Palliative Medicine is a rapidly evolving speciality that often challenges both practitioners’ clinical expertise and professional development; the practical, emotional and interpersonal difficulties encountered in caring for dying patients have been extensively reported upon. Accordingly, the aim of palliative care education is to provide appropriate knowledge, skills and attitudinal development, facilitating learning that results in able and confident health care professionals who will deliver optimal care for the patient and family. However, ‘care of the dying’ is an area that has traditionally received little or no attention within existing curricula for medical training.
Assessing the preparedness of newly qualified doctors to meet the challenges of practising palliative care is crucial as all doctors are likely to have increased contact with palliative care patients. The number of patients with palliative care needs will increase year on year due to changes in health and demographic variables; for example, the WHO project that by the year 2050 the proportion of the European population over the age of 65 will rise from a current 16.3% to 27.8%. Cancer, the condition most associated with palliative care, is particularly associated with the elderly, with 70% of new diagnoses occurring in those over the age of 65. Accordingly, an ageing population is likely to lead to an increase in the number of patients with cancer (and other chronic incurable diseases) requiring palliative care. Equally, as patients are living longer with cancer (and other chronic conditions) greater contact with health care professionals to manage symptomatic difficulties and provide psychosocial support, in increasingly likely.
In 2007, the EAPC Task Force on Medical Education published recommendations on a curriculum for undergraduate medical education in palliative care. The recommendations highlighted specific educational components, objectives and strategies in an attempt to assist curriculum planners in integrating sufficient core content (within undergraduate medical training) to provide graduating doctors with the skill set required to meet the needs of palliative care patients. To date, a pan European strategic evaluation of both the training in palliative care for undergraduate medical graduates, and their preparedness once qualified, has yet to be undertaken.
The proposed study will utilise existing validated measures (SEPC & TS) to assess the preparedness of newly qualified medical graduates to engage in core tasks of palliative medicine. The SEPC is a 3 themed, 23 item questionnaire that assesses respondents perceived efficacy in practicing palliative care. Developed and validated within an undergraduate medical setting in the United Kingdom, the questionnaire is theoretically underpinned by Self-Efficacy theory, which links efficacy perceptions with behaviour. The Thanatophobia Scale, developed within the acute care setting in the United States, is a validated measure which assesses respondents attitudes (expressed for the theoretical model as perceived outcomes) towards caring for dying patients. Together, these measures provide a theoretically robust measure of the preparedness of physicians to practice.
This pilot study will field data on preparedness, and is likely to highlight variables (for further detailed examination) pertinent in the preparation of physicians (such as the number of dedicated hours for education and training, timing of education and training, conceptual content of training). It is expected that the pilot will establish the foundations for larger intra and international comparative studies to assess of the effect of undergraduate education and training in palliative medicine.