End-of-Life Care
Curriculum
Melanie Johnson, MSII
Wake Forest University
School of Medicine
Outline
Overview of current curriculum at WFUSM
Improving the curriculum
My plan of action
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For 2003-2004
For 2004-2005 and beyond
Overview of current
curriculum
Wake Forest University/Baptist Medical Center &
Hospice and Palliative Care Center
OVERVIEW:
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Medical School Curriculum
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MS Is
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Lecture to whole class and then small group discussion of
the issues raised
MS IIs
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HPCC Medical Director & Staff of WFUBMC
Lecture and small groups
MS IIIs
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(Now) 32 hours during Ambulatory Medicine rotation
Dr. Richard Stephenson WFUBMC
Current MSI & MSII Schedule
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Lectures and small group discussions
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Small groups consist of
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2 professors (1 M.D. and 1 Ph.D.)
Topics include but are not limited to:
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Hospice and Palliative Care
Communicating Bad News
Advance Directives
MSIII Rotation (2002)
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Every Wednesday during Ambulatory
Medicine
All MSIIIs (9 or 10 each month)
H&P, POC, Eval form, and “Reflection Paper”
Favorite, “most meaningful” rotation
Dr. Richard Stephenson WFUBMC
Current MSIII Schedule
Week 1
Week 2
Week 3
Week 4
Pre-test
Hospice
Pain I
Common Sx
Ethics in
EOLC
Bad News
Pain II
Depression
W/W
Whole Patient
MHB
Last Hours
Spirituality
Lunch
KBR or
KBR or
KBR or
Bereavement
Home visits
RN
SW
Chaplain
Home visits
RN
SW
Chaplain
Home visits
RN
SW
Chaplain
Presentations
Reflections
Post-test
Review Posttest
Dr. Richard Stephenson WFUBMC
Medical interns, residents and
fellows…
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Interns
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3 to 5 Half days
Practical review of the Medicare
Hospice Benefit
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Who qualifies & what do they get
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Pain 101 and 201 (opioids)
Rounds
Admissions
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3rd
year residents electives
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Some didactics
Lots of direct patient care
Project
Teaching
First-responder for consults at
WFU/BMC
House calls
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Fellows elective
Geriatric, Hem/Onc, General IM
Everything 3rd year Resident does
plus…
Research a topic
More of a role in teaching
Presentation to hospice clinical staff
Fellowship in Hospice and
Palliative Care
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being implemented this academic
year
Dr. Richard Stephenson WFUBMC
Improving the
Curriculum
Goals:
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Bridge the gap between the first 2 years of
med school and the 3rd year rotation
Allow opportunities for students to have direct
exposure to hospice and palliative care
before the 3rd year rotation
Enhance communication skills
Enhance knowledge of the psychosocial
aspects of hospice and palliative care
Improving 1st and 2nd year
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Incorporate additional lectures into the
following classes
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Doctor Patient Relations
Medicine as a Profession
Suggested lecture topics:
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Cultural Sensitivity
Spirituality
Grief and Bereavement
Family counseling/conferences
Outcomes
MSIII Rotation Evals 2001
4.9
4.85
4.8
4.75
Class of 2001
4.7
4.65
4.6
Hosp
Phil
Sym
KBR
Grief
Own
(1= no opportunity to learn…5= outstanding opportunity)
Dr. Richard Stephenson WFUBMC
MSIII Rotation Evals 2001
(cont)
4.6
4.5
4.4
4.3
4.2
4.1
4
3.9
3.8
3.7
Class of 2001
Psych Phys Ethics Home
Dying Dying
Ivs
Dr. Richard Stephenson WFUBMC
Improving the 3rd year
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Suggested lectures
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Hydration and IV use
Physiology of dying
Ethical Issues
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Physician assisted suicide
Withdrawing and withholding care
Dealing with personal feelings
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Debriefing exercises
Small group discussions
Journaling
My plan in action…
for 2003-2004
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Spread the word
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Distribute brochures in student mailboxes
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E-mail the entire student body
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Post signs on bulletin boards
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Lunch meeting/information session
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Overview of hospice and palliative care
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Background information
Video “To Live until I die”
Need for awareness and education
Sign up sheet to become volunteers
For interested students
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Train them to become volunteers at the Kate B. Reynolds Hospice Home
Will be assigned a patient and will follow the patient and family throughout the dying
process
Provide shadowing with the interdisciplinary team
for 2003-2004 cont…
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Forming Partnerships
 With SNMA to increase African American and
other minorities awareness of hospice and
palliative care in Winston-Salem, NC
 With the Geriatric Interest Group
 With AMSA to implement the “Death and
Dying” component at WFUBMC
Plan for 2004-2005 & beyond…
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To integrate several lectures into the 1st and
2nd year courses
Apply for funding from WFUBMC to form a
special interest group
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Hold extensive monthly seminars and workshops
Promote group activities and additional volunteer
experiences.
The end….
Questions?
Comments?
Suggestions?