Medicine
End of life content
- Incorporation of end of life issues/questions in case discussions of patients with congestive heart failure, AIDS, and breast cancer
- Students will be required to longitudinally follow-up a patient with an advanced chronic illness that they cared for during their clerkship. Students would be expected to have at least 2 additional encounters with a patient after their initial encounter. Follow-up could be in the patient's home on their own or with another healthcare worker, at a clinic appointment, etc.
- There will be an expectation that students collaborate with social workers in the evaluation of psychosocial needs and discharge planning needs of patients with advanced chronic illness and dying patients during their inpatient experience.
- The will be an interactive session on management of decubitus ulcers, a problem commonly encountered by vulnerable patients at the end of life. A potential presenter may be an LUMC wound care nurse.
Assessment
Students' attitudes toward end of life care will be commented on in the professionalism section of the course evaluation
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.
- 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
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.
- demonstrate an understanding of the impact of life-threatening illness on patients and their families
- respectfully and effectively communicate issues of end of life patient care with non-physician healthcare workers, including clergy
- demonstrate appropriate techniques for collaborating with and teaching members of the healthcare team
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.
- identify the major obligations of physicians to their patients at the end of life
- work collaboratively as members of a healthcare team in a variety of settings
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.
- identify the multiple determinants of suffering: physical, psychological, social, cultural and spiritual
- identify the psychological, sociologic, cultural and spiritual aspects of loss and bereavement
- develop and implement a care plan for patients when cure is no longer a rational goal and health services are most appropriately directed at comfort
- collaborate effectively with an interdisciplinary team to deliver end of life care to meet the needs of dying patients and their families
- develop a care plan responsive to the various environments in which end of life and palliative treatment are provided and recognize the advantages and disadvantages of the environment
- apply knowledge to effectively evaluate and manage the most common physical symptoms encountered at the end of life
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.
- demonstrate an awareness of information resources for providers, patients and families
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
- demonstrate knowledge of the philosophy of hospice and the services provided by a hospice program
- demonstrate knowledge of the American healthcare system including reimbursement mechanisms, the roles of government and private sector, and the ways patients pay for healthcare
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