End of Life Education at Touro University

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

2. 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 3rd yr rotation with Dr. West, Sutter Medical Director. Current curriculum

3. 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 Goals

4. Chronological Approach

6. 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. Start

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.

8. What do you do?

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

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. • 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? Middle

11. 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. End

12. 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. Conclusion