Educating Future Physicians for
Palliative/End of Life Care:
EFPPEC
Paul Daeninck MD MSc FRCPC
Louise Hanvey BN MHA
for the EFFPEC project team
Topics
Need for Palliative Care
EFPPEC overview
Progress
Future work
What do Patients &
Families Want?
Competence
Compassion
Pain and symptom
management
Clear decision making
Preparation for death
Affirmation 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 death
Pain/symptom management
Avoiding prolongation of dying
Achieving a sense of control
Relieving burden on others
Strengthening relationships with
loved ones
Singer 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 diseases
Trust 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
n=16, 2001
Oneschuk D, et al. J Pall Care. 2004;20:32-37
Palliative Care
in Medical Schools
“Integrated” in other sessions:
Independent program:
Supervised patient encounters:
Mean # of hours:
Multidisciplinary faculty:
6
6
4
11 (3-22)
3
n=16, 2001
Oneschuk D, et al. J Pall Care. 2004;20:32-37
Palliative Care
in Medical Schools
Exposure Year
# of Med Schools
One
8 (50%)
Two
12 (75%)
Three
6 (38%)
Four
5 (31%)
Oneschuk D, et al. J Pall Care. 2004;20:32-37
What do Medical Students
Want?
83% of students favoured ↑ pall. care education
Oneschuk 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
illness
Palliative care not
just “at the end”
Palliative Medicine Training For
Family Medicine Residents
Mandatory rotation in palliative care?
5/16
Median length of rotation
2 wks
Elective time in palliative care for family
16/16
medicine residents
Median length of rotation 3 1/2 wks
Median number of residents
participating
Specific faculty positions for palliative
medicine
10%
9/16
Oneschuk D, Bruera E. Pall Med 1998
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
Project Outline
LH
Project Overall Goal
By the year 2008, all undergraduate 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 Partners
Association 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 University
Paul Daeninck - U of Manitoba
Doreen Oneschuk - U of Alberta
Hubert Marcoux – Université Laval
Robert Wadel - U of Calgary
Maryse Bouvette - CASN
Sue Maskill - AFMC
Sharon Baxter - CHPCA
EFPPEC Partners
Professional Partnerships
CASN
Canadian Ass’n of Faculties of Pharmacy
CAPPE
CASW
Professional Resource Groups
CSPCP
RCPSC/CFPC
MCC
Philosophy
Build 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
EFPPEC Objectives
Support development of consensusbased 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
“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
4: Communicate Effectively with
Patients, Families, & Other Caregivers
5: Collaborate as a Member of an
Interdisciplinary Team
6: Attend to Suffering
Progress:
Where are
we at?
Local Teams
Team leader identified at each med school
All but 3 medical schools active
Team leaders form interdisciplinary
stakeholder teams to:
Familiarize them with the goals of EFFPEC
Inventory their local curricula in EOLC
Build consensus around the competencies
Local Teams
Project 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 Team
Local 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 Commons
Developed with the help of the Pallium
Project
Website for sharing information and
educational programs
Unique features
Forum
Searchable
Notification of subscribers
Communications
Developing communication strategy:
Logo and branding
Website (www.efppec.ca)
Newsletters & other forms of regular
communications with local teams
Symposia
Conference presentations & booths
Visits to university faculties
Evaluation
Instrumental 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 Symposium
Held 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 Symposium
Planning 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 competencies
Learning commons
Developing palliative / EOLC questions
in licensing / certification exams
Working with accreditors
Interprofessional project funding
Individual schools
Sustainability
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?