Continuing Education in Palliative Care Is enough being done?

Dr Sylvia McCarthy Hospis Malaysia

Are we doing enough?

The answer is always no! Enough for what? What is the aim of CME? To improve established clinical practice in palliative care To increase access to palliative care To ensure that all patients with life limiting illness can have an palliative approach to management

Do our working practices foster CME?

Many physicans work in isolation Participating in hospital based education Nursing structures Psychologists

Push for palliative care education

Part of curriculum requirement Hospital accreditation programs

Who needs the Education?

Ability to disseminate palliative care depends on enthusiastic individuals often working alone with little support and sometimes opposition Education at an organisational level. Support for the individuals

Education Needs
Central information re availability of training education Current resources
Who can teach? What should we teach? Who needs to know?

What do they know at the moment?

Where are Patients receiving palliative care?

At home carers Nursing homes nursing staff and carers General wards general medical training Specialist Palliative Care Units

Palliative care is about Quality of Life

Medical undergraduate teaching Nursing basic diploma & degree courses Nursing oncology post basic diploma Nursing post basic palliative care

But psychologists Dieticians Physiotherapists Occupational therapists Social workers

Integrating palliative care education in current health professionals training

Training for healthcare professionals who have had little prior exposure to palliative care

CME

Palliative Care as a component of other disciplines

Most end of life care and decision making happens in general hospitals and primary care.
Palliative care should be part of basic training both for all health care professionals

Interprofessional or by discipline
Interprofessional education reflects the ethos of palliative care ie a multidisciplinary approach.

But It may be more practical to teach within disciplines ie make palliative care a component of already established teaching curricula

Interprofessional education
Holistic care requires skills in many areas
Physical Psychosocial Spiritual

Multi disciplinary/multiskill ed

Physiotherapists Occupational therapists Psychologists Nurses Doctors Pharmacists

 Conferences
Networking Knowledge Concepts

Clinical attachments
skills attitude

Distance learning
Knowledge reflection

Workshops
Knowledge Skills Attitudes networking

E learning
Knowledge reflection

CME for those practicing palliative care

Journal Club Conference Attendance
local regional International

Involvement in research

Whose responsibility is it to provide palliative care education/CME?

Universities Ministry of Health NGOs Pharmaceutical companies

At what level
Undergrad Preclinical/clinical If we concentrate on the ethical considerations and understanding death and dying, students may fail to make the connection with the need for good clinical skills and continue to view palliative care as a soft option

postgrad

Training the trainers

Is Palliative Care education different?
Our effective is the education we are currently delivering?

Need to be adaptive and creative Challenging group dynamics Enjoy working with patients desperation based medicine more than evidence-based medicine. Enjoyed watching the interaction between participants Facilitators learn too. Exhausting!

What are we teaching?

Attitudes

Skills

Knowledge

What do they need to know

Symptom assessment and management Diagnosing dying Prognostication End of life care/planning

But Communication Imparting information Emotional support Ethical Frameworks When to intervene/act Nursing skills Care of a dying patient

What do they already know

Hopeless Depressed Giving Emotional Support Emotions Quality of life

But

Clinical skills Ethical frameworks Communication skills

How are we teaching?

Lectures Workshops Clinical attachments Effective learning can only occur in conjunction with clinical exposure Lecture cant address attitudes and skills

Challenges for learners

Communication Emotions Talking about Death Soft subject Failure medicine

Challenges for teachers

Balancing the need to provide clinical services with education requirements

Clinical experiences without debriefing leave an emotional void

F Financing CME Who is paying for CME?

Who should be paying?

Pharmaceutical companies NGOs Universities Government

Place of teaching
Community Hospital based

What Drives Our Learning?

I dont know what to do? I have to learn it I will get into trouble I need CME points Someone sent me

Involving Patients and Family in Teaching

Using IT
E learning Emails Case based teaching

Art and Palliative Care

Reading lists Viewing recomendations

Need to evaluate our education programs

Knowledge
Satisfaction surveys Ratings versus comments

Where
Here or abroad

Collaborations to Enhance Education

Using foreign expertise
2 way process Willingness to learn the cultural setting Adapt teaching methods

Quality or Quantity?
Do we want many participants learning a little bit Or A few well trained practitioners able to practice competently and independantly?

And So
We are doing quite a lot It is never enough
Co ordination of palliative care education
Prioritising Clear aims Measuring outcomes Pooling resources