• Christoph Ostgathe, Raymond Voltz, Friedemann Nauck, and Eberhard Klaschik.
• Department of Palliative Medicine, University Hospital, Cologne and Department of Anaesthesiology and Palliative Medicine, Malteser Hospital, University Bonn, Bonn. christoph.ostgathe@uk-koeln.de
• Palliat Med. 2007 Mar 1;21(2):155-6.

IntroductionThe effect of a curriculum without compulsory courses in palliative medicine on students' knowledge, kills and attitudes towards the care of dying patients and decisions at the end of life was investigated.MethodsIn a cross sectional, questionnaire based survey at the medical school of Bonn 1st, 3rd and 5th year students had to grade their knowledge and skills in items concerning palliative medicine. Attitudes towards end of life decisions were queried.ResultsThe return rate was 78%. Significant increase in self estimation of certainty comparing 1st to 5th year students were detected for the items distinction between palliative and curative medicine (p <0.001), symptom control (p <0.001), pain management (p =0.001) and communication (p =0.036). No significant differences were recorded for the items accompaniment of dying patients, breaking bad news and integration of spiritual aspects. The low overall certainty is reflected in poor knowledge. A significant decrease of the approval for euthanasia by request was evident (p =0.012).DiscussionA medical curriculum without compulsory course does increase confidence in some of the core competencies in palliative care, but the overall results at the end of the training are poor. The WHO claims that palliative care has to be "compulsory in courses leading to a basic professional qualification" has still to be fulfilled in Germany. This study can serve as a baseline to evaluate the effect of mandatory courses in palliative care.

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