The WHO has called for Palliative Care to be “integrated as a routine element of all undergraduate medical... ...training”. Across Europe, the provision of training in palliative medicine for medical undergraduates is variable. Accordingly, newly qualified physicians are entering practice with variable skill sets and may be unprepared to meet the needs of palliative care patients and their families. The project « International Medical Education in Palliative Care: Research on Undergraduates » conducted by a Task Force from the EAPC Steering Group on Medical Education and Training, has developed EORTC structured translations of validated assessment tools (Self Efficacy in Palliative Care Scale; Thanatophobia Scale) in French, German, Spanish and Italian, and established the feasibility of using these tools to assess the effects of undergraduate training. This project seeks to extend the developed methodology on a national basis to establish baselines for comparison on the preparedness of newly qualified doctors to practice palliative care: baselines will have the potential to be institutional, regional, national and European. An electronic version of the tools has been developed, with an accompanying database and will be piloted in the UK, then released to Task Force partners for formatting in native languages, and distribution through local and national frameworks as appropriate.
Aims and Objectives
The aim is to assess the preparedness of newly qualified medical graduates to meet the needs of palliative care patients and their families.
Key Objectives are to conduct a pilot project that will;
- Pilot an electronic assessment tool (Self-Efficacy in Palliative Care Scale; Thanatophobia Scale)
- Using existing EORTC structured translations, establish French, German, Italian & Spanish electronic versions of the assessment tool)
- Engage with Local and National networks to facilitate the distribution and collection of data on newly qualified doctors’ preparedness to practice palliative care
- Develop, as required, local, regional, national and international benchmarks on the preparedness of newly qualified doctors to practice palliative care
Palliative Medicine is a rapidly evolving speciality that often challenges practitioners’ clinical expertise and professional development. [i] [ii] [iii] 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, with the WHO projecting that the proportion of the European population over the age of 65 will rise from a current 16.3% to 27.8%.[iv] In response, the WHO has called for Palliative Care to be “integrated as a routine element of all undergraduate medical... ...training” [v] However, palliative care is an area that has traditionally received little attention, investment and assessment within existing curricula for medical training. [vi] [vii]
In 2012, a Task Force (IMEP) from the EAPC Steering Group on Medical Education and Training developed EORTC structured translations of validated assessment tools (Self Efficacy in Palliative Care Scale ; Thanatophobia Scale) [viii] in French, German, Spanish and Italian. The translated assessment tools were piloted within local institutions to establish the feasibility of collecting meaningful data on the effect of undergraduate training programmes. Data from 267 newly qualified clinicians was collected from France, Spain, Ireland, Germany, Italy and England. Analysis of the data returned has identified little problem with the utility of the assessment tool, and further statistical analysis has identified variable patterns in the provision of training in palliative medicine and a significant relationship between exposure (hours of training) and preparedness to practice.[ix]
This project seeks to extend the developed methodology and partner cooperation within the IMEP study on a national basis to establish baselines for comparison on the preparedness of newly qualified doctors to practice palliative care: baselines will have the potential to be institutional, regional, national and European. An electronic version of the tools has been developed, with the development of a accompanying database. The electronic version of the tool will be piloted in the UK, then released to Task Force partners for formatting in native languages. Following the application of national translations, local and national frameworks will be engaged as appropriate to facilitate the distribution of the tool and the collection of data. The data from the baseline will assist in the further assessment and promotion of the integration of training in palliative medicine across Europe.
Steering Group Meeting : Progress on the development of the pilot project will be presented at the annual EAPC Steering Group on Medical Education and Training Meetings
Pilot of the Electronic Assessment Tool
Following Ethical approval, the electronic version of the tool will be piloted with newly qualified doctors in four acute hospitals within the UK.
Development of National Electronic Tools
Using existing EORTC structured translations, French, German, Italian & Spanish electronic versions of the assessment tool will be produced.
Engagement and support of local and national frameworks, and ethical permissions, will be sought to facilitate the distribution of the questionnaire to assess preparedness to practice palliative care.
Local and national frameworks will facilitate the distribution questionnaire, with data automatically recorded post completion in the secure electronic database at the University of Liverpool.
Analysis of the data will be performed by the project lead in Liverpool. Analysis will be supported by Dr Trevor Cox , Senior Lecturer in Statistics with the Liverpool Cancer Trials Unit. Baselines will be established for both internal review and potential publication by partners.
Final Report :
A final report, with recommendations on the continued development and expansion of the project, will be completed. Papers for publication, both within each host country and for wider international dissemination, will be prepared
[i] Merrill J Lorimor R Thornby J & Woods A. Caring for the terminally ill persons: comparative analysis of attitudes (Thanatophobia) of practising physicians, student nurses and medical students. Psychological Reports 1998 : 83; 123-128.
[ii] MacLeod R. Learning to care: a medical perspective. Journal of Palliative Medicine 2000: 14; 209-216.
[iii] Miller M Kearney N and Smith K. Measurement of cancer attitudes: a review. Journal of Oncology Nursing 2000:4; 233-245.
[iv] Clark D Hockley J and Ahmedzai, S. The future for palliative care. Buckingham: Open University Press,1997.
[v] World Health Organisation. Strengthening of palliative care as a component of integrated treatment within the continuum of care. WHO, 2014.
http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R7-en.pdf (Accessed 20th Sept 2015 )
[vi] Field D. Education for palliative care: formal education about death, dying and bereavement in UK medical schools in 1983 and 1994. Medical Education 1995: 29; 414-419.
[vii] Carrasco JM, Lynch TJ, Garralda E, Woitha K, Elsner F, Filbet M, Ellershaw JE,Clark D, Centeno C. Palliative Care Medical Education in European Universities: A descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development. J Pain Symptom Manage. 2015 May 27. pii: S0885-3924(15)00241-9.
[viii] Mason SR and Ellershaw JE. Assessing undergraduate palliative care education: validity and reliability testing of two scales examining perceived efficacy and outcome expectancies in palliative care. Journal of Medical Education 2004. 38:1103-1110
[ix] Mason et al., Undergraduate medical education in palliative care: an international pilot study. Academic Medicine (Submitted 2015)
A grant application to North West Cancer Research (UK) is in preparation to support the pilot of the electronic tool (the project is not dependent upon securing this funding).