american medical student association (amsa) end of life (eol) education initiative project in-a-box...
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American Medical Student Association American Medical Student Association (AMSA) End of Life (EOL) Education (AMSA) End of Life (EOL) Education Initiative Project in-a-Box (PIB)Initiative Project in-a-Box (PIB)
Richard J. LinRichard J. Lin
Harvard Medical SchoolHarvard Medical School
August 1, 2003August 1, 2003
Chicago, ILChicago, IL
An Experiential Learning An Experiential Learning Module of EOL CareModule of EOL Care
Overview of current EOL curriculumOverview of current EOL curriculum Development of an experiential EOL Development of an experiential EOL
learning module - The EOL Care learning module - The EOL Care Mentorship ProgramMentorship Program
Program evaluation and assessmentProgram evaluation and assessment Finance, portability, and future Finance, portability, and future
integration into the core curriculumintegration into the core curriculum
HMS EOL Curriculum OverviewHMS EOL Curriculum Overview
Lack of EOL Component in the Lack of EOL Component in the Current Core CurriculumCurrent Core Curriculum
MSI and MSII - Popular elective “Living MSI and MSII - Popular elective “Living with Life-threatening Illness”with Life-threatening Illness”
MSIV - Two elective rotations in Pain, MSIV - Two elective rotations in Pain, Palliative medicine, and Psychosocial Palliative medicine, and Psychosocial OncologyOncology
Residents and Physicians - Elective Residents and Physicians - Elective palliative care rotations and fellowship; palliative care rotations and fellowship; faculty development seminarfaculty development seminar
Living With Life-threatening Living With Life-threatening Illness (LWLTI) CourseIllness (LWLTI) Course
Developed by two palliative care experts at HMS, Developed by two palliative care experts at HMS, Drs. Susan Block (DFCI) and Andrew Billings Drs. Susan Block (DFCI) and Andrew Billings (MGH)(MGH)
Course formats are lecture; small group Course formats are lecture; small group discussion/reflection; case conference; role discussion/reflection; case conference; role plays; and individual patient visitsplays; and individual patient visits
Covers the basics of hospice and palliative Covers the basics of hospice and palliative medicine: death and dying process; advanced medicine: death and dying process; advanced care planning; pain control and symptom care planning; pain control and symptom management; physician roles; ethical, cultural management; physician roles; ethical, cultural and spiritual issues and spiritual issues
Informational and Experiential Informational and Experiential Gaps in LWLTIGaps in LWLTI
25 to 30 students enroll each year, accounts for 25 to 30 students enroll each year, accounts for only 7 to 8 percent of the student bodyonly 7 to 8 percent of the student body
Focus more on integration of palliative care into Focus more on integration of palliative care into mainstream medicine and less on utilizing hospice mainstream medicine and less on utilizing hospice care for dying patientscare for dying patients
Most participating patients are in the gray zone Most participating patients are in the gray zone with prominent medical issueswith prominent medical issues
Emphasizes physician leadership, no exposure to Emphasizes physician leadership, no exposure to interdisciplinary team workinterdisciplinary team work
PBL cases are not integrated with patho-PBL cases are not integrated with patho-physiology and clinical medicinephysiology and clinical medicine
The EOL Care Mentorship ProgramThe EOL Care Mentorship Program
Goals and ObjectivesGoals and Objectives
Introduction of the key concepts of Introduction of the key concepts of hospice and palliative medicinehospice and palliative medicine
Experiential learning of EOL care Experiential learning of EOL care through interdisciplinary team workthrough interdisciplinary team work
Cultivation of student interest in EOL Cultivation of student interest in EOL care and palliative medicinecare and palliative medicine
Advocacy of integration of EOL Advocacy of integration of EOL component into the core curriculumcomponent into the core curriculum
The EOL Care Mentorship ProgramThe EOL Care Mentorship Program
Forming partnerships with local hospice and Forming partnerships with local hospice and hospital-based palliative care teams hospital-based palliative care teams
Drawing the enthusiasm and expertise of a Drawing the enthusiasm and expertise of a large number of faculty members who has an large number of faculty members who has an interest in EOL careinterest in EOL care
Targeting mostly first and second year Targeting mostly first and second year medical studentsmedical students
Assigning two or three students to each Assigning two or three students to each hospice/palliative care team; potentially hospice/palliative care team; potentially serving as volunteersserving as volunteers
Potential Partner I : Potential Partner I : Healthcare Dimensions HospiceHealthcare Dimensions Hospice
A subsidiary of Dana-Farber Cancer Institute A subsidiary of Dana-Farber Cancer Institute (DFCI) and Partners Healthcare System(DFCI) and Partners Healthcare System
Serving all 37 counties in the greater Boston Serving all 37 counties in the greater Boston area, currently has 150 patientsarea, currently has 150 patients
Comprehensive hospice service for both Comprehensive hospice service for both adults and childrenadults and children
Non-for-profit, Medicare and Medicaid Non-for-profit, Medicare and Medicaid certified, JACHO accreditedcertified, JACHO accredited
Medical Director and full-time physicians, Medical Director and full-time physicians, PCP participation is highPCP participation is high
Potential Partner II : Potential Partner II : Pain and Palliative Care ProgramPain and Palliative Care Program
Based in DFCI and Brigham and Women’s Based in DFCI and Brigham and Women’s Hospital (BWH)Hospital (BWH)
Serving mostly cancer patientsServing mostly cancer patients Work alongside of the medical team to Work alongside of the medical team to
integrate palliative care into comprehensive integrate palliative care into comprehensive plan of care plan of care
Interdisciplinary team approach for pain and Interdisciplinary team approach for pain and symptom control and psychosocial supportsymptom control and psychosocial support
Physician leadership with Dr. Janet Abrahm Physician leadership with Dr. Janet Abrahm (Medical Oncologist)(Medical Oncologist)
Potential Partner III : Potential Partner III : Palliative/Supportive Medicine TeamPalliative/Supportive Medicine Team
Based in Harvard Vanguard Medical Based in Harvard Vanguard Medical Associate, a community healthcare networkAssociate, a community healthcare network
Serving community hospitals, nursing homes, Serving community hospitals, nursing homes, and extended care facilities, predominately and extended care facilities, predominately serving geriatric populationserving geriatric population
Consultative services on pain and symptom Consultative services on pain and symptom management and psychosocial supportmanagement and psychosocial support
Physician leadership with Dr. Robert Physician leadership with Dr. Robert Buxbaum (Internist and Geriatrician)Buxbaum (Internist and Geriatrician)
Potential Partner IV : Potential Partner IV : Pediatric Advanced Care TeamPediatric Advanced Care Team
Based in Children’s Hospital and DFCIBased in Children’s Hospital and DFCI Serving children with advanced illnessServing children with advanced illness Support medical treatment for underlying Support medical treatment for underlying
illness while provide optimal quality of lifeillness while provide optimal quality of life Using a family-centered approachUsing a family-centered approach Extensive grieving and bereavement support Extensive grieving and bereavement support
for parentsfor parents Physician leadership with Dr. Joanne Wolfe Physician leadership with Dr. Joanne Wolfe
(Pediatric Oncologist)(Pediatric Oncologist)
Some Possible Activities of the Some Possible Activities of the EOL Care Mentorship ProgramEOL Care Mentorship Program
Home visits with physicians, nurses, Home visits with physicians, nurses, social workers, and chaplainssocial workers, and chaplains
Nursing home visitsNursing home visits Hospital inpatient palliative care roundsHospital inpatient palliative care rounds IDG meetingIDG meeting Clinical case conferenceClinical case conference Small group reflection/discussionSmall group reflection/discussion
Logistic Considerations of the Logistic Considerations of the EOL Care Mentorship ProgramEOL Care Mentorship Program
Student time commitmentStudent time commitment Faculty time commitment and Faculty time commitment and
willingness to teach and supervisewillingness to teach and supervise Patient wishes and confidentialityPatient wishes and confidentiality Logistic arrangement with the hospice Logistic arrangement with the hospice
and the palliative care teamand the palliative care team Longitudinal program vs intensive Longitudinal program vs intensive
clinical rotationsclinical rotations
Program Assessment and EvaluationProgram Assessment and Evaluation
Participant EvaluationParticipant Evaluation
Pre- and post-test/questionnairePre- and post-test/questionnaire Preceptor evaluationPreceptor evaluation Home visit experience write-upsHome visit experience write-ups Illness history/treatment/prognosisIllness history/treatment/prognosis Pain and symptom managementPain and symptom management Psychosocial and spiritual distressPsychosocial and spiritual distress Patient wishes and family/caregiver concernsPatient wishes and family/caregiver concerns Patient-doctor communication and relationshipPatient-doctor communication and relationship Student learning experienceStudent learning experience
Program AssessmentProgram Assessment
Participant feedback and suggestionParticipant feedback and suggestion Faculty/hospice reviewsFaculty/hospice reviews Patient/family surveysPatient/family surveys Assessment by mentors and the Assessment by mentors and the
curriculum committeecurriculum committee
MiscellaneousMiscellaneous
Program FinanceProgram Finance
Potential exists for an elective, paid student Potential exists for an elective, paid student fellowship program fellowship program
AMSA seed grant for EOL Education Initiative AMSA seed grant for EOL Education Initiative Project-in-a BoxProject-in-a Box
HMS Community Service Program at the HMS Community Service Program at the Office of Enrichment ProgramsOffice of Enrichment Programs
HMS Student Council (student interest group)HMS Student Council (student interest group) HMS Center for Palliative CareHMS Center for Palliative Care The Neil Samuel Ghiso Foundation (NSGF)The Neil Samuel Ghiso Foundation (NSGF)
The Neil Samuel Ghiso FoundationThe Neil Samuel Ghiso FoundationFor Compassionate Medical CareFor 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.
Program PortabilityProgram Portability
Stand alone programStand alone program Integration into the elective LWLTI courseIntegration into the elective LWLTI course Integration into the HMS Primary Care Integration into the HMS Primary Care
Mentorship ProgramMentorship Program Expansion and Integration into the Death and Expansion and Integration into the Death and
Dying Student Interest GroupDying Student Interest Group Integration into the core curriculum (ICM and Integration into the core curriculum (ICM and
Patient-Doctor courses)Patient-Doctor courses) Adaptable to other medical schools Adaptable to other medical schools
Program ShortcomingsProgram Shortcomings
Elective in nature Elective in nature In program pilot years it may be able to take In program pilot years it may be able to take
only 4 to 8 studentsonly 4 to 8 students Designed mainly for students with advanced Designed mainly for students with advanced
knowledge/interest/experienceknowledge/interest/experience Lacking an organized didactic componentLacking an organized didactic component Time commitment and travelTime commitment and travel May not be able to follow the same patient May not be able to follow the same patient
over time due to logisticsover time due to logistics
What I have LearnedWhat I have Learned
To Cure SometimesTo Cure Sometimes
To Relieve OftenTo Relieve Often
To Comfort AlwaysTo Comfort Always
-16-16thth century anonymous century anonymous
Thank You So Much !!!Thank You So Much !!!
Horizon HospiceHorizon Hospice Dr. Mike MarschkeDr. Mike Marschke Dr. Mike PreodorDr. Mike Preodor Lori HedgesLori HedgesHospice of IllinoisHospice of Illinois Schuyler Schuyler CunninghamCunningham Jackie JohnsonJackie Johnson Joanne MurrayJoanne Murray
AMSA FoundationAMSA Foundation
Fellow EOL Interns:Fellow EOL Interns:
Angie, Andy, Ashley, Angie, Andy, Ashley, Elizabeth, Erin, Donna, Elizabeth, Erin, Donna, Hamayun, Heather, Hamayun, Heather, Jim, Mabel, Melanie, Jim, Mabel, Melanie, and Munishand Munish