A CADEMIC M EDICINE , V OL . 76, N O . 5/M AY 2001 517 m CURRICULUM Hot Topics Training in End-of-life Care through Interaction with Dying Patients JULIANN BINIENDA, MA, KENDRA SCHWARTZ, MD, MSPH, WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE, AND DAVID GASPAR, MD, UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER Objective: The majority of medical school training focuses primarily on curative principles of care. Students receive lit- tle palliative care education despite studies indicating that for most patients the bulk of their health care occurs during the last few months of their lives. Training medical students in palliative care principles will result in more meaningful end-of-life interactions for many patients. This new curric- ulum component, integrated into a family medicine clerk- ship in the third year of training, engages medical students to interact with dying patients, their families, and the allied health professionals who care for them in various hospice venues. Increasing our future physicians’ knowledge of pal- liative care principles, increasing understanding of pain man- agement, and developing knowledge of hospice resources in the community will improve the overall care of the dying patient. Description: This end-of-life care curriculum was instituted in February 2000 as part of the required third-year family medicine clerkship month. Several elements occur during the month. The month begins with a lecture introducing common hospice definitions and a discussion of the contrast between palliative and curative care. At that session, stu- dents complete a pre-visit questionnaire assessing their levels of comfort interacting with dying patients. Each student is then required to spend a full day in a hospice/palliative care site. These visits are to include actual interactions with dy- ing patients and their families either in the home, in a hos- pice residential facility, or in a tertiary care facility. Students also attend interdisciplinary team meetings in which various members of the hospice care team provide input on the best care of each patient. Hospice professionals at the sites have been familiarized with the curricular objectives and were consulted as to the best way to meet them. Students com- plete a written homework assignment to further reinforce the concept of interdisciplinary care of dying patients and a post- visit questionnaire of their impressions of the experience. At the end of the month a hospice physician gives a lecture about general principles of hospice care, including the deliv- ery of bad news, basic concepts of pain management, and the realities of practicing end-of-life care. Following the lec- ture are small-group debriefing sessions during which the stu- dents share their individual experiences with dying patients. Discussion: Prior to the hospice visits many of the students indicated feeling hesitant to interact with dying patients, some fearing the perceived negative feelings associated with dying; others being nervous (‘‘not knowing what to say’’). Yet despite these hesitancies, all of the students have indi- cated that this learning experience was beneficial. They have been especially positive about the patient interactions. The student evaluations indicate a need not only for offering the knowledge based on end-of-life care principles but also for developing the communication skill set to work with dying patients and their families. Inquiries: Juliann Binienda, MA, Department of Family Medicine, Wayne State University, 15400 W. McNichols, 2nd Floor, Detroit, MI 48235. m A One-day Interclerkship on End-of-life Care MARJORIE CLAY,PHD, JULIE JONASSEN,PHD, AND ANN NEMITZ, MD [DECEASED], UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL Objectives: The convergence of public and professional con- cern about deficiencies in the care of dying patients raises the question of what medical education can do to better prepare future physicians to provide this care. In 2000, the University of Massachusetts Medical School conducted a focused one-day intervention at the end of the students’ third year to address issues arising in care of the dying patient. A multidisciplinary Committee on End-of-life Education designed the intervention to prepare students to: (1) recognize the appropriate time for shifting the care plan from curing disease to providing palliative care; (2) under- stand resources available to the dying patient within the hos- pital and in the community; (3) participate in interdisciplin- ary care of the dying patient; (4) develop an approach to managing common symptoms at the end of life; (5) under- stand the physician’s role in addressing the needs of the dy- ing patient, the patient’s family, and society; and (6) begin reflecting on the physician’s personal reactions to the care of patients with terminal illness.