1. Transforming health care globally… through palliative care www.PalliativeMed.org www.IPCRC.net

2. 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

3. Objective… A Road Map to Build Palliative Care Capacity in Sweden through education…

5. Call to Action… Train ALL healthcare professionals to provide palliative care…

6. 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

7. How will you teach…?

8. How People Learn Memory: Short  intermediate  long-term Memory: Short  intermediate  long-term 3 major facts / hour 3 major facts / hour Information retention per unit time Information retention per unit time 10 minutes new information 2 minutes rest to process it

9. Principles of Learning in Healthcare Practical Practical Participatory Participatory Multiple demands Multiple demands Hank Slotnick, PhD, North Dakota

10. Reading / Online Retention ? 1.Awareness / Attitudes 2.Knowledge 3.Skills 4.Behavior Change Experience 5.Patient / Family 6.Organization/Society

11. Lectures Retention ? 1.Awareness / Attitudes Lectures 10 % 2.Knowledge 3.Skills 4.Behavior Change Experience 5.Patient / Family 6.Organization/Society

12. Group Learning Retention ? 1.Awareness / Attitudes Lectures 10 % 2.Knowledge Small-group Cases 25 % 3.Skills Role-play 35 % 4.Behavior Change Experience 5.Patient / Family 6.Organization/Society

13. Effective presentations ‘ theater ’ Movement MovementBodyHands Voice VoiceToneVolumeSpeed Eye contact Eye contact Minimize distractions Minimize distractions

14. Who will you teach…?

15. 1° Basic Skills All Healthcare Professionals 1° Advanced Skills Cariology, Geriatrics, Oncology, Etc. 2° Expert skills Palliative Care Consultants / Teams 3° Academic Palliative Care Palliative Care Skills...

16. Community Volunteer Spiritual counselor Nurse Bereavement counselor Physical therapist Pharmacist Physician Psychologist Social worker Family PATIENT Interdisciplinary Care

17. What will you teach…?

18. PC Skills... 1° Basic Skills All Healthcare Professionals

19. ‘ Buzz ’ Groups 1 – 2 1 – 2

20. General Doctors ?

21. 1999

22. EPEC 1999 National consensus of 280 ethics, hospice, palliative care experts 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

23. EPEC 1999 4 plenary sessions 4 plenary sessions 12 modules 12 modules Open, train-the-trainer model Open, train-the-trainer model Widely accepted Widely accepted Standard of practice ‘ inside ’ Standard of practice ‘ inside ’

24. 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 Sample 200 of first 585 trainers touched 120,000 professionals in 15 months 120,000 professionals in 15 months Estimated patients & families affected Estimated patients & families affected Per Clinician 585 Clinicians Patients / DayPatients / Year 10 2.4 K 1.4 M 10024 K14 M

25. US Palliative Medicine Specialists > 3.000 certified specialists > 3.000 certified specialists 80 % started training with EPEC 80 % started training with EPEC

26. End-of-Life Nursing Education Consortium Curriculum…

27. Nurses ?

28. ELNEC – Nursing Curricula, 2002 Oncology Version: Open AdaptableReproducible Google: ELNEC

29. Palliative Care Skills... 1° Advanced Skills Cariology, Geriatrics, Oncology, Etc.

30. Doctors seeing Advance Illnesses ?

31. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation. Education in Palliative and End-of-life Care - Oncology The Project EPEC-O TM 2007

32. EPEC-O 2007 National consensus of > 80 oncology experts 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

33. Multiple Issues that Cause Suffering

34. Core Skills for Providing Palliative Care

35. EPEC-O 2007 32 modules - 3 plenaries, 2 how to teach 32 modules - 3 plenaries, 2 how to teach Syllabus, slides Open, adaptable Video vignettes Teaching strategies Annotated bibliography Hyperlinks to references online

36. 2007 Free CD / DVD Free CD / DVD American Society of Clinical Oncology ( ASCO ) provides education credits American Society of Clinical Oncology ( ASCO ) provides education credits Online modules Online modules Translations TranslationsSpanishUkrainian www.IPCRC.net www.IPCRC.net

37. IPM Interdisciplinary Curriculum Will you translate any of these curricula ?

39. A multi-year education strategy to build palliative care capacity... www.PalliativeMed.org www.IPCRC.net

40. Time ( yr )  357911 Sensitization Courses ( Basic & Advanced ) Visiting Scholars ( Expert Identification ) Fellowships ( Experts ) Leadership ( Leaders ) Scholars in Residence ( Education & Research )

41. Nursing & Medical Trainees Nursing students 9 schools 9 schools UCSD Medical students Residents Family practice Family practice Internal medicine Internal medicine Psychiatry Psychiatry Experiential ‘ bedside training ’ Observational visits Observational visits Structured program Structured program Electives Electives

43. PC in Curricula / Exams In US Boards In US Boards In several specialty exams In several specialty exams 10 % of Medical Oncology Exam

44. Physicians Practicing in San Diego 10 % trained at UCSD School of Medicine 33 % did their medical residency in San Diego

45. Practicing Clinicians Continuing education – optional or compulsory ? Continuing education – optional or compulsory ? In California 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 )

46. Conference Presentations Oncology Oncology Cardiology Cardiology Geriatrics Geriatrics Elder Care Elder Care Nephrology Nephrology

47. Many Domestic & International Partners

48. In-Country Courses 3-5 day, 2 & 3 week 2004 – Jordan 32 2005 – Jordan 72 2006 – Mongolia 75 2007 – Jordan 50 Georgia 50 Georgia 50 Mexico 75 Mexico 75 2008 – Georgia – 75 Vietnam 75 Vietnam 75 Saudi Arabia 150 Saudi Arabia 150 2009 – Ukraine 95 Egypt 105 Egypt 105 Slovenia 50 Slovenia 50 2010 – Ukraine 36 Salzburg 40 Salzburg 40 MECC 50 MECC 50 2011 – Georgia 75 Vietnam 100 Vietnam 100 Cyprus 55 Cyprus 55 Turkey 52 Turkey 52

50. First dose of oral morphine – Al Basheer Hospital

51. 1-week Classroom vs. 3-weeks Bedside Training 2 Open Society Institute ( OSI ) Courses, Salzburg 1 week ( 5 days ) 1 week ( 5 days ) Classroom Classroom Interactive didactic 2 Jordan Courses, Amman, Jordan 3 weeks ( 15 days ) 3 weeks ( 15 days ) 1 week classroom 1 week classroom Interactive didactic 2 weeks bedside training 2 weeks bedside training

52. P < 0.001

54. Day 1 After Course

55. Day 1 After Course

56. 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.”

57. 1st International Palliative Medicine Physician