Academic medicine : journal of the Association of American Medical Colleges
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The American Academy of Pediatrics' statement on palliative care for children emphasizes the need to identify and address barriers to effective palliative care. The authors describe a seminar for pediatrics residents on death and bereavement that addresses these issues. The day-long seminar for second-year residents has been offered annually since 1996. ⋯ The seminar uses an intense and comprehensive multidisciplinary approach to accomplish seven goals: (1) to have residents gain expertise in talking with parents about the death of their child; (2) to have residents practice and experience how it feels to be in emotionally charged situations; (3) to train residents to become more knowledgeable concerning autopsy and organ donation, and to learn strategies to approach these topics with a child's parents; (4) to have residents gain an understanding of the role of the ministry for families who are grieving; (5) to provide residents with multidisciplinary strategies to support a family after a child has died; (6) to help residents gain insight into the impact of death on their own emotions and the importance of addressing their own emotions to cope with stress and potential burnout; (7) and to help residents better understand the parents' perceptions of the medical care providers and their dying child. In their evaluation comments, the residents report value from a seminar designed to help them address issues of patient death and bereavement. This type of educational intervention should be considered for the curriculum by other residency programs.
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The authors report the results of a Robert Wood Johnson Foundation-funded project that catalyzed New York State medical schools to develop and implement strategic plans for curricular change to enhance palliative care education. The project used the Palliative Education Assessment Tool for curricular mapping of palliative care education throughout each school's four-year curriculum and used site visits to facilitate strategic planning within each institution. Of the 14 New York State medical schools, 13 participated in the project. ⋯ Of these goals, 67 (94.4%) had been implemented or were in the active-planning process one year after the plans were created. Overall, palliative care content was enhanced in four curricular areas: basic science courses, ethics and humanities courses, clerkship rotations, and faculty development in palliative care. The process of self-assessment, curriculum mapping of a specific thematic area, and strategic planning for change appears to have successfully enhanced the palliative care content in the medical schools' curricula.
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Health care institutions are examining ways to improve physicians' skills in the delivery of end-of-life (EOL) care. Experts have suggested that influencing physicians' knowledge and attitudes concerning EOL care can influence subsequent EOL practices, including hospice use for appropriate patients; yet few studies have examined empirically the influence of physicians' knowledge and attitudes on such practices. The authors assessed the influences of self-rated knowledge and attitudes on physicians' discussions and referrals for hospice care. ⋯ This study demonstrated that self-rated knowledge and attitudes may influence hospice referral. The results support current efforts to develop medical school curricula and continuing education programs that better cover the many aspects of caring for the dying, including hospice use.
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National recommendations have been developed for physicians' end-of-life (EOL) education. No comprehensive assessment has been done to examine postgraduate (residency and fellowship) EOL training. ⋯ The lack of comprehensive EOL training requirements may help explain the known problems in physicians' EOL care. Major reform in EOL requirements is needed at the level of residency review committees.
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End-of-life (EOL) and palliative care education in medical school curricula stand at a crossroads. Consensus has emerged that these topics merit systematic instruction throughout medical school training, yet curricula all too often consist of sporadic lectures focused on bioethics instead of clinical skills. The medical student authors identified a deficit in their curriculum, and designed and implemented an EOL curriculum module for their colleagues. ⋯ Approximately 75% of the 86 eligible students attended the module in 2000 and 2001. Feedback has guided the curriculum's refinement by the medical student authors. In addition, a standardized patient exercise, introduced in 2001, allowed students to reinforce the skills learned during the module.