Required training in hospice and palliative care at the University of Maryland School of Medicine

Abstract

Background: Over a period of four years the authors developed and integrated into the curriculum of their medical school training programs in palliative medicine. Critical required elements in the freshman year focus on attitudes and the physician's role in the care of terminally ill patients and their families. A 16-hour module has been designed to be a required element for junior students. It includes in-depth classroom and experiential training in palliative medicine. The results of the pilot of this module are presented.

Methods: The module consisted of one four-hour half-day session for four consecutive weeks during the ambulatory block in internal medicine. The first half-day class included both lectures and small-group discussions. Pain management, management of non-pain symptoms, and recognition of and basic interventions in spiritual and psychosocial suffering were covered. Required out-of-classroom reading assignments were distributed. The second and third half days were experiential, during which the student, in the company of a hospice nurse, made palliative care evaluations of terminally ill hospice patients. The last half day was a classroom session where the students presented their palliative care plan(s) for the patient(s) they had encountered on half days 2 and 3 to an interdisciplinary team (IDT) of the other students, a hospice medical director, a social worker, a hospice nurse, and a chaplain. Student scores on a 60-item objective test and participation in the IDT meeting were the primary data sources used to evaluate student achievement of the course objectives.

Results and conclusions: The majority of students attained the course objectives. Student evaluations of the module were very positive, particularly with regard to the home visits and the need for this training. It is anticipated that the module will be required during the 1999-00 academic year, with each student's performance contributing to his or her final grade in junior medicine.