Bringing the Experience to the Classroom Susan MacDonald BScN, MD CCFP FCFP Associate Professor of Medicine and Family Medicine, Memorial University Divisional Chief of Palliative Care HCCSJ

Abstract Providing the practical experience of patient care is integral to productive and enjoyable teaching in the person centered field of Palliative Care. However, limitations of program size and numbers of both patients and clinical teachers can restrict or prevent this important interaction from taking place. At Memorial University, the limited number of clinicians (2 full time MDs), prior obligation to residency teaching (restricting the number of learners on the Palliative Care Unit), and large number of undergraduate students (60 per year) has prevented including a clinical component to the courses taught in all four years. Consequently, we have elected to "Bring the Experience to the Classroom". This is facilitated through the creative use of patient and/or family members live interviews in the classroom, video tape interviews (to highlight specific teaching points), demonstrations of team meetings, multiple case studies, role playing exercises and even the experience of filming a movie about Palliative Care, directly into the classroom. Student feedback has been very enthusiastic, with many students citing the “actual experience” as the most meaningful aspect to the courses, and as an impetuous to further learning and interest in this area. The course evaluations have been very positive. We continually revise the courses, and have embarked on the process of filming a documentary about the process of student learning and clinical experience in Palliative Care.

Background Memorial University: 2 Palliative Care Doctors on Faculty 60 students per year undergraduate 24 residents in second year Family Medicine Family Medicine has a one month mandatory rotation in Palliative Care

Undergraduate Courses in Palliative Care First year: Breaking bad news: Clinical skills course with didactic lecture and clinical skills sessions with practice patients and role playing sessions. We use a couple of standard stories. About 4-5 hours. Second Year: Approximately 15 hours of course material. Several didactic lectures on pain and symptom management. Intro lecture to what is palliative care and why they need to know this. The patient interview session. (I have one of my patient’s come in and meet the class and I interview them for the student. Sometimes I bring in videos I've done of patients) Small group sessions for individual study and case review (when tutors are available). No exam. Third Year: One hour session with clinical clerks while on the medicine rotation. An open "ask the expert" session where student discuss concerns, cases and ideas. Fourth Year : Two one-hour review sessions and examination on pain and symptom management. Didactic format and written exam after. Post Grad: Teaching in specialty half day programs: still in the process of formalizing this for this year. Family medicine: One month mandatory rotation including PCU, consultation team and clinics.

Interactive Experiences Film: the class participated in the filming of the documentary “Pleasant Street” by cancer survivor Gerrry Rogers Videos: Interviews of patients and their families, filmed at home or in the hospital. Mock interviews: conducted in the classroom Patient and Family interviews: patients and families attend the class, are interviewed and then answer the students questions Mock team meeting: demonstration by the team of how a multidisciplinary team works (discusses the patient that was interviewed or on video) Role playing: students engage in a series of role playing exercises, topics they will encounter on the wards Open “ask the expert” sessions Informal tutorials (optional) where students can discuss how the topic affects them?emotional context

Feedback First Year:(breaking bad news [role playing]) >70% found course helpful or very helpful, 10% not helpful Some students uncomfortable with role playing Many thought opportunity to try and break bad news in a practice setting was useful practice Some facilitators don’t like role playing Second Year: (mock team, videos, patient interviews, open small groups) Interactive sessions with patient (live or taped) are rated most highly >70% of students found the small group sessions very helpful/helpful No student rated the course less than “good” or “very good” Strongest wish by students: to visit the palliative care unit No examination was repeatedly cited as improving learning Third Year: (ask the expert) strongly positive verbal feedback Fourth Year: (Didactic lectures, cases, exam) Average feedback

Feedback Team meeting: “It is excellent to hear each team members concerns, involvements etc. (I feel this area hugely neglected elsewhere)” Whole person session/the physician as care giver: “Thank you Dr. M for making those wonderful comments at the about “It’s okay to make mistakes” and “it’s okay to care”.” Patient/family interviews: “Patient interview was excellent. More patients please.” “The guest speaker was very inspirational. I really enjoyed her story and her very positive attitude.” “”The format of the course was great. I felt I could sit back and really listen and understand the important points about the course.” “She was an awesome storyteller. It’s a story that most of us will probably never forget.” “The session with the guest speaker helped us see right away that we all need to know it.” Personal reflection: “More time in medical school should be spent on self- awareness.”

New Directions Incorporation of film into course More thorough evaluation of the courses (what is working and what isn’t) Review and overhaul of the Breaking bad news course