Junior Doctors’ Views of How Their Undergraduate Clinical Electives in Palliative Care Influenced Their Current Practice of Medicine

Crawford, Gregory B.; Zambrano, Sofía C.

doi:10.1097/acm.0000000000000632

Cited by 33 publications

(37 citation statements)

References 32 publications

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“…A formal assessment of the learning needs of the students, especially after their first contacts with dying patients, might be helpful for further development of the curriculum. Our results are in line with previous studies showing that education in PM is appreciated by medical students as well as by physicians [25–27]. …”

Section: Discussionsupporting

confidence: 93%

“…A recent study by Gerlach et al showed that a course consisting of seven times 90-minute classes in palliative care increased medical students’ self-confidence concerning somatic, spiritual and psychological aspects of PM and resulted in high knowledge in a post-course test [24]. Education in PM may also help to adapt patient-centered care in general [25]. However, most of these studies have concentrated on the short term effects of a single course of PM education [20, 23, 24].…”

Section: Discussionmentioning

confidence: 99%

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Undergraduate curriculum in palliative medicine at Tampere University increases students’ knowledge

et al. 2017

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BackgroundEducation in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland.MethodsWe searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students’ knowledge was evaluated using a progress test over three consecutive years.ResultsWe found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p < 0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p < 0.001).ConclusionsThe curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Undergraduate curriculum in palliative medicine at Tampere University increases students’ knowledge

et al. 2017

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“…Qualitative studies concluded that previous training in PC increases the competencies of trainees with end-of-life care 20,21 and general patient care. 41 Two thirds of the trainees surveyed agreed that mandatory rotations in PC should be implemented in medical schools and residency training programs. Most oncology fellowships across the nation do not have mandatory rotations in PC.…”

Section: Discussionmentioning

confidence: 99%

ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

Wong

Reddy

Williams

et al. 2016

JOP

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QUESTION ASKED: What are graduate medical education trainees' attitudes and beliefs regarding palliative care, what is their awareness of the availability and role of palliative care services, and does previous exposure to a palliative care rotation facilitate a better awareness of palliative care?SUMMARY ANSWER: A vast majority of oncology trainees perceived palliative care services to be beneficial for patient care (92%) and were supportive of mandatory palliative care training (74%). Surgical oncology trainees and trainees with no previous palliative care exposure were significantly less likely to consult palliative care and had significantly less awareness of palliative care. METHODS:We conducted an institutional review board-approved online survey to determine awareness of palliative care among graduate medical trainees at MD Anderson. One hundred seventy oncology trainees who completed at least 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowship and residency program during the 2013 academic year completed an online questionnaire. Descriptive, univariate, and multivariate analyses were performed. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:Although there was a substantial response rate (78%), the results may not be generalizable as the survey was conducted at a single institution. Also, the frequency of palliative care referrals is self-reported. REAL-LIFE IMPLICATIONS:Our findings suggest that exposure to palliative care training may lead to increased awareness of palliative care among oncologists, and thus, increased overall and early referrals to palliative care. Surgical oncology trainees may benefit from increased exposure to palliative care rotations. More research is needed to characterize the impact of training on referral patterns to palliative care. In the meantime, efforts should be made to include formal palliative care rotations in oncology training. Participants and MethodsWe conducted a survey to determine awareness of PC among graduate medical trainees at a comprehensive cancer center with an established PC program. One hundred seventy oncology trainees who completed $ 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowships and residency programs during the 2013 academic year completed an online questionnaire. Descriptive, univariable, and multivariable analyses were performed. ResultsThe response rate was 78% (132 of 170 trainees); 10 trainees without hands-on patient care were excluded.

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“…35 42 Senior support is variable and specialty-dependent, 12 17 22 38 42 with most support being practical advice rather than emotional. 17 Senior support is particularly lacking when senior doctors had limited experience of caring for frail older patients or greater experience in medical or surgical interventions. 37 38 40 41 Junior doctors report receiving support outside the medical team, from nursing colleagues, 22 27 35 40 41 47 palliative care specialists, 12 18 22 25 40 friends and family, 17 39 and online advice.…”

Section: Thrown In At the Deep Endmentioning

confidence: 99%

“…12 40 41 Palliative care rotations, at postgraduate or undergraduate level, are seen as the best way to achieve this 12 15 20-22 25 28 because the rotations or placements are valued as opportunities to address the unmet needs from medical school, which included specific and transferable skills in symptom control, professionalism, teamwork, communication, reflective practice 17 20 21 25 37 44 and in ethical-legal framework. 17 There was one exception where junior doctors reported hospice placements as medically deskilling experiences, but this had a low weight of evidence. 20 Other learning methods valued by junior doctors include observation of senior colleagues 14 17 21 31 37 40 43 49 and reflection in clinical contexts 14 17 24 40 41 or social settings.…”

Section: Addressing the Gapmentioning

confidence: 99%

Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis

Bharmal

Morgan

Kuhn

et al. 2019

BMJ Support Palliat Care

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BackgroundPalliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.AimTo review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.MethodsSystematic literature review and narrative synthesis.ResultsA search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.ConclusionMedical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.

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Junior Doctors’ Views of How Their Undergraduate Clinical Electives in Palliative Care Influenced Their Current Practice of Medicine

Cited by 33 publications

References 32 publications

Undergraduate curriculum in palliative medicine at Tampere University increases students’ knowledge

Undergraduate curriculum in palliative medicine at Tampere University increases students’ knowledge

ReCAP: Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center

Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis

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