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Background: In response to the nationwide need for improved care of patients at end of life, our medical school implemented approximately 20 hours of mandatory coursework on the care of dying patients for all students, with satisfactory completion required for graduation. Objective: We now report a long-term evaluation of this coursework. Design/subjects/measurements: A 74-item questionnaire concerning attainment of palliative care and other medical school course objectives, postgraduate practice encounters with patients at end of life, and postgraduate behaviors in palliative care was mailed to all students who graduated from our medical school in 2000, 2001, and 2002. Responses were graded by a Likert-type scale. Additionally, the Association of American Medical Colleges Medical School Graduation Questionnaire (AAMC/GQ) reports for all schools and for our medical school were queried for data regarding palliative care. Results: The return rate of the questionnaire was 54%. The respondents perceived the training to be valuable and effective. They displayed good postgraduate palliative care practices such as choosing to use opiates other than meperidine for pain in the end-of-life setting. Fiftythree percent of the respondents reported that dying patients were often or frequently under their care since graduation. Despite evidence for the efficacy of the training, the respondents perceived that preparedness in certain palliative care domains was somewhat below preparedness in benchmark medical school competencies such as assessment/management of hypertension and diabetes. The AAMC/GQ surveys indicated that for the years 2000–2002, at least 20% more of our graduates perceived that their training in pain management and palliative care was adequate than did all other medical students graduating nationwide. Conclusions: The evaluation provides support for the conclusion that mandatory training in palliative and end-of-life care is effective, perceived to be valuable, and contributes to good palliative and end-of-life care practices in our graduates. Furthermore, the training meets a significant demand in our graduates' clinical practice: end-of-life care. However, expanded medical school emphasis and curriculum hours are still needed for palliative care topics, because preparedness in palliative care skills was perceived to be inferior to benchmark medical skills. To our knowledge, this is the first report of a rigorous summative evaluation of the efficacy of required coursework in palliative and end-of-life care in a U.S. medical school curriculum. [ABSTRACT FROM AUTHOR]

Stimulated by support from an R25 grant from the National Cancer Institute, we assembled a multidisciplinary team to design, implement, evaluate, and institutionalize in our medical school curriculum a training program to enable all students to graduate with basic competency in palliative and end-of-life care. In the fall of 1994, we reviewed the medical curriculum extensively to determine the need and optimal sites for integration of new educational modules. The freshman and junior years were found most suitable for our purposes; hence, behavioral objectives targeted at the freshman and junior medical student as learner were designed for the domain of palliative and end-of-life care. By 1996, negotiations with the medical school curriculum committee and with individual course masters secured permission and time allotments to include new coursework as required elements. We integrated approximately 20 hours of required training into the medical school curriculum, accomplished by modules that utilized small group learning, didactic presentations, out-of-classroom assignments, and practicum/experiential teaching methods. Freshman year curriculum consisted of a 3-hour module that considers the role of the physician in end-of-life care. Junior year training included a 1-hour module on advance directives and a 16-hour classroom and practicum course on hospice and end-of-life care. Performance-based assessment revealed that the students achieved the behavioral objectives. Furthermore, the students perceived benefit from the training and concluded that palliative care education should be a required part of their medical school experience. In September 2000, the medical school's Clinical Years Committee officially designated the palliative and end-of-life care training modules a mandatory part of the curriculum, with satisfactory completion a requirement for graduation. [ABSTRACT FROM AUTHOR]

Describes an adult education program that was developed from a general palliative medicine curriculum. Modification to nursing facility (NF) physician curriculum; Goals for NF physicians from a general medical student curricula.