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End of Life Education at Touro University Kenneth Leong, OMS II.

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Presentation on theme: "End of Life Education at Touro University Kenneth Leong, OMS II."— Presentation transcript:

1 End of Life Education at Touro University Kenneth Leong, OMS II

2 Current curriculum  Breaking bad news lecture  Breaking bad news to a standardized patient  Medical ethics lecture  DNR/DNI lecture  2-hour lecture on End-of-Life care by a hospice physician  Elective 3 rd yr rotation with Dr. West, Sutter Medical Director.

3 Goals Establish a EOL curriculum at Touro University Nurture interest about EOL issues in students to partake in EOL elective (Colleen Fitzgerald) Have students become active in the EOL medical community

4 Chronological Approach StartMiddleEnd Begin with 4 cases and discussing with the class what you would do if this is your family member. o Case 1 - An 70 yo patient w/ no advance directive and never spoke of wishes. Had an MI 5 years ago. o Case 2 - elderly patient w/ no advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state. What do you do? o Case 3 - patient with metastatic GI cancer with mets to lungs. Patient has gone through chemo and radiation. Patient appears dyspnic, nausea and vommiting, and a distended abdomen. Pain is at a 10. Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older. o Feeding. Show what a PEG tube looks like. o Constellation of problems seen during end of life Show what pressure sores look like Contracted Aspiration Thrush Delirium vs. dementia Address morphine stigma What are the costs and benefits of placing a feeding tube? What happens physically when a person dies? o Scan the blue book “Gone From My Sight” into a PowerPoint Organize students to attend the annual AAHPM meeting. Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year. Establish an end-of-life elective course

5 StartMiddleEnd What happens when you code? o Participants - Dr, RN's, RT, Lab, medical students, gawkers, crowd control o CPR w/ patient with osteopenia o Pics of central line or video of putting in one o Video of PEG tube Introduce Hospice as a modality of care o What is hospice and what makes a patient hospice-appropriate? o What is the hospice philosophy? o What role does each member of the interdisciplinary team play? What happens to you when you survive a code?

6 Start  Begin with 4 cases and discussing with the class what you would do if this is your family member.  Case 1 - elderly patient w/ no advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state.  Case 2 - patient with metastatic GI cancer with mets to lungs. Patient has gone through numerous rounds of chemo and radiation. The oncologist insists upon a new trial drug that may be effective. Patient has nausea, vomiting, and has pain at a 9. Patient expresses that he is “sick and tired of feeling sick.”  Case 3 – Latino female patient who has colon cancer that has metastasized to the liver. Although she is enrolled on hospice, her family insists that she must NOT be informed of this.

7  Case 4 – You see in the hospital an 85 yo white male with end stage CHF. Patient has Alzheimer's dementia and was admitted to the hospital for fluid in his lungs and edema. He is on the following meds:  Lovastatin, carvedilol, aspirin, Cardura, furosemide, jet nebulized albuterol & atrovent, roxanol, senna, dulcolax, robutussin.

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9 Start (cont’d) What happens when you code? o Participants - Dr, RN's, RT, Lab, medical students, gawkers, crowd control o CPR w/ patient with osteopenia o Video of a central line being placed o Video of PEG tube What happens when you survive a code?

10 Middle Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older. ◦ Parenteral feeding ◦ Constellation of problems seen during end of life  Decubiti  Contracted  Aspiration  Thrush  Delirium vs. dementia Address morphine stigma What are the costs and benefits of placing a feeding tube? What happens physically when a person dies? ◦ Scan the blue book “Gone From My Sight” into a PowerPoint ◦ View the movie “Wit” as either an elective course (Colleen), or advertised as a school event. Introduce Hospice as a modality of care ◦ What is hospice and what makes a patient hospice-appropriate? ◦ What is the hospice philosophy? ◦ What role does each member of the interdisciplinary team play?

11 End Establish an end-of-life elective course Have students become active in the EOL medical community and attend the annual AAHPM assembly Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year.

12 Conclusion  End-of-life issues are poorly addressed in medical education—Touro University is no exception. With the aid of generous aid from AMSA and VITAS, my goal is to create a comprehensive curriculum that addresses this need.


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