European Study on Undergraduate Palliative Care Medical Education
Basic training and continuing education in Palliative Care (PC) should be integrated as a routine element of all undergraduate medical education as the WHO recently proposed (WHO, 2014). Innovative models of PC education have emerged lately to promote active learning and experiential learning combining lectures with clinical experiences and didactic approaches for a comprehensive PC learning experience.
The data of the ATLAS of PC in Europe show that in 13/43 countries (30%) a Palliative Medicine (PM) course is taught in all medical schools, being compulsory in six of them (14%). Countries such as Belgium, Norway, Israel, United Kingdom, France or Germany have adopted national policies for mandatory PC teaching in all Medical Schools. The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland.
Despite this descriptive data obtained from the first mapping exercise, there is lack of understanding of how palliative medicine is taught in European universities. It is also appropriate to study the concrete barriers and opportunities that palliative medical education has today and to set up recommendations for palliative care national associations, professors and professionals.
The University of Navarra and the University of Bologna have previous experience mapping advance education in palliative care in Europe. They propose a new project to study, in depth, medical Palliative Care education in Europe. The new study will be carried in two phases:
Phase 1: Case study of PC undergraduate medical education in 7 European universities through in-depth semi-structured interviews of 7 professors;
Phase 2: Global mapping the European status of undergraduate education country by country through a international survey of experts.
Research outcomes will be articles, scientific publications and an Atlas Supplement on Medical Education in Palliative Care (Monograph).
Aims & objectives
To explore and describe how undergraduate PC Medical Education is delivered in Europe and the barriers and opportunities to the introduction of the palliative competence in the medical curricula.
To map the current situation in order to give professionals and policy makers tools for further course development.
Basic training and continuing education in Palliative Care (PC) should be integrated as a routine element of all undergraduate medical and professional nursing education, as the WHO recently proposed (WHO, 2014). In The United States, the report on Dying in America from the Institute of Medicine asked, as one of its five final recommendations, that educational institutions state the PC knowledge and skills of all clinicians who care for serious illness (IOM, 2014). PC education at undergraduate level has the mission of conferring the basic primary PC skills and competences required by all physicians and other health care professionals. From recent literature reviews we know something about how this innovative teaching is being incorporated into undergraduate studies.
A review of US medical school surveys on the teaching of palliative and End of Life Care (EoL) was offered in 2014 by Horowitz et al. Authors reveal varied and uneven approaches, ranging from 2 hours in the classroom on EoL to weeks of PC training or hospice-based clinical rotations. In the US PC competencies at medical school are being incorporated mainly into other courses. This suggests a primarily theoretical approach to a field that should ideally include observed interaction with simulated and real patients. In the author’s opinion, basic PC competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment.
A review highlights recent modes of PC education that have emerged lately to promote active learning, including the use of audio, films, art, debates or homework (Centeno, 2015). Alternatively, new experiential learning, which is being promoted in PC teaching, encourages students to reflect on and learn from, human experience. In that category they found trends such as clinical case studies, volunteer hospice companion programs and clinical practice attendance. Following on from their findings, they proposed combined programs with clinical experiences and didactic approaches for a comprehensive PC learning experience.
A secondary analysis of data obtained in the European ATLAS has been undertaken (Carrasco ,2015). Of 53 countries, 43 (81%) provided the requested information on medical education of palliative care at the undergraduate level. In 13 countries (30%), a PM course is taught in all medical schools, being compulsory in six of them (14%). In 15 countries (35%), PM is taught in at least one university. Countries such as Belgium, Norway, Israel, United Kingdom, France or Germany have adopted national policies for mandatory PC teaching in all Medical Schools. A full professor of PM was identified in 40% of countries. The highest level of PM educational development was found in Israel, Norway, the U.K., Belgium, France, Austria, Germany, and Ireland.
Despite this descriptive data from the first mapping exercise, there is lack of understanding of how palliative medicine is taught in the European universities. Proposed questions include:
- Which are the preferred models of teaching?
- How are competencies at medical school incorporated as independent subject or into other courses?
The program of work gives opportunity to perform a dedicated SWOT analysis to study the concrete barriers and opportunities that palliative medical education has today and to propose recommendations for palliative care national associations and the palliative care workforce in the university.
In 2014, The University of Navarra and the University of Bologna successfully completed a project on mapping process for specialization in palliative medicine in Europe. Results were published and disseminated across Europe as a supplement of the ATLAS and several letters and articles in journals (Bolognese at al, 2014, Centeno C, 2015). The experience working together, as a team, in a research project of mapping advance education in palliative care in Europe is of particualr value to developing this new project on undergraduate medical education.
The new study will be carried in two phases :
Phase 1: Case study of PC undergraduate medical education in 7 European Universities.
Key informants will be Professors in the Universities with active undergraduate teaching in palliative care and with relation to the EAPC Steering Committee of Medical Education or the promoting univesities. Specific countries will be selected according different level of performance in the Medical Education European Ranking (Carrasco, 2015). Method will be semi-structured interview in person or by tele-conference. Fine-tuning of results will be done by review of the manuscript for all informants.
Countries and Task Force Members: Frank Elsner (Germany), Marilene Filbet (France), John Ellershaw (United Kingdom) Carlos Centeno (Spain), Guido Biasco (Italy), Aleksandra Kotlinska-Lemieszek (Poland), Agnés Csikós (Hungary) and Carl Johan Furst (Lund, Sweden).
This phase will seek several detailed features:
- national directives or national framework for palliative medicine education (official regulations)
- current educational program: main features of the existing programs including contents, methods, length, participants, evaluation
- professorship: background, experience, position
- generalizability or estimation of the situation in the country. Finding the contrast of experiences.
- develop a directory of contacts of associated professors in palliative care which will constitute the network of medical educators
- highlight barriers and opportunities to the diffusion of undergraduate programs
The information obtained in the phase 1 with 7 countries will permit to elaborate a more accurate survey for a pan European project.
Phase 2: Mapping the European status of Undergraduate Palliative Care Medical Education
We propose a global mapping of the European status of undergraduate education country by country through a international survey of experts, utilising the same methods in the EAPC ATLAS or the Supplement on Specialization.
Adding members to the EAPC Task Force on Undergraduate Medical Education in Palliative Care with key persons from each European country. Drafting a survey with items defined by the case study analysis drawn on the first phase.
Main questions to address will be:
- What is the workforce capacity of the European Universities?
- How many future doctors are receiving palliative care medical education?
- What are the characteristics of PC teachers at the undergraduate level in Europe?
- What are the characteristics of palliative care programmes in respect of, content, length and topics of the PC courses?
Outcomes will be articles and others scientific publications and an Atlas Supplement on Medical Education in Palliative Care (Monograph)
Clínica Universidad de Navarra
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National Cancer Research Institute
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Fondazione Isabella Seràgnoli
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Carlos Centeno presented the idea in the annual meeting of the EAPC Steering Committe on Education for Physician, in Budoni, Sardinia.
Feb: First meeting of the research team in the University of Bologna
April: Submission of the proposal to the EAPC Board
June: First Interviews at Dublin EAPC Conference, Phase 1
June-December : Analysis of results
December: An article will be submitted
All year : Identify a ¨key physician¨ in each country and send them a proposal of the study for Phase 2.
June: draft and distribution of survey/questionnaire within a common template
Dec: Collection of results and comparative analysis of Phase 2.
Presentation of results at EAPC-RN Conference
- ATLANTES Program, Instiute for Culture and Society, University of Navarra
- “Giorgio Prodi” Center for Cancer Research, University of Bologna and Accademia delle Scienze di Medicina Palliativa, Bologna
- European Association for Palliative Care