that this experience began inversely: instead of working to convince academic authorities to include palliative care in their curricula, they invited us to work on the subject.
- The progressive increase of students that chose palliative care as an optional subject: 29% (11/27) in 2010 and 59% in 2015 (46/59).
- The interest of students in the humanistic aspects of medicine and their flexibility to embrace them.
- The fact that students may become vectors of change. During their residency, students challenged patient-family/health personnel miscommunication, inadequate symptom control, use of futile practices, etc and this has led to the creation of palliative care services in some institutions.
All this is more than enough to encourage us to continue working on the implementation of undergraduate palliative care education.
Reference
1 Mutto EM, Bunge S, Vignaroli E, Bertolino M, Villar MJ, Wenk R. Medical Students' Palliative Care Education in a Latin American University: A Three-Year Experience at Austral University in Buenos Aires, Argentina. Journal of Palliative Medicine. 2014 Oct, 17 (10): 1137-1142.