Transcript Dixon 6: Goals of Education & Implementation Awareness / Attitudes
Transforming health care globally… through palliative care www.PalliativeMed.org www.IPCRC.net
Challenges in Teaching Palliative Medicine
Frank D. Ferris, MD, FAAHPM, FAACE Institute for Palliative Medicine at San Diego Hospice University of California San Diego University of Toronto
Objective…
A Road Map to Build Palliative Care Capacity in Sweden through education…
Call to Action…
Train ALL healthcare professionals to provide palliative care…
Dixon 6: Goals of Education & Implementation 1.
Awareness / Attitudes 2.
3.
Knowledge Skills 4.
Behavior Change Experience 5.
Patient / Family 6.
Organization / Society Increase palliative care capacity Dixon J. Evaluation and the Health Professions, 1978 Ferris et al. Knowledge Insufficient for Change, 2001
How will you teach…?
How People Learn
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Memory: Short
intermediate
long-term
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3 major facts / hour Information retention per unit time 10 minutes new information 2 minutes rest to process it
Principles of Learning in Healthcare
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Practical
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Participatory
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Multiple demands Hank Slotnick, PhD, North Dakota
Reading / Online Retention ?
1.
2.
3.
4.
5.
6.
Awareness / Attitudes Knowledge Skills Behavior Change Experience Patient / Family Organization/Society
Lectures Retention ?
Lectures 10 % 1.
2.
3.
4.
5.
6.
Awareness / Attitudes Knowledge Skills Behavior Change Experience Patient / Family Organization/Society
Group Learning 1.
2.
3.
4.
5.
6.
Awareness / Attitudes Knowledge Retention ?
Lectures 10 % Small-group Cases 25 % Skills Behavior Role-play 35 % Change Experience Patient / Family Organization/Society
Effective presentations ‘ theater ’
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Movement Body Hands
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Voice Tone Volume Speed
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Eye contact Minimize distractions
Who will you teach…?
Palliative Care
1 ° Basic Skills All Healthcare Professionals
Skills...
2 ° Expert skills 1 ° Advanced Skills Cariology, Geriatrics, Oncology, Etc.
Palliative Care Consultants / Teams 3 ° Academic Palliative Care
Interdisciplinary Care Spiritual counselor Volunteer Nurse Family Physician PATIENT Psychologist Social worker Community Physical therapist Pharmacist Bereavement counselor
What will you teach…?
1 ° Basic Skills All Healthcare Professionals
PC Skills...
• •
1 – 2 1 – 2 ‘ Buzz ’ Groups
General Doctors ?
1999
EPEC 1999
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National consensus of 280 ethics, hospice, palliative care experts Linda Emanuel, Principal Aim: To teach all physicians and other members of the interdisciplinary team the core skills of palliative care
Not intended to make every clinician a palliative care expert
EPEC 1999
• • • • •
4 plenary sessions 12 modules Open, train-the-trainer model Widely accepted Standard of practice ‘ inside ’
First 15 Months in the USA Robinson K, Sutton S, von Gunten CF et al, J of Palliative Medicine 2004
• • •
Sample 200 of first 585 trainers touched 120,000 professionals in 15 months Estimated patients & families affected Per Clinician Patients / Day 10 100 Per Clinician Patients / Year 2.4 K 24 K 585 Clinicians Patients / Year 1.4 M 14 M
US Palliative Medicine Specialists
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> 3.000 certified specialists 80 % started training with EPEC
End-of-Life Nursing Education Consortium Curriculum…
Nurses ?
ELNEC – Nursing Curricula, 2002 Oncology Version: Open Adaptable Reproducible Google: ELNEC
Palliative Care Skills...
1 ° Advanced Skills Cariology, Geriatrics, Oncology, Etc.
Doctors seeing Advance Illnesses ?
2007
The
TM
EPEC-O
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
EPEC-O 2007
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National consensus of > 80 oncology experts Aim: To teach all oncologists and other members of the interdisciplinary cancer care team the advanced skills of palliative care
Not intended to make every oncologist a palliative care expert
Multiple Issues that Cause Suffering
Core Skills for Providing Palliative Care
EPEC-O 2007
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32 modules - 3 plenaries, 2 how to teach Syllabus, slides Open, adaptable Video vignettes Teaching strategies Annotated bibliography Hyperlinks to references online
2007
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Free CD / DVD American Society of Clinical Oncology ( ASCO ) provides education credits Online modules Translations Spanish Ukrainian
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www.IPCRC.net
IPM Interdisciplinary Curriculum Will you translate any of these curricula ?
A multi-year education strategy to build palliative care capacity... www.PalliativeMed.org www.IPCRC.net
Time ( yr )
Sensitization 3 5 Courses ( Basic & Advanced ) 7 Visiting Scholars ( Expert Identification ) Fellowships ( Experts ) 9 Leadership ( Leaders ) Scholars in Residence ( Education & Research ) 11
Nursing & Medical Trainees
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Nursing students 9 schools UCSD Medical students
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Residents Family practice Internal medicine Psychiatry
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Experiential ‘ bedside training ’ Observational visits Structured program Electives
PC in Curricula / Exams
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In US Boards In several specialty exams 10 % of Medical Oncology Exam
Physicians Practicing in San Diego
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10 % trained at UCSD School of Medicine
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33 % did their medical residency in San Diego
Practicing Clinicians
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Continuing education – optional or compulsory ?
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In California To get a new license, since 2002, obligatory to demonstrate training in palliative / end-of-life care To renew license in 2006, 12 hours education in pain & palliative care ( AB 487 )
Conference Presentations
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Oncology Cardiology Geriatrics Elder Care Nephrology
Many Domestic & International Partners
2004 – Jordan 32 2005 – Jordan 72 2006 – Mongolia 75 2007 – Jordan 50 Georgia 50 Mexico 75 2008 – Georgia – 75 Vietnam 75 Saudi Arabia 150 In-Country Courses 3-5 day, 2 & 3 week 2009 – Ukraine 95 Egypt 105 Slovenia 50 2010 – Ukraine 36 Salzburg 40 MECC 50 2011 – Georgia 75 Vietnam 100 Cyprus 55 Turkey 52
First dose of oral morphine – Al Basheer Hospital
1-week Classroom vs. 3-weeks Bedside Training
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2 Open Society Institute ( OSI ) Courses, Salzburg 1 week ( 5 days ) Classroom Interactive didactic 2 Jordan Courses, Amman, Jordan
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3 weeks ( 15 days ) 1 week classroom Interactive didactic
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2 weeks bedside training
P < 0.001
P < 0.001
P < 0.001
Day 1 After Course
Day 1 After Course
Jordanian Physician… “During the first week [ in the classroom ] I felt that I will not
benefit… and it will not do any change in my practice.
BUT, after starting practical session a huge and unexpected change happened… I will do every efforts I have to practice this knowledge in my real life.”
1st International Palliative Medicine Physician