An Online Palliative and End of Life Care Course for Medical Students Ilene Lewis, MS II University of California – Davis School of Medicine

Current Palliative and End of Life Care Curriculum in Medical Schools AAMC = Association of American Medical Colleges Curriculum Directory: NOTE: AAMC represents 125 allopathic medical schools accredited by the LCME (Liaison Committee on Medical Education) including 17 Canadian medical schools Topic Separate Required Course Part of Required Course Separate Elective Course Part of Elective Course Other Educational Experience ALT/COMPLEMENTARY.MED COMMUNICATION SKILLS END OF LIFE CARE GERIATRICS HOME HEALTH CARE MEDICAL ETHICS PAIN MANAGEMENT PALLIATIVE CARE

Current Palliative and End of Life Care Curriculum in Medical Schools According to the AAMC Curriculum Directory, the following schools have clerkships for the Class of 2008: According to the AAMC Curriculum Directory, the following schools have clerkships for the Class of 2008: –SUNY-Downstate Medical Center COM Primary Care II Clerkship in Geriatrics and Palliative Care Hours: 296, Weeks: 4 Primary Care II Clerkship in Geriatrics and Palliative Care Hours: 296, Weeks: 4 –Ponce School of Medicine Community Medicine and Geriatrics, Hours: 65 Community Medicine and Geriatrics, Hours: 65 Geriatrics, Hours: 65 Geriatrics, Hours: 65 –University of Miami School of Medicine Geriatrics, Weeks: 4, with Psychiatry, Weeks: 2 Geriatrics, Weeks: 4, with Psychiatry, Weeks: 2 Geriatrics, Weeks: 6 Geriatrics, Weeks: 6

Current Palliative and End of Life Care Curriculum at UC - Davis Year 1 – Doctoring (Required Course) Year 1 – Doctoring (Required Course) –Culture and Medicine Spirituality Spirituality Death Awareness Death Awareness Bereavement Bereavement –Communication Skills Breaking Bad News Breaking Bad News –Adult and Geriatric Development Elder Abuse Elder Abuse Assigned home visits with a geriatric patient Assigned home visits with a geriatric patient –~ Monthly –Follow same patient all 4 years –Medical Ethics and the Law –Small Group Discussions 2 different groups: Application of Medical Principles (AMP), and Doctoring small group 2 different groups: Application of Medical Principles (AMP), and Doctoring small group Each group meets once a week Each group meets once a week Simulated patients, role playing, and learning issues are researched and presented to the groups Simulated patients, role playing, and learning issues are researched and presented to the groups

Current Palliative and End of Life Care Curriculum at UC - Davis Year 2 - Oncology (Required Course) Year 2 - Oncology (Required Course) –End of Life and Hospice Care Lecture Year 4 – Elective Clerkships Year 4 – Elective Clerkships –Geriatrics in Community Health –Practicum in Care for the Terminally Ill –Law and Medicine (can be taken during any year) Physician Assisted Suicide, Terminal Sedation, Medical Ethics, Pain Management Physician Assisted Suicide, Terminal Sedation, Medical Ethics, Pain Management

Role of Online Curriculum Provide more focused and comprehensive preparation for caring for patients and families at the end of life Provide more focused and comprehensive preparation for caring for patients and families at the end of life Provide continuity in presentations Provide continuity in presentations Can be integrated into existing curriculum in the 1 st and 2 nd year Can be integrated into existing curriculum in the 1 st and 2 nd year

Online Curriculum Proposal Required 2 year web based series of PowerPoint presentations and exercises on palliative and end of life care Required 2 year web based series of PowerPoint presentations and exercises on palliative and end of life care Presentations will be designed by medical school faculty and will be ~ 50 min each Presentations will be designed by medical school faculty and will be ~ 50 min each Virtual Preceptors will be available via to respond to student questions Virtual Preceptors will be available via to respond to student questions Chat room available for students to communicate with each other Chat room available for students to communicate with each other Each module will have a review of key points and suggested readings Each module will have a review of key points and suggested readings Self-assessment quizzes will be provided for each module that will generate score reports to identify areas for review Self-assessment quizzes will be provided for each module that will generate score reports to identify areas for review Question Bank for each module Question Bank for each module One final comprehensive examination after all modules are completed (90% is passing – able to retake until score is achieved) One final comprehensive examination after all modules are completed (90% is passing – able to retake until score is achieved) Required evaluations of each modules content Required evaluations of each modules content

Curriculum Materials and Resources Curriculum Materials: Curriculum Materials: –Textbook/Syllabus –Pocket Guides American Academy of Hospice and Palliative Medicine Guide American Academy of Hospice and Palliative Medicine Guide American Pain Society: Principles of Pain Management American Pain Society: Principles of Pain Management Robert Buckmans Communication Skills Robert Buckmans Communication Skills Opioid Equianalgesic Card Opioid Equianalgesic Card Additional Resources: Additional Resources: –Websites –Movies –Recommended Readings –Advance Directive Examples –Do-Not-Resuscitate Form

Online Curriculum Format Modules will be based on American Board for Hospice and Palliative Medicine (ABHPM) Physician Credentialing Standards: Modules will be based on American Board for Hospice and Palliative Medicine (ABHPM) Physician Credentialing Standards: 1.Non-Pain Symptom Management (30%) 2.Pain Management (25%) 3.Ethical and Legal Decision Making (8%) 4.Communication and Teamwork (7%) 5.Impending Death (7%) 6.Psychosocial and Spiritual Issues (7%) 7.Hospice and Palliative Approach to Care (6%) 8.Grief and Bereavement (5%) 9.Prognostication (5%)

Online Curriculum Format Modules will be organized to reflect existing curriculum presentations Modules will be organized to reflect existing curriculum presentations Deadlines for completing modules and self-assessment quizzes will correspond with the conclusion of existing lecture series on given topics Deadlines for completing modules and self-assessment quizzes will correspond with the conclusion of existing lecture series on given topics

Online Curriculum Format Generally: Generally: –Completed in Year 1: 20 Required Hours 1. Introduction to Palliative and End of Life Care (17%) Includes PrognosticationIncludes Prognostication 2. Communication Skills (11%) 3. Ethical and Legal Decision Making (17%) 4. Psychosocial and Spiritual Issues (11%) –Completed in Year 2: 16 Required Hours 5. Non-Pain Symptom Management (14%) 6. Pain Management (17%) 7. Impending Death (14%) Includes Grief and BereavementIncludes Grief and Bereavement

Module 1: Introduction to Palliative and End of Life Care 6 Required hours (including 1 hr self-assessment) Defining Palliative and End of Life Care Defining Palliative and End of Life Care Accessing End of Life Care Delivery Systems Accessing End of Life Care Delivery Systems Quality of Life Assessments and Prognostication Quality of Life Assessments and Prognostication Specific Populations: Elderly, Substance Abusers, and Incarcerated Specific Populations: Elderly, Substance Abusers, and Incarcerated Pediatric Palliative and End of Life Care Pediatric Palliative and End of Life Care Optional Exercises: Optional Exercises: –Death Attitude Survey –A Good Death Survey

Module 2: Communication Skills 4 Required hours (including 1 hr self- assessment) Breaking Bad News Breaking Bad News Confidentiality and Families Confidentiality and Families Working with an Interdisciplinary Team Working with an Interdisciplinary Team

Module 3: Ethical and Legal Decision Making 6 Required hours (including 1 hr self- assessment) Informed Consent and Patient Rights Informed Consent and Patient Rights Advance Care Planning Advance Care Planning Nutrition and Hydration in End of Life Care Nutrition and Hydration in End of Life Care Medical Procedures and Diagnostic Tests in End of Life Care Medical Procedures and Diagnostic Tests in End of Life Care Physician Assisted Suicide and Terminal Sedation Physician Assisted Suicide and Terminal Sedation

Module 4: Psychosocial and Spiritual Issues 4 Required hours (including 1 hr self- assessment) Psychosocial Responses Psychosocial Responses Culture and End of Life Care Culture and End of Life Care Religious Beliefs and Practices Religious Beliefs and Practices Optional Exercises: Optional Exercises: –Vignettes of Patients/Families speaking about their experiences –Scenarios – choose your adventure style

Module 5: Non-Pain Symptom Management 5 Required Hours (including 1 hr self- assessment) Common Symptoms at the End of Life Common Symptoms at the End of Life e.g. Fatigue, Incontinence, Cachexia, etc. Respiratory Symptoms at the End of Life Respiratory Symptoms at the End of Life Gastrointestinal Symptoms at the End of Life Gastrointestinal Symptoms at the End of Life Delirium, Agitation, and Depression Delirium, Agitation, and Depression

Module 6: Pain Management 6 Required Hours (including 1 hr self- assessment) Acute and Chronic Pain Acute and Chronic Pain Pain Assessment Pain Assessment Pharmacologic Management of Pain Pharmacologic Management of Pain Non-Pharmacologic Management of Pain Non-Pharmacologic Management of Pain Barriers to Pain Management Barriers to Pain Management

Module 7: Impending Death 5 Required Hours (including 1 hr self- assessment) Signs of Impending Death Signs of Impending Death Symptom Management During Last Days of Life Symptom Management During Last Days of Life Managing Caregiver Stress and Other Family Issues Managing Caregiver Stress and Other Family Issues The Grief Process The Grief Process Optional Exercises: Optional Exercises: –Grief-Loss Inventory

Implementation Goals Present to curriculum committee to secure support for project Present to curriculum committee to secure support for project Contact medical school faculty to prepare presentations/be virtual preceptors for project Contact medical school faculty to prepare presentations/be virtual preceptors for project Develop website design with programmer Develop website design with programmer Contact publishers/book suppliers for donations of curricular materials Contact publishers/book suppliers for donations of curricular materials Write grant proposal for future purchases of curricular materials Write grant proposal for future purchases of curricular materials