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2° Expert skills Palliative Care Consultants / Teams Palliative Care Skills...

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Presentation on theme: "2° Expert skills Palliative Care Consultants / Teams Palliative Care Skills..."— Presentation transcript:

1 2° Expert skills Palliative Care Consultants / Teams Palliative Care Skills...

2 Palliative Medicine Specialists 2006 ABMS recognized subspecialty 2006 ABMS recognized subspecialty 10 of the 24 parent boards 12 month US fellowship, > 71 graduates 12 month US fellowship, > 71 graduates Class of 2011 - 2012

3 2006 – Palliative Medicine Recognized as Subspecialty by American Board of Medical Specialties 2006 – Palliative Medicine Recognized as Subspecialty by American Board of Medical Specialties 1.1 year Fellowship or Experiential qualification ( 2006 – 2013 only) Oversight: American Committee Graduate Medical Education Accreditation: American Academy of Family Practice 2.Certification exam Multiple choice ABIM: American Board of Internal Medicine

4 Internal Medicine Family Medicine Anesthesiology Pediatrics Surgery Emergency Medicine OB / GYN Physical Medicine & Rehab Radiology (XRT) Psychiatry & Neurology 10 Sponsoring Specialties Hospice and Palliative Medicine

5 Next Steps Clinical ClinicalCompetenciesOutcomes Teaching skills Teaching skillsPresentationFacilitation Bedside mentorship Leadership skills Leadership skills Research project Research project

6 360° Evaluation 1.Patient and family care 2.Medical knowledge 3.Practice-based learning and improvement 4.Communication and interpersonal skills related to process of providing care 5.Professionalism 6.System based practice

7 IPM US Fellows Employment 7 San Diego 10 Los Angeles 1 Hawaii 1 New Zealand

8 Internal Medicine Family Medicine Anesthesiology Pediatrics Surgery Emergency Medicine OB / GYN Physical Medicine & Rehab Radiology (XRT) Psychiatry & Neurology 10 Sponsoring Specialties Hospice and Palliative Medicine

9 Palliative Medicine Fellowship… Developing Clinical Capacity Palliative Medicine Fellowship… Developing Clinical Capacity

10 Hypothesis Training palliative medicine specialists will advance palliative care delivery and increase opioid consumption

11 Int’l Palliative Medicine Fellowship Over 24 - 36 months Over 24 - 36 months 4 – 6 months at San Diego Hospice 2 visit by IPM Faculty in-country Competency-based Practical bedside mentorship, not observership

12 International Fellows

13 Pilot: 11 Int’l Fellow Graduates Demonstrated competencies to IPM faculty Demonstrated competencies to IPM faculty All recognized as consultants 3 Jordan 2 Georgia 2 Mongolia 1 Slovenia 1 Spain 2 Vietnam

14 King Hussein Cancer Center Jordan 2 fellow graduates  consultants 2 fellow graduates  consultants

15 King Hussein Cancer Center Jordan Built palliative care program Built palliative care program 2 palliative medicine consultants > 50 staff 10-bed inpatient unit ( of 140 beds ) Inpatient consults Ambulatory outpatient clinics Homecare Saw > 2,000 patients in 5 years ( since October 2004 )

16 KHCC Pall Care Growth New Patients Length of Stay

17 KHCC Outpatient Opioid Consumption 2004 - 2.7 kg2006 - 5.3 kg2008 - 6.2 kg

18 Jordan Opioid Consumption INCB 1980-2008 Morphine Use in Jordan ( mg / capita ) ≈ 11.8 kg 4x  ≈ 2.9 kg

19 Urska Lunder Ljubljana, Slovenia Medical Director, Palliative Care, Golnik Hospital Medical Director, Palliative Care, Golnik Hospital 19 bed unit, consultation service, home care MoH Pilot Pathway Project - 3 regions MoH Pilot Pathway Project - 3 regions Teaching extensively Teaching extensively Faculty European School of Oncology European Union Research on EOL European Union Research on EOL IPM Leadership Development Initiative IPM Leadership Development Initiative

20 Gantuya Tserendorj Ulaanbaatar, Mongolia Medical Director, Palliative Care, National Cancer Center Medical Director, Palliative Care, National Cancer Center 16 bed unit, consultation service, outpatient clinics MoH agreed to pay for PC services MoH agreed to pay for PC services Teaching regularly across Mongolia Teaching regularly across Mongolia Member Board of Directors new Foundation of First Lady of Mongolia dedicated to vaccination & palliative care Member Board of Directors new Foundation of First Lady of Mongolia dedicated to vaccination & palliative care

21 Mongolia June 2009

22 Reach of 11 Fellows Direct: If each cares / influences care of 1,000 pts / yr, for 30 yr PatientsLives EachTouched 11 Fellows30,000330,000 + families Indirect: Teaching, research, advocacy

23 Next Step  Expanded international pilot project NCI R25E grant 2011 – 2015 20 Fellows Cyprus 2 Ghana 2 Tanzania 2 Egypt 1 ( + 1 ) Italy 1 ( + 1 )Uganda 2 Georgia 3Peru 1 Others… Brazil, Colombia, Rwanda ?  US pilot project Address workforce shortage

24 Growing Global Leaders… Advancing Palliative Care

25 Cohort 2: 23 Leaders, 10 Mentors Argentina South Africa Nigeria Uganda 4 India 2 Vietnam Albania Armenia Serbia Kenya Turkey Guatemala Colombia Brazil Bangladesh 2 Mongolia Nepal Romania

26 Cohort 2: 23 Leaders, 10 Mentors Argentina Uganda India Australia Belgium UK Canada USA Germany Sweden

27 5 Practices of Exemplary Leaders… 1. Model the way 2. Inspire a shared vision 3. Challenge the process 4. Enable others to act 5. Encourage the heart

28 Niche… Over 2 years Develop Individual Development Plan ( IDP )  Build leadership skills ( self ) Residential courses - curriculum Coaching  Apply leadership skills in practical palliative care activities Mentorship by senior palliative care leaders  Advance palliative care capacity locally, regionally, globally

29 Foster Leadership Skills

30 Attitudes about Leadership p = 0.0005 p = 0.05 PositiveNegative BeforeRetrospectiveAfter

31 Leadership Core Skills All p < 0.003 Self Organizational Regional / International

32 Sample outcomes to date…

33 Palliative Care Activities… Latin America New PC undergraduate medical education curriculum 2 universities New PC undergraduate medical education curriculum 2 universities Beginning interdisciplinary post-graduate courses Beginning interdisciplinary post-graduate courses Improving PC E-learning course for doctors & nurses Improving PC E-learning course for doctors & nurses

34 Palliative Care Activities… Czech Republic Regular multi-disciplinary meetings in Cancer Institute,  referrals Regular multi-disciplinary meetings in Cancer Institute,  referrals New website for Czech Society of Palliative Care New website for Czech Society of Palliative Care Palliative medicine recognized as new medical specialty Palliative medicine recognized as new medical specialty

35 Palliative Care Activities… Africa Integrating PC into medical, nursing & dental schools Integrating PC into medical, nursing & dental schools Integrate palliative care in 10 hospitals in country Integrate palliative care in 10 hospitals in country Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies

36 Palliative Care Activities… Vietnam First Dept. PC Ho Chi Minh Cancer Center First Dept. PC Ho Chi Minh Cancer Center Beginning home care New PC unit Hanoi New PC unit Hanoi Vietnamese E-learning in PC Vietnamese E-learning in PC

37 International Scholar-in-Residence Dr. Staffan Lundström Stockholm, Sweden

38 International Reach 2003 – 2015 Patients ParticipantsEachLives Presentations > 10,0001001 M Presentations > 10,0001001 M Courses> 50020001 M Courses> 50020001 M Fellows11 + 20 10,000+.3 M+ Fellows11 + 20 10,000+.3 M+ Leaders19 + 2310,000+.4 M+ Leaders19 + 2310,000+.4 M+ > 2,7 M+

39 Key Message A consistent, planned approach to education interventions and evaluation over 5-10 years changes behaviors and the experiences of patients and families, organizations and societies

40 Mohammad Bushnaq at End of Fellowship… “ Overall, I can say it very clear that: my experience with palliative care not only changed my career, but also the way I am looking to the life, the way I communicating with people, the way I am trying to understand others, and how you can be a happy person by working for noble ideas…

41 …Mohammad Bushnaq “ I truly believe that palliative care is NOT limited to terminally ill patients, or even for sick person; but also it is the answer for all people on earth, for nations as a language to replace the language of conflict between nations we hear everyday in the media.

42 Call to Action in Sweden  Education Standardized curricula Trainees - students, residents Practicing professionals Specialty recognition Fellowship training

43 “ The standards of practice we create and the people we train will look after us when it’s our turn to receive care… ” Will Sweden be ready ?

44 www.PalliativeMed.org www.IPCRC.net You must be the change you want to see in the world Gandhi You must be the change you want to see in the world Gandhi

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