End-of-Life Care Curriculum

1
End-of-Life Care Curriculum

• Melanie Johnson, MSII
• Wake Forest University
• School of Medicine

2
Outline

• Overview of current curriculum at WFUSM
• Improving the curriculum
• My plan of action
• For 2003-2004
• For 2004-2005 and beyond

3
Overview of current curriculum
4
Wake Forest University/Baptist Medical Center
Hospice and Palliative Care CenterOVERVIEW

• Medical School Curriculum
• HPCC Medical Director Staff of WFUBMC
• MS Is
• Lecture to whole class and then small group
  discussion of the issues raised
• MS IIs
• Lecture and small groups
• MS IIIs
• (Now) 32 hours during Ambulatory Medicine
  rotation

Dr. Richard Stephenson WFUBMC
5
Current MSI MSII Schedule

• Lectures and small group discussions
• Small groups consist of
• 2 professors (1 M.D. and 1 Ph.D.)
• Topics include but are not limited to
• Hospice and Palliative Care
• Communicating Bad News
• Advance Directives

6
MSIII Rotation (2002)

• Every Wednesday during Ambulatory Medicine
• All MSIIIs (9 or 10 each month)
• HP, POC, Eval form, and Reflection Paper
• Favorite, most meaningful rotation

Dr. Richard Stephenson WFUBMC
7
Current MSIII Schedule
Dr. Richard Stephenson WFUBMC
8
Medical interns, residents and fellows

• Interns
• 3 to 5 Half days
• Practical review of the Medicare Hospice Benefit
• Who qualifies what do they get
• Pain 101 and 201 (opioids)
• Rounds
• Admissions
• 3rd year residents electives
• Some didactics
• Lots of direct patient care
• Project
• Teaching
• First-responder for consults at WFU/BMC
• House calls

• Fellows elective
• Geriatric, Hem/Onc, General IM
• Everything 3rd year Resident does plus
• Research a topic
• More of a role in teaching
• Presentation to hospice clinical staff
• Fellowship in Hospice and Palliative Care
• being implemented this academic year

Dr. Richard Stephenson WFUBMC
9
Improving the Curriculum
10
Goals

• Bridge the gap between the first 2 years of med
  school and the 3rd year rotation
• Allow opportunities for students to have direct
  exposure to hospice and palliative care before
  the 3rd year rotation
• Enhance communication skills
• Enhance knowledge of the psychosocial aspects of
  hospice and palliative care

11
Improving 1st and 2nd year

• Incorporate additional lectures into the
  following classes
• Doctor Patient Relations
• Medicine as a Profession
• Suggested lecture topics
• Cultural Sensitivity
• Spirituality
• Grief and Bereavement
• Family counseling/conferences

12
Outcomes MSIII Rotation Evals 2001
(1 no opportunity to learn5 outstanding
opportunity)
Dr. Richard Stephenson WFUBMC
13
MSIII Rotation Evals 2001 (cont)
Dr. Richard Stephenson WFUBMC
14
Improving the 3rd year

• Suggested lectures
• Hydration and IV use
• Physiology of dying
• Ethical Issues
• Physician assisted suicide
• Withdrawing and withholding care
• Dealing with personal feelings
• Debriefing exercises
• Small group discussions
• Journaling

15
My plan in action
16
for 2003-2004

• Spread the word
• Distribute brochures in student mailboxes
• E-mail the entire student body
• Post signs on bulletin boards
• Lunch meeting/information session
• Overview of hospice and palliative care
• Background information
• Video To Live until I die
• Need for awareness and education
• Sign up sheet to become volunteers
• For interested students
• Train them to become volunteers at the Kate B.
  Reynolds Hospice Home
• Will be assigned a patient and will follow the
  patient and family throughout the dying process
• Provide shadowing with the interdisciplinary team

17
for 2003-2004 cont

• Forming Partnerships
• With SNMA to increase African American and other
  minorities awareness of hospice and palliative
  care in Winston-Salem, NC
• With the Geriatric Interest Group
• With AMSA to implement the Death and Dying
  component at WFUBMC

18
Plan for 2004-2005 beyond

• To integrate several lectures into the 1st and
  2nd year courses
• Apply for funding from WFUBMC to form a special
  interest group
• Hold extensive monthly seminars and workshops
• Promote group activities and additional volunteer
  experiences.

19
The end.

• Questions?
• Comments?
• Suggestions?