Educating Future Physicians In Palliative And End Of Life Care Project: Successes

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Educating Future Physicians In Palliative And End
Of Life Care ProjectSuccesses Challenges

• Larry Librach MD,CCFP,FCFP
• Physician Leader EFPPEC
• W. Gifford Jones Professor Pain Control
  Palliative Care
• University of Toronto

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• In some respects, this centurys scientific and
  medical advances have made living easier and
  dying harder
• Approaching Death-The Institute of Medicine

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Background

• In 2003, Health Canada provided funding for a
  national education project for future physicians
  called EFPPEC
• The project is heading into last 1 ½ years of
  its mandate
• We gave a preliminary report 2 years ago

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Project Overall Goal

• By the year 2008, all undergraduate medical
  students and the residents at Canadas 17 Medical
  Schools will be receiving effective training in
  palliative and end-of-life care and will graduate
  with competencies in these areas.

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Issues Leading to the Development of EFPPEC
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The Education Work Group of the Canadian Strategy
on Palliative End of Life Care

• Interprofessional group
• Identified core competencies for all health care
  professionals
• Identified needs for education by surveys

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End of Life Care Needs of Canadians

• Quality End-of-life Care The Right of Every
  Canadian
• Canadian Senate Report 2000 2005
• Social responsibility of medical schools

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Documented Deficiencies In Training Future
Physicians

• Oneschuk D, et al. The status of undergraduate
  palliative care education in Canada. J Pall Care.
  20042032-37
• Noted lack of curriculum in all postgraduate
  residency programs

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Palliative Medicine

• Recognition of palliative medicine as a specialty
• Residency program
• CSPCP
• Academic expertise in education

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All Family Physicians Should Be Involved In
Providing Palliative Care

• Not just Palliative Care specialists teams
• Palliative care not just at end.

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The Informal Hidden Curriculum

• Influence of faculty as role models
• Good bad
• Faculty behaviour attitude influences residents
• Implicit explicit messages

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The Growth of Palliative Care

• More prominent organizations
• CHPCS, QEOLCC
• Norms of Practice
• Regionalized care
• Need to meet demands for PM physicians care
  standards

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EFPPEC Structure
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EFPPEC Partners

• AFMC is principal partner.
• CHPCA is co-partner.
• Health Canada funding
• Office is located at CHPCA in Ottawa.

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EFPPEC Project Team

• Project Manager
• Louise Hanvey
• Physician Leader
• Larry Librach
• Administrative Assistant
• Jennifer Kavanagh

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EFPPEC Management Committee

• Alan Neville (Chair)-McMaster University
• Rob Wedel-U of Calgary
• Hubert Marcoux- U of Laval
• Paul Daeninck-U of Manitoba
• Doreen Oneschuk-U of Alberta
• Maryse Bouvette-MN
• Sue Maskill-ACMC
• Sharon Baxter-CHPCA
• Gerard Yetman- Health Canada

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Challenge Integrate, Not Usurp

• A curriculum that is already full.
• Map out opportunities for integration
• Block SD et al. Journal of General Internal
  Medicine. 1998 13(11)768-73,

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Tasks Status
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Enlist Support of Deans of All 17 Medical Schools

• Need for top down authorization
• Easier than expected
• AFMC accredits these schools is sponsoring
  partner
• All in favour and enthusiastic

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Task 1Local Team Development
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Background

• Every medical school has a somewhat different
  culture blend of learning methods
• Each school has curriculum that may have EOLC
  components that need to be identified
• Bottom up approach

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Tasks for Local Teams

• Form an interprofessional team of educators
• Identify team leader(s)
• Implement a curriculum inventory tool submit
• Begin to integrate into curriculum committees
  process for UG PG
• Attend first EFPPEC symposium

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Results

• All 17 have identified local teams leaders
• Most are very active
• 3 are still struggling although getting more
  active
• All teams are IP

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Results

• Initial curriculum inventories done in the
  majority
• 11 of 17
• Good attendance at 1st symposium
• Have established regular e-mail newsletters

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Task 2Develop Consensus on UG Medicine Basic
Competencies
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Background

• CSEOLC had developed core competencies
• Used these to identify specific enabling
  competencies
• Subjected these to national consensus building
• PC, medical educators

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Results of Consensus Building

• From a participant list of 327 medical educators,
  there were a total of 210 respondents, a response
  rate of 64.2
• Most items achieved consensus of around 90
• Changes suggested incorporated

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UG Medicine Competencies

• SEE HANDOUTS

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Task 3Develop UG Curriculum Guidelines Based on
Competencies
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Background

• There had been a previous attempt at defining
  curriculum objectives in palliative / EOLC
• Too long
• Not the right time
• Local provincial efforts had started by
  consensus that a national document would carry
  more weight

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Tasks

• Work with the UG Education Committee of the
  CSPCP, the Ontario group the Québec Groups from
  the medical schools to see if efforts could be
  combined
• Incorporate competencies, enabling competencies
  limited specific objectives
• Get national consensus on the curriculum guideline

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Results

• Almost two year project to meld the efforts of
  groups
• Draft produced subjected to national survey
• Fewer responses in total but good input from
  educators
• Changes have been made penultimate draft being
  reviewed before translating publishing

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Further Tasks

• Ensure the Medical Council of Canada exams
  incorporate EOLC questions OSCEs

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Task 4Continuing Professional Development
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Background

• Recognition that many PC educators not well
  integrated into system in their schools partly
  because of lack of training to be educators
• Feedback from PC people indicating their need for
  education on teaching, evaluation, program
  development etc.
• Expressed need for education forum in EOLC

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Tasks

• Establish an annual EFPPEC Symposium dedicated to
  teaching learning in PEOLC
• Partnered with an organization
• IPE in nature

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Results

• 2 EFPPEC Symposia have been held in conjunction
  with the 5 partner Canadian Association of
  Medical Education
• First devoted to opinion leader development
• Second with workshops progress reports

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Results

• Videoconferences
• 4 so far
• Across Canada
• Inexpensive
• Allow sharing of experiences

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Challenges

• How can this be sustained?
• Expensive if current model maintained
• Where when to have the meeting
• Most PC educators not at CAME meeting

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Solutions

• Move the meeting as a preconference to the annual
  CHPCA conference
• 2007 in Toronto
• CSPCP as partner
• Incorporate an education stream throughout CHPCA
  conference

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Task 5Postgraduate Competencies in PEOLC
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Background

• Get an initial buy-in (top-down)
• 2 accrediting organizations for PGME
• CFPC RCPSC
• Need to identify incorporate any competencies,
  enabling competencies objectives for each
  specialty
• Rely on accreditation to ensure basic training

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Background

• Some literature examples but little Canadian
  activity
• Need to avoid overwhelming objectives
• Need to target specialties who need enhanced
  knowledge
• e.g. oncology

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Tasks

• Work with CFPC
• Already had made some changes
• Develop specific objectives in format of 4
  principles as well
• Consensus building
• Work with RCPSC
• Establish specific objectives do consensus
  building

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Results-Family Medicine
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Palliative Care FM Training

• From the most recent edition of the CFPCs
  Standards for Accreditation of Residency Training
  Programs (The Red Book), the following section
  has been included
• Palliative and End of Life Care
• Residents must learn the skills, knowledge, and
  attitudes related to the management of physical,
  psychological, social and spiritual needs of
  dying patients and their families. Residents must
  be familiar with medical and societal attitudes
  towards death and dying.

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Common Competencies for Family Medicine Residents

• SEE HANDOUT

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Results-CFPC

• Have achieved consensus
• National working group of family medicine
  programs educators working on curriculum
  guidelines

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Results-RCPSC

• Initial meetings with RCPSC to discuss mechanisms
• Draft enabling competencies objectives for
• Core medicine
• Critical care
• Groups working on pediatrics, oncology, core
  surgery

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Results-RCPSC

• Will move on other specialites
• Need to go to specialty committees for vetting
  then we will do similar consensus building

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Task 6Communications
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Background

• Need to enhance networking publicize efforts
• EFPPEC Project materials to be developed

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Tasks

• Bilingual materials that are constantly reviewed
• Develop system for sharing info across programs
• Do presentations publish

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ResultsEFPPEC Communications Strategy

• Materials
• Website
• Reaching out to offer help

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ResultsLearning Commons

• PALLIUM product
• On-line resource of materials
• Registry editing functions
• Search capacity
• Notification capacity
• On-line workspace for projects
• Still working out glitches

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Challenges

• Sustaining the Learning Commons identifying
  host site

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Task 7Sustainability
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Challenges

• What to do when the money runs out?
• What about an IPE effort?
• Is there a potential for further funding?
• Source?
• Monitoring of changes

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Summary

• An ambitious 4 year project to introduce
  effective teaching in end of life care and
  produce physicians who are competent in this area
• larry.librach_at_utoronto.ca