1. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Developing postgraduate teaching for palliative care through innovative, collaborative approach in Rwanda
Leng M1,4,5, Dixson J2, Bagasha P1, King L2, Grant L4, Dusabejambo V2,3
1 Makerere and Mulago Palliative Care Unit, Makerere University, Kampala, Uganda
2 College of Medicine and Health Sciences, University of Rwanda
3 Kigali University Teaching Hospital/CHUK
4 Global Health Academy, University of Edinburgh, Edinburgh, UK
5 Cairdeas International Palliative Care Trust, UK
UCI-PCAU Joint International Conference on Cancer & Palliative care.

2. Curriculum development and delivery
UK-Uganda faculty
Dr Gursaran Purewal
Dr Martin Leiper
Dr Elizabeth Swain
Dr Kathy Myers
Ms Michelle McGannan
Dr Peace Bagasha
Integrating palliative care into national health systems in Africa: a multi–country intervention study. Grant et al. Journal of Global Health June 2017 Vol. 7 No
UCI-PCAU Joint International Conference on Cancer & Palliative care.

3. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Background
Embedding competencies for palliative care within health care curricula is essential for integrating services and ensuring, an empowered workforce and patient-centred care.
basic training and continuing education
intermediate training should be offered to all health care workers who routinely work with patients with life-threatening illnesses, including those working in oncology, infectious diseases, paediatrics, geriatrics and internal medicine
specialist palliative care training
UCI-PCAU Joint International Conference on Cancer & Palliative care.

4. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Background
What palliative care competencies are needed for postgraduate doctors to enable them to integrate palliative care?
What values underpin these competencies
UCI-PCAU Joint International Conference on Cancer & Palliative care.

5. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Background
Transformative education
Professional practise
doing
experience
knowledge
feelings
expectations
assumptions
attitudes
beliefs
values
Psychological, spiritual and social needs,
D Fish and C Coles 1998
Leng M. Changing value, challenging practice; IJPC Jan 2011
UCI-PCAU Joint International Conference on Cancer & Palliative care.

6. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Aim
The University of Rwanda (UR) Masters of Medicine (MMED) Internal Medicine programme has developed an innovative, flipped-classroom core lecture series to support postgraduate training.
PC was embedded to build shared core competencies among all trainees.
Teaching mode was to be efficient, active, collaborative, and self-directed.
Leverage existing international collaborations to build a PC curriculum for Internal Medicine postgraduates.
A partnership between UR, University of Edinburgh and technical support from Makerere University supported the programme.
Model utilised experience from Makerere University / MPCU
UCI-PCAU Joint International Conference on Cancer & Palliative care.

7. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Methodology
Core competencies were agreed with domains:
what is PC
pain and symptom control
ethics and legal issues
Communication
end of life care.
6 narrated presentations developed
Shared using google drive.
Participants undertook personal study at a time of their choosing followed by face to face interactive tutorials
Feedback was collected from participants and tutors.
UCI-PCAU Joint International Conference on Cancer & Palliative care.

8. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Results
Postgraduates rated the series favourably, with scores averaging 4.5/5 (90%) or greater for both online and classroom-based tutorials
topic relevance, content quality, clarity of delivery, and contribution to their learning
Postgraduates accessed training materials according to their preferred learning style and 100% recommended retaining both lectures and tutorials for future years.
Tutorial leaders noted the enthusiastic engagement of learners in case discussions.
UCI-PCAU Joint International Conference on Cancer & Palliative care.

9. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Results
Qualitative feedback regarding the lectures included comments; “amazing”, “interactive”, “very helpful”, and a “good, brand new way of interactive teaching”.
PC MCQ’s were included in the end of year assessment examination
All lectures and tutorial activities are retained and available for future postgraduate training in Rwanda and as part of the partnership resources.
UCI-PCAU Joint International Conference on Cancer & Palliative care.

10. UCI-PCAU Joint International Conference on Cancer & Palliative care.

11. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Conclusions
Integrating PC competencies is an important way forward, however teaching capacity and curriculum gaps can make this challenging.
National capacity can be built; working in partnerships and facilitating input from international experts to develop teaching resources,.
Innovative teaching methods allowing for different learner preferences enhance the experience.
Developing teaching capacity in country, adapting formal curriculums and postgraduate specialisation is the next step.
UCI-PCAU Joint International Conference on Cancer & Palliative care.

12. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Conclusions
Palliative care supports values based care; transforming practice, lives, systems, societies
'The palliative care training has made a huge impact; I now see the patient as a person and not a disease, I don't avoid difficult conversations, I don't order unnecessary investigations, I see them as part of a family, I do holistic care. It was not like that before.'  MMed doctor
UCI-PCAU Joint International Conference on Cancer & Palliative care.

13. UCI-PCAU Joint International Conference on Cancer & Palliative care.
Thanks to all
References
A Palliative Care Curriculum Toolkit, A practical guide to integrating palliative care into Health Professional Education file:///C:/Users/Personal/Downloads/palliative_care_curriculum_to olkit.pdf
What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers Frey R et al. Progress in Palliative Care /115
World Health Assembly. Strengthening of palliative care as a component of integrated treatment within the continuum of care. 134th Session of the World Health Assembly
Changing values, challenging practice; Leng M. IJPC Jan 2011
Integrating palliative care into national health systems in Africa: a multi–country intervention study. Grant et al. Journal of Global Health June 2017 Vol. 7 No
UCI-PCAU Joint International Conference on Cancer & Palliative care.