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American Medical Student Association (AMSA) End of Life (EOL) Education Initiative Project in-a-Box (PIB) Richard J. Lin Harvard Medical School August.

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Presentation on theme: "American Medical Student Association (AMSA) End of Life (EOL) Education Initiative Project in-a-Box (PIB) Richard J. Lin Harvard Medical School August."— Presentation transcript:

1 American Medical Student Association (AMSA) End of Life (EOL) Education Initiative Project in-a-Box (PIB) Richard J. Lin Harvard Medical School August 1, 2003 Chicago, IL

2 An Experiential Learning Module of EOL Care Overview of current EOL curriculum Overview of current EOL curriculum Development of an experiential EOL learning module - The EOL Care Mentorship Program Development of an experiential EOL learning module - The EOL Care Mentorship Program Program evaluation and assessment Program evaluation and assessment Finance, portability, and future integration into the core curriculum Finance, portability, and future integration into the core curriculum

3 HMS EOL Curriculum Overview

4 Lack of EOL Component in the Current Core Curriculum MSI and MSII - Popular elective “Living with Life-threatening Illness” MSI and MSII - Popular elective “Living with Life-threatening Illness” MSIV - Two elective rotations in Pain, Palliative medicine, and Psychosocial Oncology MSIV - Two elective rotations in Pain, Palliative medicine, and Psychosocial Oncology Residents and Physicians - Elective palliative care rotations and fellowship; faculty development seminar Residents and Physicians - Elective palliative care rotations and fellowship; faculty development seminar

5 Living With Life-threatening Illness (LWLTI) Course Developed by two palliative care experts at HMS, Drs. Susan Block (DFCI) and Andrew Billings (MGH) Developed by two palliative care experts at HMS, Drs. Susan Block (DFCI) and Andrew Billings (MGH) Course formats are lecture; small group discussion/reflection; case conference; role plays; and individual patient visits Course formats are lecture; small group discussion/reflection; case conference; role plays; and individual patient visits Covers the basics of hospice and palliative medicine: death and dying process; advanced care planning; pain control and symptom management; physician roles; ethical, cultural and spiritual issues Covers the basics of hospice and palliative medicine: death and dying process; advanced care planning; pain control and symptom management; physician roles; ethical, cultural and spiritual issues

6 Informational and Experiential Gaps in LWLTI 25 to 30 students enroll each year, accounts for only 7 to 8 percent of the student body 25 to 30 students enroll each year, accounts for only 7 to 8 percent of the student body Focus more on integration of palliative care into mainstream medicine and less on utilizing hospice care for dying patients Focus more on integration of palliative care into mainstream medicine and less on utilizing hospice care for dying patients Most participating patients are in the gray zone with prominent medical issues Most participating patients are in the gray zone with prominent medical issues Emphasizes physician leadership, no exposure to interdisciplinary team work Emphasizes physician leadership, no exposure to interdisciplinary team work PBL cases are not integrated with patho- physiology and clinical medicine PBL cases are not integrated with patho- physiology and clinical medicine

7 The EOL Care Mentorship Program

8 Goals and Objectives Introduction of the key concepts of hospice and palliative medicine Introduction of the key concepts of hospice and palliative medicine Experiential learning of EOL care through interdisciplinary team work Experiential learning of EOL care through interdisciplinary team work Cultivation of student interest in EOL care and palliative medicine Cultivation of student interest in EOL care and palliative medicine Advocacy of integration of EOL component into the core curriculum Advocacy of integration of EOL component into the core curriculum

9 The EOL Care Mentorship Program Forming partnerships with local hospice and hospital-based palliative care teams Forming partnerships with local hospice and hospital-based palliative care teams Drawing the enthusiasm and expertise of a large number of faculty members who has an interest in EOL care Drawing the enthusiasm and expertise of a large number of faculty members who has an interest in EOL care Targeting mostly first and second year medical students Targeting mostly first and second year medical students Assigning two or three students to each hospice/palliative care team; potentially serving as volunteers Assigning two or three students to each hospice/palliative care team; potentially serving as volunteers

10 Potential Partner I : Healthcare Dimensions Hospice A subsidiary of Dana-Farber Cancer Institute (DFCI) and Partners Healthcare System A subsidiary of Dana-Farber Cancer Institute (DFCI) and Partners Healthcare System Serving all 37 counties in the greater Boston area, currently has 150 patients Serving all 37 counties in the greater Boston area, currently has 150 patients Comprehensive hospice service for both adults and children Comprehensive hospice service for both adults and children Non-for-profit, Medicare and Medicaid certified, JACHO accredited Non-for-profit, Medicare and Medicaid certified, JACHO accredited Medical Director and full-time physicians, PCP participation is high Medical Director and full-time physicians, PCP participation is high

11 Potential Partner II : Pain and Palliative Care Program Based in DFCI and Brigham and Women’s Hospital (BWH) Based in DFCI and Brigham and Women’s Hospital (BWH) Serving mostly cancer patients Serving mostly cancer patients Work alongside of the medical team to integrate palliative care into comprehensive plan of care Work alongside of the medical team to integrate palliative care into comprehensive plan of care Interdisciplinary team approach for pain and symptom control and psychosocial support Interdisciplinary team approach for pain and symptom control and psychosocial support Physician leadership with Dr. Janet Abrahm (Medical Oncologist) Physician leadership with Dr. Janet Abrahm (Medical Oncologist)

12 Potential Partner III : Palliative/Supportive Medicine Team Based in Harvard Vanguard Medical Associate, a community healthcare network Based in Harvard Vanguard Medical Associate, a community healthcare network Serving community hospitals, nursing homes, and extended care facilities, predominately serving geriatric population Serving community hospitals, nursing homes, and extended care facilities, predominately serving geriatric population Consultative services on pain and symptom management and psychosocial support Consultative services on pain and symptom management and psychosocial support Physician leadership with Dr. Robert Buxbaum (Internist and Geriatrician) Physician leadership with Dr. Robert Buxbaum (Internist and Geriatrician)

13 Potential Partner IV : Pediatric Advanced Care Team Based in Children’s Hospital and DFCI Based in Children’s Hospital and DFCI Serving children with advanced illness Serving children with advanced illness Support medical treatment for underlying illness while provide optimal quality of life Support medical treatment for underlying illness while provide optimal quality of life Using a family-centered approach Using a family-centered approach Extensive grieving and bereavement support for parents Extensive grieving and bereavement support for parents Physician leadership with Dr. Joanne Wolfe (Pediatric Oncologist) Physician leadership with Dr. Joanne Wolfe (Pediatric Oncologist)

14 Some Possible Activities of the EOL Care Mentorship Program Home visits with physicians, nurses, social workers, and chaplains Home visits with physicians, nurses, social workers, and chaplains Nursing home visits Nursing home visits Hospital inpatient palliative care rounds Hospital inpatient palliative care rounds IDG meeting IDG meeting Clinical case conference Clinical case conference Small group reflection/discussion Small group reflection/discussion

15 Logistic Considerations of the EOL Care Mentorship Program Student time commitment Student time commitment Faculty time commitment and willingness to teach and supervise Faculty time commitment and willingness to teach and supervise Patient wishes and confidentiality Patient wishes and confidentiality Logistic arrangement with the hospice and the palliative care team Logistic arrangement with the hospice and the palliative care team Longitudinal program vs intensive clinical rotations Longitudinal program vs intensive clinical rotations

16 Program Assessment and Evaluation

17 Participant Evaluation Pre- and post-test/questionnaire Pre- and post-test/questionnaire Preceptor evaluation Preceptor evaluation Home visit experience write-ups Home visit experience write-ups Illness history/treatment/prognosis Illness history/treatment/prognosis Pain and symptom management Pain and symptom management Psychosocial and spiritual distress Psychosocial and spiritual distress Patient wishes and family/caregiver concerns Patient wishes and family/caregiver concerns Patient-doctor communication and relationship Patient-doctor communication and relationship Student learning experience Student learning experience

18 Program Assessment Participant feedback and suggestion Participant feedback and suggestion Faculty/hospice reviews Faculty/hospice reviews Patient/family surveys Patient/family surveys Assessment by mentors and the curriculum committee Assessment by mentors and the curriculum committee

19 Miscellaneous

20 Program Finance Potential exists for an elective, paid student fellowship program Potential exists for an elective, paid student fellowship program AMSA seed grant for EOL Education Initiative Project-in-a Box AMSA seed grant for EOL Education Initiative Project-in-a Box HMS Community Service Program at the Office of Enrichment Programs HMS Community Service Program at the Office of Enrichment Programs HMS Student Council (student interest group) HMS Student Council (student interest group) HMS Center for Palliative Care HMS Center for Palliative Care The Neil Samuel Ghiso Foundation (NSGF) The Neil Samuel Ghiso Foundation (NSGF)

21 The Neil Samuel Ghiso Foundation For Compassionate Medical Care Mission The Neil Samuel Ghiso Foundation is dedicated to fostering compassionate care for chronically and terminally ill patients and their families through medical education and training. Activities This year NSGF initiated its first program, the Neil Ghiso Fellowship, awarding grants to two Harvard medical students to work with palliative care teams in the treatment of chronically and terminally ill patients. In addition to caring for patients, the fellows will conduct research relating to compassionate care and, at the conclusion of the project, will submit papers reflecting on their experiences and sharing their findings. Over time NSGF plans to expand this program to other medical schools.

22 Program Portability Stand alone program Stand alone program Integration into the elective LWLTI course Integration into the elective LWLTI course Integration into the HMS Primary Care Mentorship Program Integration into the HMS Primary Care Mentorship Program Expansion and Integration into the Death and Dying Student Interest Group Expansion and Integration into the Death and Dying Student Interest Group Integration into the core curriculum (ICM and Patient-Doctor courses) Integration into the core curriculum (ICM and Patient-Doctor courses) Adaptable to other medical schools Adaptable to other medical schools

23 Program Shortcomings Elective in nature Elective in nature In program pilot years it may be able to take only 4 to 8 students In program pilot years it may be able to take only 4 to 8 students Designed mainly for students with advanced knowledge/interest/experience Designed mainly for students with advanced knowledge/interest/experience Lacking an organized didactic component Lacking an organized didactic component Time commitment and travel Time commitment and travel May not be able to follow the same patient over time due to logistics May not be able to follow the same patient over time due to logistics

24 What I have Learned To Cure Sometimes To Cure Sometimes To Relieve Often To Relieve Often To Comfort Always To Comfort Always -16 th century anonymous

25 Thank You So Much !!! Horizon Hospice Dr. Mike Marschke Dr. Mike Marschke Dr. Mike Preodor Dr. Mike Preodor Lori Hedges Lori Hedges Hospice of Illinois Schuyler Schuyler Cunningham Cunningham Jackie Johnson Jackie Johnson Joanne Murray Joanne Murray AMSA Foundation Fellow EOL Interns: Angie, Andy, Ashley, Elizabeth, Erin, Donna, Hamayun, Heather, Jim, Mabel, Melanie, and Munish


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