Expanding Education in EOL Care at Wayne State University SOM

1. Expanding Education in EOL Care at Wayne State University SOM Juan Geldres, MS II July 30, 2004

2. Objectives • To introduce medical students to EOL care and its role in health services delivery through experiential, interactive and didactic methods • To help students understand the psychological, sociological, cultural and spiritual aspects of death and dying • To help students recognize and respond to cultural, linguistic and spiritual diversity • To improve students’ ability to reflect self-critically on personal and professional experiences, views and beliefs surrounding death and loss

3. Year I Co-curricular seminar/hospice volunteering D&D Interest Group activities Year II--Clinical Medicine course EOL lectures (prognostication, pain mgmt., advanced care planning, hospice, foregoing futile treatment) Small group meetings (advanced care planning, difficult EOL decisions) Year III Lecture on Breaking Bad News Hospice visit during Family Med rotation Advanced care planning exercise with pt. in Continuity Clinic Clerkship Year IV 12-hr. EOL seminar series in Ambulatory Med rotation 1-mo. Hospice Elective Palliative Medicine elective (new in 07/04) EOL/Palliative Medicine Curriculum at WSU SOM

4. 2003-04 Activities of WSU chapter of AMSA Death & Dying Interest Group • Saturday morning seminar introducing students to Hospice and Palliative Care • Lunchtime lecture on Communicating Bad News, given by Dr. John Finn • Lunchtime panel covering religious considerations in EOL care, as part of Ethnic Week • Movie night and discussion—Wit • Shadowing of Hospice physician during house calls

5. Small group lunch topics • Picturing Death exercise • Use Deborah Boardman’s Picturing Death journal exercise (www.deborahboardman.com) • Have students write about and discuss their perceptions of what a “good death” is • Have students write about and discuss their ideal “death room”

6. Small group lunch topics (cont’d) • Philosophical discussion on Death & Dying • What would happen if man were immortal? • What is suffering? • What happens after we die? • How does religion/spirituality affect our views of life and death?

7. Small group lunch topics (cont’d) • Documentary viewing and discussion • To Live Until I Die • Letting Go: A Hospice Journey (HBO, 1996) • On Our Own Terms—Bill Moyers series

8. Small group lunch topics (cont’d) • Book/essay discussion sessions • Assign short stories/excerpts to read and initiate group discussion • Barnard, David. Crossing Over: Narratives in Palliative Care • Byock, Ira. Dying Well: Peace and Possibilities at the End of Life • Tolstoy, Leo. The Death of Ivan Illich • Involve students by asking them to select reading or article

9. Small group lunch topics (cont’d) • Communication Skills Workshop • Reinforces lunchtime lecture given by Dr. Finn • Provides students with opportunity to practice communicating with patients in difficult situations • Provides students with opportunity for self-assessment and improvement through videotaping of interviews

10. Small group lunch topics (cont’d) • Legal and Ethical Issues in EOL Care • Explain and educate about various topics • Informed consent • Withholding and withdrawing treatments • DNR orders • Physician-assisted suicide • Provide case studies for students to consider and discuss

11. Small group lunch topics (cont’d) • Sharing of student experiences about illness and death • Initiate writing workshop employing format used by Dr. Hauser • Have students write about illness from perspective of the body of an ill person • Have students write about their experiences in dissecting cadavers in anatomy • Organize panel of MS-III/IV and/or residents to share their experiences with dying patients

12. Horizon Hospice Dr. Mike Marschke Cari Bagcus Staff Hospice of IL Schuyler Cunningham Staff Vitas Hospice Laura Walker Staff AMSA Joan Hedgecock Brittany Bettendorf Dr. Mike Stellini Fellow Participants Thank you!!