In the first year, just weeks after medical school begins, all students participate in an “Introduction to end-of-life care workshop,” in which they observe and participate in an interview of a patient with terminal illness. Very early in training, students began to understand a patient’s experience of living with a terminal illness and recognize what doctors (and medical students) can do for patients even when cure or prolongation of life is no longer possible.
With coordinated visits to inpatient or home hospice or hospital palliative care consultation, all second year students observe an experienced hospice or palliative care clinician evaluate a patient with terminal illness. During this assignment, students learn the key elements of assessment of patients at end-of-life, including physical symptoms as well as psycho-social and spiritual aspects of terminal illness and begin to reflect on professional and personal challenges of caring for patients at end-of-life.1
During the clinical years, students engage in a novel ward-based, experiential end-of-life care exercise in which students complete a comprehensive assessment of a patient during a clinical clerkship. The assignment includes:
- guided interview(s) of the patient and family
- a case write-up
- discussion at a faculty facilitated case conference
Students become more aware of end-of-life issues faced by patients in the acute care setting, gain more comfort communicating with patients at end-of-life, and appreciate the importance of reflection on the experience of caring for patients at end-of-life.
Another clerkship-based palliative care educational experience combines online learning with traditional workshops. Working collaboratively, students from the Schools of Medicine, Nursing, Divinity and Social Work interns will work through interactive computer cases with content that will emphasize pain and symptom management, the role of culture and spirituality in palliative care, and the critical importance and fostering of interdisciplinary team care of the patient.
During the fourth-year, students have a class on "How to ascertain resuscitation preferences, perform death pronouncements and family death notifications." In addition, students have the opportunity to practice advanced communication skills with simulated patients, including a primary palliative care office visit, a goals of care discussion, and a family death notification. There are also electives in Hospice and Palliative Medicine and Spirituality in Medicine.
1 Ellman MS, Rosenbaum JR, Bia M. Development and implementation of an innovative ward-based program to help medical students acquire end-of-life care experience. Acad Med. 2007; 82:723-727.