2017; Volume 18, No 7, July

Featured Article

ITES – An initiative to transform the system – Iniciativa Transformando el Sistema

Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to our newsletter. This month, it is the turn of Dr. Roberto Wenk. Roberto is a member of the IAHPC Board of Directors and a past Chair. As a physician and the Director of the Programa de Medicina Paliativa-Fundación FEMEBA, Argentina, he has combined care of patients and families with graduate teaching for many years.

Here, Dr. Wenk talks about the ITES project that is transforming medical and nursing education in palliative care and making a significant contribution to the development of palliative care in Latin America.

ITES – An initiative to transform the system (or in Spanish, Iniciativa Transformando el sistema) was developed by Liliana De Lima, IAHPC, Tania Pastrana, University of Aachen, and myself, Roberto Wenk, of the Fundación FEMEBA. We started the project in 2013 after the incorporation in 2010 of palliative care as an elective subject in the clinical years of the medical degree in Universidad Austral, Argentina.

We were motivated to start an activity that aimed to promote and include palliative care in the curricula of Latin American medical and nursing schools for four reasons:

• The great satisfaction reported by the Universidad Austral students in learning about a different caring model and the positive changes that occurred in their knowledge and attitudes. One indicator – perhaps the most important one – is that several students during their residencies demanded changes in patient care and influenced the creation of palliative care services.
• The need for palliative care in Latin America (figure 1). The prevalence of chronic diseases in the region is high and the affected patients often die after a long disease trajectory with severe symptoms and great suffering without treatment.
  Figure 1
• The availability and accessibility of palliative care in Latin America is extremely low (figure 2). Palliative care is mostly available for adults with cancer living in big urban centers. The main reasons for this situation are lack of adequate policies, education, implementation efforts, availability of opioids, etc.
  Figure 2
• The fact that education in palliative care is recognized as an indispensable component for all healthcare professionals, and that it is necessary to develop palliative care education in medical curriculums.

We have carried out the ITES project in two countries: Colombia and Argentina. In both cases, the projects were developed in similar stages: contact and promotion (meeting with academic authorities, faculty and students to promote the undergraduate teaching of palliative care), workshops to achieve consensus on the palliative care competencies for undergraduate medical and nursing schools, and workshops on teaching and evaluation methods, (Kolb stiles, curriculum design, learning outcomes, Bloom's taxonomy, etc.)

In Colombia, contact and promotion with representatives of six universities took place in March 2014. The first two-day workshop, attended by 36 participants, was held in November 2015 followed by the second two-day workshop, in Cali and Bogota, with 40 participants in total, held in December 2015 (pictured here).

In Argentina, contact and promotion with representatives of six universities took place in May 2016. Then in Buenos Aires in April 2017, we held a two-and-a-half-day workshop, combining consensus on palliative care competencies and educational methods, with 29 participants. (pictured here).

Both activities achieved similar consensus on the following competencies (in alphabetical order).

In both cases, the following questions were asked at the end of the activity. Responses were assessed on a Likert 0 to 5 scale.

• "What went well?"
• "What could be improved?"
• "What was missing?"

We are currently starting a survey among Colombian participants on the effect of ITES after two years on the integration of palliative care in the undergraduate curricula of their universities.

What did we learn from these experiences?

• It is necessary to use multiple approaches for contact and promotion
• It is necessary to include the national palliative care associations and leaders from the medical area
• In Latin America, there are diverse curricular offerings with different levels of integration and teaching formats.

We are convinced that ITES is making a significant contribution to the development of palliative care in Latin America and could be applicable in other regions of the world.

Links and Resources

• Download a paper relating to ITES from the Projects/PC Competencies section of the IAHPC website. Pastrana T, Wenk R, De Lima L, Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities, Journal of Palliative Medicine, Vol 19, (1) 2016.
• Contact Dr. Roberto Wenk by email.
• Read Roberto’s bio.

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