Opinion & Special Article: Next Steps in Palliative Care Education for Neurology Residents

Abstract

Many neurologic diseases are life limiting and markedly impair patients' quality of life. Growing recommendations in the field recommend that neurologists have primary skills in palliative medicine that will allow them to manage symptoms and discuss end of life decisions with patients and families. Previous work has shown that formal palliative care training in neurology residencies is very limited. In this paper we briefly describe a national survey of neurology residents where we assess both the quantity and quality of the teaching they receive in end-of-life care as compared to a common and an uncommon neurologic condition. Based on the gaps we identified, as well as previous studies and recommendations in neuropalliative care, we provide nine recommendations to help neurology residency programs improve their teaching of primary neuropalliative care skills.

The State of Palliative Care Education in United States Physical Medicine and Rehabilitation Residency Programs: Heterogeneity and Opportunity for Growth

“…8,9,[18][19][20][21][22][23][24] In neurology, recommendations for enhancing primary PC education for residents have recently been set forth, which include using patient simulations to practice advanced communication skills and structuring opportunities to debrief after challenging clinical scenarios. 18 Given overlapping neurology/PM&R populations, such recommendations may be valuable to consider in PM&R as well. A recent perspective by the Physiatry Palliative Care Task Force of the Association of Academic Physiatrists describes the holistic, quality of life-centered approach to care shared by PM&R and PC and provides several physiatry-relevant PC resources for learning, teaching, and clinical practice.…”

“…There is increasing recognition across medical and surgical specialties, including PM&R, of the need for and value of PC education for resident trainees. 8,9,[18][19][20][21][22][23][24] In neurology, recommendations for enhancing primary PC education for residents have recently been set forth, which include using patient simulations to practice advanced communication skills and structuring opportunities to debrief after challenging clinical scenarios. 18 Given overlapping neurology/PM&R populations, such recommendations may be valuable to consider in PM&R as well.…”

Emerging Subspecialties in Neurology: Cortical Careers in Neuropalliative Care

“…Research in the field is expanding, and Dr. Holloway notes a particular need to address gaps in current models of care such as hospital NPC. Curriculum development to address gaps in training is also an ongoing area of research, 3-5 and Dr. McFarlin hopes that primary PC skills will expand in neurology training. Dr. Miyasaki adds that in the future, the public needs to create demand for access to PC to combat work force pressures and influence policy decisions.…”

“…Neurologists must have competence in primary PC skills, including assessing for and managing symptoms, providing basic psychosocial and spiritual support, communicating prognosis sensitively, and engaging in shared decision-making 2,3 ; however, there are training gaps in neurology residency programs to adequately equip trainees with these skills. 4,5 Neurologists can strengthen these skills through PC electives, courses, and online curricula (Table). They can also pursue a 12-month Accreditation Council for Graduate Medical Education fellowship in Hospice and Palliative Medicine (HPM), 2 of which have dedicated NPC tracks.…”

A Narrative Review of Problems in Learning and Practicing Palliative Care in Neurology Clinics in Japan and Proposed Solutions

“…Neurologists do need to receive education, both theoretical and practical, for palliative care [ 19 , 20 ]. In Japan, there are increasing educational opportunities at all levels, as described below.…”