Transforming
health care globally…
through palliative care
www.PalliativeMed.org
www.IPCRC.net
Challenges in
Teaching
Palliative Medicine
Frank D. Ferris, MD, FAAHPM, FAACE
Institute for Palliative Medicine
at San Diego Hospice
University of California San Diego
University of Toronto
Objective…
A Road Map
to Build
Palliative Care Capacity
in Sweden through
education…
Call to
Action…
Train ALL
healthcare professionals
to provide palliative care…
Dixon 6: Goals of Education &
Implementation
1. Awareness / Attitudes
2. Knowledge
3. Skills
4. Behavior
Change Experience
5. Patient / Family
6. Organization / Society
Increase palliative care capacity
Dixon J. Evaluation and the Health Professions, 1978
Ferris et al. Knowledge Insufficient for Change, 2001
How
will you teach…?
How People Learn
• Memory:
Short  intermediate  long-term
• 3 major facts / hour
• Information retention per unit time
10 minutes new information
2 minutes rest to process it
Principles of
Learning in Healthcare
• Practical
• Participatory
• Multiple demands
Hank Slotnick, PhD, North Dakota
Reading / Online
Retention ?
1.
2.
3.
4.
Awareness / Attitudes
Knowledge
Skills
Behavior
Change Experience
5. Patient / Family
6. Organization/Society
Lectures
1.
2.
3.
4.
Awareness / Attitudes
Knowledge
Skills
Behavior
Change Experience
5. Patient / Family
6. Organization/Society
Retention ?
Lectures 10 %
Group Learning
1.
2.
3.
4.
5.
6.
Retention ?
Awareness / Attitudes
Lectures 10 %
Knowledge
Small-group Cases 25 %
Skills
Role-play 35 %
Behavior
Change Experience
Patient / Family
Organization/Society
Effective presentations
‘ theater ’
• Movement
Body
Hands
• Voice
Tone
Volume
Speed
• Eye contact
• Minimize distractions
Who
will you teach…?
Palliative Care
Skills...
2°
Expert skills
1°
Basic Skills
All Healthcare
Professionals
1°
Advanced Skills
Cariology,
Geriatrics,
Oncology,
Etc.
Palliative Care
Consultants /
Teams
3°
Academic
Palliative Care
Interdisciplinary Care
Spiritual
counselor
Volunteer
Nurse
Family
Physician
Social
worker
PATIENT
Community
Physical
therapist
Psychologist
Pharmacist
Bereavement
counselor
What
will you teach…?
PC Skills...
1°
Basic Skills
All Healthcare
Professionals
‘ Buzz ’ Groups
• 1–2
• 1–2
General Doctors ?
1999
EPEC 1999
• National consensus of 280 ethics,
hospice, palliative care experts
Linda Emanuel, Principal
Aim: To teach all physicians and
other members of the interdisciplinary
team the core skills of palliative care
Not intended to make every clinician a
palliative care expert
EPEC 1999
•
•
•
•
•
4 plenary sessions
12 modules
Open, train-the-trainer model
Widely accepted
Standard of practice ‘ inside ’
First 15 Months in the USA
Robinson K, Sutton S, von Gunten CF
et al, J of Palliative Medicine 2004
• Sample 200 of first 585 trainers touched
• 120,000 professionals in 15 months
• Estimated patients & families affected
Per Clinician
Per Clinician
585 Clinicians
Patients / Day
Patients / Year
Patients / Year
10
100
2.4 K
24 K
1.4 M
14 M
US Palliative Medicine
Specialists
• > 3.000 certified specialists
• 80 % started training with EPEC
End-of-Life
Nursing
Education
Consortium
Curriculum…
Nurses ?
ELNEC – Nursing Curricula,
2002
Oncology
Version:
Open
Adaptable
Reproducible
Google:
ELNEC
Palliative Care
Skills...
1°
Advanced Skills
Cariology,
Geriatrics,
Oncology,
Etc.
Doctors seeing Advance Illnesses ?
2007
The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
EPEC-O 2007
• National consensus of > 80 oncology
experts
Aim: To teach all oncologists and
other members of the
interdisciplinary cancer care team the
advanced skills of palliative care
Not intended to make every oncologist
a palliative care expert
Multiple
Issues
that
Cause
Suffering
Core
Skills for
Providing
Palliative
Care
EPEC-O 2007
• 32 modules - 3 plenaries, 2 how to teach
Syllabus, slides
Open, adaptable
Video vignettes
Teaching strategies
Annotated bibliography
Hyperlinks to references online
2007
• Free CD / DVD
• American Society
of Clinical
Oncology
( ASCO ) provides
education credits
• Online modules
• Translations
Spanish
Ukrainian
• www.IPCRC.net
IPM
Interdisciplinary
Curriculum
Will you translate
any of these curricula ?
A multi-year
education strategy to
build palliative care
capacity...
www.PalliativeMed.org
www.IPCRC.net
Time ( yr )
3
5
7
9
Sensitization
Courses ( Basic & Advanced )
Visiting Scholars ( Expert Identification )
Fellowships ( Experts )
Leadership ( Leaders )
Scholars in Residence ( Education & Research )
11
Nursing & Medical Trainees
Nursing students
• 9 schools
Experiential
‘ bedside training ’
UCSD Medical
• Observational visits
students
• Structured program
Residents
• Family practice
• Internal medicine
• Psychiatry
• Electives
PC in Curricula / Exams
• In US Boards
• In several specialty exams
10 % of Medical Oncology Exam
Physicians Practicing
in San Diego
• 10 % trained at
UCSD School of Medicine
• 33 % did their medical residency
in San Diego
Practicing Clinicians
• Continuing education – optional or
compulsory ?
• In California
To get a new license, since 2002,
obligatory to demonstrate training in
palliative / end-of-life care
To renew license in 2006, 12 hours
education in pain & palliative care
( AB 487 )
Conference Presentations
•
•
•
•
•
Oncology
Cardiology
Geriatrics
Elder Care
Nephrology
Many Domestic &
International Partners
In-Country Courses
3-5 day, 2 & 3 week
2004 – Jordan 32
2009 – Ukraine 95
2005 – Jordan 72
Egypt 105
2006 – Mongolia 75
Slovenia 50
2007 – Jordan 50
2010 – Ukraine 36
Georgia 50
Salzburg 40
Mexico 75
MECC 50
2008 – Georgia – 75
2011 – Georgia 75
Vietnam 75
Vietnam 100
Saudi Arabia 150
Cyprus 55
Turkey 52
First dose of oral morphine –
Al Basheer Hospital
1-week Classroom vs.
3-weeks Bedside Training
2 Open Society
Institute ( OSI )
Courses, Salzburg
2 Jordan Courses,
Amman, Jordan
• 1 week ( 5 days )
• Classroom
• 3 weeks ( 15 days )
• 1 week classroom
Interactive didactic
Interactive didactic
• 2 weeks bedside
training
P < 0.001
P < 0.001
P < 0.001
Day 1
After
Course
Day 1
After Course
Jordanian Physician…
“During the first week [ in the
classroom ] I felt that I will not
benefit… and it will not do any
change in my practice.
BUT, after starting practical session a
huge and unexpected change
happened… I will do every efforts
I have to practice this knowledge in
my real life.”
1st International Palliative
Medicine Physician