Introduction to the Practice of Medicine III
End of Life Content
- 2 half day sessions – Education for Physicians on End of Life Care (EPEC) based
- Whole patient assessment
- Goals of care
- Pain Management
- Common physical symptoms
- Improving end of life care and elements and models of end of life care
- Last hours of living
- Delirium, depression, anxiety
Assessment
Written examination questions
End of Life Curriculum Goals and Objectives Addressed
Goal #1 Medical Knowledge
Students must demonstrate knowledge about the medical aspects of death and dying, as well as the skills and attitudes necessary to use this knowledge effectively as a physician. Our students will know:
- death is a natural part of the life cycle
- the concepts and philosophy of palliative care
- uncertainties of prognostication when managing terminally ill patients
- the various settings in which palliative and end of life care are provided
- the pathophysiology and management of the common symptoms encountered at end of life:
- pain
- nausea and vomiting
- anxiety
- constipation
- delirium
- depression
- dyspnea
- the potential adverse effects of common medications used for control of symptoms of terminally ill patients
- the World Health Organization pain ladder
- the physiologic changes that occur as patients are dying
Goal #2 Communication Skills
Students must demonstrate knowledge of the principles of communication and the skills and attitudes that allow effective interactions with patients, families, healthcare workers, and others who affect the well-being of patients at the end of life. Students will be able to:
- elicit, record, and present a whole patient assessment for a person with a life-threatening illness
- demonstrate appropriate skills and strategies for communication of goals of care with patients and their families (e.g. living will, DNR, donor programs)
- demonstrate appropriate skills and strategies for communication during difficult situations, such as giving bad news (knowledge developed, skills not demonstrated)
- demonstrate appropriate skills and strategies for developing advance directives with patients and their families (knowledge developed, skills not demonstrated)
Goal #3 Professionalism
Students must demonstrate a combination of knowledge, skills, attitudes, and behaviors necessary to function as a member of the health care team caring for the dying. Students will be able to:
- identify the major obligations of physicians to their patients at the end of life
Goal #4 Patient Care
Students must use their knowledge , skills, and attitudes to provide patient care at the end of life that is appropriate, effective and sensitive to the psychological, sociologic, cultural and spiritual aspects of death and dying. Students will be able to:
- identify the multiple determinants of suffering: physical, psychological, social, cultural and spiritual
- apply knowledge to effectively evaluate and manage the most common physical symptoms encountered at the end of life (knowledge gained, not applied)
- apply knowledge of the points of consensus and controversy to make reasonable judgements regarding the following ethical aspects of end of life care:
- non-abandonment of patients (knowledge gained, not applied)
- access of patients to high quality palliative and end of life care
Goal #5 Practice Based and Lifelong Learning:
Students should demonstrate the knowledge , skills, and attitudes needed to be able to begin to evaluate their method of practice, use appropriate tools of evidence to analyze clinical practice, and understand concepts of quality in healthcare and quality improvement for patients and their families at the end of life. Students should be able to:.
- Recognize that research and evidence based practice of quality symptom palliation and end of life medicine are growing fields
Goal #6 Social and Community Context of Healthcare
Students must demonstrate the knowledge, skills, attitudes necessary to function within the larger healthcare system in which they will receive further training and identify resources available to provide high-quality care for their patients. Our students will:
- demonstrate knowledge of the philosophy of hospice and the services provided by a hospice program
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