More medical schools investing in palliative care education

Palliative care education programs are gaining momentum regionally, leading some to hope for a “domino effect” that would fuel further growth.

Without major changes, the demand for palliative care in the United States is forecast exceed the offer of the clinicians who were trained to do it over the next ten years. A major obstacle to building this workforce is that most clinicians have little to no exposure to these types of care during their training.

A 2018 to learn showed that most students in clinical subjects do not feel prepared to take care of their families at the end of their lives.

In response to the growing need, more and more educational and academic institutions have created new avenues for clinical education in hospice and palliative care.

Regional programs appear

One such example is the recent launch of CARE-7, a four-year palliative care curriculum introduced at the Perelman School of Medicine at the University of Pennsylvania.

“As these programs grow, I think it will become more apparent just how important these skills are,” said Dr. Alana Sagin, associate professor of hospice and palliative care at Perelman and CARE-7 curriculum leader, told Hospice News in an email. “Those who pave the way make it easier for others to follow. I hope it will change the culture enough that a curriculum like this will be an expected part of medical education.”

Educators and healthcare providers are increasingly working together to move the needle.

Connecting medical students early with palliative care professionals, trainers and interdisciplinary team members will hopefully further emphasize the importance of these services and ultimately expand the workforce, says Dr. Nadia Bennett, Perelman Associate Dean for the Clinical and Health Systems Science Curriculum and CARE-7 Program Advisor.

“Palliative care providers can continue to capitalize on the fact that learning how to care for patients with serious illnesses is an essential skill for all healthcare providers, regardless of what area they move into,” Bennett told Hospice News. “Fortunately, more and more institutions are realizing this.”

A number of universities have independently developed new programs focused on hospice, palliative care, nursing goals and other home health services, including the University of New Mexicothe University of Nebraska, the University of Arizona and the University of Maryland.

The University of New Mexico Health Sciences recently launched a new palliative care program aimed at improving care for patients facing life-threatening illnesses or nearing the end of life. The New Mexico Palliative Care ECHO program is part of the university’s Project ECHO model, which offers approximately 70 different educational programs to more than 750 organizations around the world through virtual learning courses.

The interdisciplinary program is open to all primary and specialty care providers in New Mexico, chaplains, social workers and virtually “anyone involved in palliative care and end-of-life care,” university officials said.

Flexibility is a common thread running through all palliative care education programs, according to Christopher Piromalli, associate professor at the University of New Mexico. Piromalli is also Co-Medical Director of Project ECHO.

“Each community has different patient populations, different cultural perspectives and lenses, different staff numbers, challenges and learning needs,” Piromalli told Hospice News. “It’s critical [to] really think of a community of learners. It is important to have a flexible and two-way learning pedagogy and to be flexible to accommodate the “here and now” needs that communities and learners might have.”

Pillars of curriculum design for palliative care

According to educators speaking to Hospice News, agility in curriculum development, delivery and supportive partnerships are key to building and sustaining palliative care education.

According to Sagin, considering the context of the student’s learning environment is crucial when designing and implementing these curricula. Part of this involves understanding that learners can be pressed for time in both their personal and professional lives.

Flexible course scheduling and offering a mix of in-person and distance learning options are important components, Piromalli said. Offering virtual learning opportunities in small chunks of time can be beneficial in generating and maintaining interest in palliative care programs, he added.

“It uses technology so that no matter where they are, they can be part of a community of learners who are growing and acquiring those special skills,” Piromalli said. “Technology has really expanded the opportunities for people to get the education they need. It’s a powerful tool for getting people to share their expertise and interact and engage across platforms.”

Offering virtual mentorship during student progress in palliative care programs can also encourage participation, said Kyky Knowles, director of replication operations at Project ECHO.

Developing these relationships can encourage participants to stay connected after graduation and build stronger collaborative relationships between medical communities, she explained.

Integrating technology into palliative care learning can also make it more convenient for educators to participate and collaborate in content development, Piromalli says. With a limited number of trainers available to deliver training, offering virtual classroom opportunities allows educators a flexible schedule and opens the door to a broader range of perspectives on care delivery, he said.

“It’s about communicating regularly with learners and creating a multidisciplinary team that’s really focused on equity and diversity,” Knowles said. “We want to make sure learners want to keep coming back. That their curriculum is innovative, flexible and engaging.”

Laying the groundwork includes developing basic skills in communicating with patients and families, and expanding knowledge about serious illnesses and end-of-life care options, Sagin says.

“Communication skills are an important part of a palliative care curriculum. [They] are so universally applicable,” Sagin told Hospice News. “[It’s] Improving the primary palliative care skills of all our graduates, as these skills make them better physicians while reducing the burden on palliative care staff. The goal of CARE-7 is to produce physicians who are comfortable with the foreseeable situations that arise when discussing critical illness, symptom management, and support.”

Regardless of whether graduates enter the field of palliative care, learning the building blocks of that care can lead to greater awareness across the healthcare spectrum — and potentially more referrals.

Many physicians are reluctant to refer patients to hospice or palliative care because they do not fully understand the nature of these services or their benefits. Many also lack the necessary skills to conduct Conversations about care goals with patients and relatives.

Caring for seriously ill and terminally ill patients drains employees and often leads to burnout.

The ability to assess and manage one’s mental health needs is an important element of palliative care education, Sagin said.

“If you build it, they will come”

According to Knowles, developing a solid program curriculum considering these pillars is key to gaining stakeholder buy-in and ensuring sustainability.

“If you build a really amazing program, the money will follow,” Knowles told Hospice News. “We’ve seen this time and time again with our partners creating these innovative programs and finding money and financial support to keep them growing. It helps leaders of various institutions and organizations see the benefits of how this education will impact the quality of care for patients and families.”

Developing funding resources takes time and effort, Knowles added. Reaching out to a broad network of stakeholders, including state and local governments, healthcare providers, advocacy groups, and community leaders, can be critical. Reaching leaders in diverse faith groups and in rural and underserved populations can also be key to long-term equity and access to health, she explained.

Participating in ongoing discussions with funders helps build partnerships that contribute to the success of palliative care learning programs, according to Bennett.

“Once the value is recognized, hopefully resources will follow,” added Sagin.

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