End-of-Life Care: An Introduction for Osteopathic Medical Students

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End-of-Life Care An Introduction for Osteopathic
Medical Students

• Colleen Fitzgerald
• Touro University College of Osteopathic Medicine

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Holistic Philosophy

• As Osteopaths, we are trained to examine each
  patient in a holistic manner.
• My goal is to present highlights of my Fellowship
  experience so other students can catch a glimpse
  of a patients transition to the end of life
  while receiving Hospice benefits.

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Touros Curriculum

• Currently, the End of Life care curriculum at
  Touro Universitys College of Osteopathic
  Medicine includes two lectures delivered by our
  Hospice Medical Director, Dr. Cathy West.
• The first lecture is delivered to first-year
  students and addresses the barriers to good end
  of life care, a discussion of the tasks and
  responsibilities that clinicians have in caring
  for patients at the end of life, and an
  introduction to hospice care.

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Touros Curriculum

• Dr. West delivers the second lecture to
  second-year students, which addresses how to
  concretely manage symptoms and pain before
  students begin third-year rotations. Dr. West
  addresses the general fear about addiction, and
  explains the difference between physical and
  psychological dependence.
• Students also have the option to take a one-month
  hospice rotation as an elective during the third
  or fourth year.

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Small Group Experience

• I hope to take advantage of Touros new
  curriculum, which divides students into small
  groups three times a week for a more integrative,
  hands-on learning experience.
• During one such session, I plan to introduce a
  small-group lab session for first-year students
  that consists of one morning and one afternoon
  session.

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Small Group Experience

• The first hour of one two-hour morning session
  will consist of an introduction to the concept of
  a hospice team. During a role-playing session,
  each group will act as one agent of the team
  caring for the same patient. For example, one
  entire team will explore the role of the social
  worker. Another will act as the nurse, another
  the physician, etc. One member of each team will
  role-play the patient/family member according to
  a pre-determined scenario. At the end of the
  session, one member of each team will present
  their findings to the entire class, similar to a
  team meeting, so all can experience the benefit
  of a team approach in the care of hospice
  patients.
• During the second hour, a panel of actual hospice
  team members will discuss end-of-life-care issues
  they encounter daily, and the communication
  breakdown they see between doctors, nurses,
  patients, and families.

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Small Group Experience

• The afternoon lab will consist of an experiential
  session. Within each small group, each student
  will pick a scenario and role-play with another
  student the breaking of bad news to patients.
• Students will also learn to discuss when
  aggressive care may no longer be appropriate for
  a patient, and when hospice care is a feasible
  alternative.
• The structure of our new curriculum is ideal for
  the role-playing experience. After working in
  small groups for several months before the lab,
  students have developed intimate relationships
  with each other, which mirrors the doctor-patient
  relationship.

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Hospice Care A Truly Hands-On Experience

• I have also discovered a faculty member who is
  willing to research Osteopathic Manipulative
  Therapy for pain management during end-of-life
  care, and subsequently deliver a lecture to
  second-year students. This lecture and these lab
  sessions will be designed to complement the
  lectures already delivered by Dr. West in timing
  and in content.

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Training Future Physicians

• Finally, with Dr. Wests assistance, I hope to
  introduce an elective class for Hospice Volunteer
  Training. This mini-elective will result in
  students becoming certified as hospice
  volunteers.
• Hospice volunteer training has prepared me to
  deal with very sensitive issues, and I believe
  this valuable experience will greatly benefit
  students entering any field of medicine.