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Palliative Care Skills ...

Palliative Care Skills. 2 ° Expert skills Palliative Care Consultants / Teams. Palliative Medicine Specialists. 2006 ABMS recognized subspecialty 10 of the 24 parent boards 12 month US fellowship, > 71 graduates. Class of 2011 - 2012.

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Palliative Care Skills ...

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  1. Palliative Care Skills... 2°Expert skillsPalliative CareConsultants /Teams

  2. Palliative Medicine Specialists • 2006 ABMS recognized subspecialty • 10 of the 24 parent boards • 12 month US fellowship, > 71 graduates Class of 2011 - 2012

  3. 2006 – Palliative Medicine Recognized as Subspecialty by American Boardof Medical Specialties • 1 year Fellowship orExperiential qualification( 2006 – 2013 only) • Oversight: American Committee Graduate Medical Education • Accreditation: American Academy of Family Practice • Certification exam • Multiple choice • ABIM: American Board of Internal Medicine

  4. 10 Sponsoring Specialties Internal Medicine Physical Medicine & Rehab Psychiatry & Neurology Radiology (XRT) Emergency Medicine Pediatrics Surgery OB / GYN Family Medicine Anesthesiology Hospice and Palliative Medicine

  5. Next Steps • Clinical • Competencies • Outcomes • Teaching skills • Presentation • Facilitation • Bedside mentorship • Leadership skills • Research project

  6. 360° Evaluation • Patient and family care • Medical knowledge • Practice-based learning and improvement • Communication and interpersonal skills related to process of providing care • Professionalism • System based practice

  7. IPM US Fellows Employment 7 San Diego 10 Los Angeles 1 Hawaii 1 New Zealand

  8. 10 Sponsoring Specialties Internal Medicine Physical Medicine & Rehab Psychiatry & Neurology Radiology (XRT) Emergency Medicine Pediatrics Surgery OB / GYN Family Medicine Anesthesiology Hospice and Palliative Medicine

  9. Palliative Medicine Fellowship… Developing Clinical Capacity

  10. Hypothesis Training palliative medicine specialists will advance palliative care delivery and increase opioid consumption

  11. Int’l Palliative Medicine Fellowship • Over 24 - 36 months • 4 – 6 months at San Diego Hospice • 2 visit by IPMFaculty in-country • Competency-based • Practical bedside mentorship, not observership

  12. International Fellows

  13. Pilot: 11 Int’l Fellow Graduates • Demonstrated competencies to IPM faculty • All recognized as consultants • 3 Jordan • 2 Georgia • 2 Mongolia • 1 Slovenia • 1 Spain • 2 Vietnam

  14. King Hussein Cancer Center Jordan • 2 fellow graduates  consultants

  15. King Hussein Cancer Center Jordan • Built palliative care program • 2 palliative medicine consultants • > 50 staff • 10-bed inpatient unit ( of 140 beds ) • Inpatient consults • Ambulatory outpatient clinics • Homecare • Saw > 2,000 patients in 5 years ( since October 2004 )

  16. New Patients KHCCPallCareGrowth Length of Stay

  17. KHCC Outpatient Opioid Consumption 2004 - 2.7 kg 2006 - 5.3 kg 2008 - 6.2 kg

  18. Jordan OpioidConsumption INCB 1980-2008 Morphine Use in Jordan ( mg / capita ) ≈ 11.8 kg 4x  ≈ 2.9 kg

  19. Urska LunderLjubljana, Slovenia • Medical Director, Palliative Care, Golnik Hospital • 19 bed unit, consultation service, home care • MoH Pilot Pathway Project - 3 regions • Teaching extensively • Faculty European School of Oncology • European Union Research on EOL • IPM Leadership Development Initiative

  20. Gantuya TserendorjUlaanbaatar, Mongolia • Medical Director, Palliative Care, National Cancer Center • 16 bed unit, consultation service, outpatient clinics • MoH agreed to pay for PC services • Teaching regularly across Mongolia • Member Board of Directors new Foundation of First Lady of Mongolia dedicated to vaccination & palliative care

  21. Mongolia June 2009

  22. Reach of 11 Fellows Direct: If each cares / influences careof 1,000 pts / yr, for 30 yr Patients Lives Each Touched11 Fellows 30,000330,000 + families Indirect: Teaching, research, advocacy

  23. Next Step • Expanded international pilot project • NCI R25E grant 2011 – 2015 • 20 Fellows • Cyprus 2 Ghana 2 Tanzania 2 • Egypt 1 ( + 1 ) Italy 1 ( + 1 ) Uganda 2 • Georgia 3 Peru 1 • Others… Brazil, Colombia, Rwanda ? • US pilot project • Address workforce shortage

  24. Growing Global Leaders… Advancing Palliative Care

  25. Cohort 2: 23 Leaders, 10 Mentors Romania 2 Mongolia Serbia Nepal Armenia Turkey Albania Bangladesh Guatemala 4 India 2 Vietnam Nigeria Colombia Uganda Kenya Brazil South Africa Argentina

  26. Cohort 2: 23 Leaders, 10 Mentors Sweden Canada UK Germany Belgium USA India Uganda Australia Argentina

  27. 5 Practices of Exemplary Leaders… • Model the way • Inspire a shared vision • Challenge the process • Enable others to act • Encourage the heart

  28. Niche… Over 2 years Develop Individual Development Plan ( IDP ) • Build leadership skills ( self ) • Residential courses - curriculum • Coaching • Apply leadership skills inpractical palliative care activities • Mentorship by senior palliative care leaders • Advancepalliative care capacitylocally, regionally, globally

  29. Foster Leadership Skills

  30. Attitudes about Leadership Positive Negative p = 0.0005 p = 0.05 Before Retrospective After

  31. Leadership Core Skills All p < 0.003 Regional /International Organizational Self

  32. Sample outcomesto date…

  33. Palliative Care Activities…Latin America • New PC undergraduate medical education curriculum 2 universities • Beginning interdisciplinary post-graduate courses • Improving PC E-learning course for doctors & nurses

  34. Palliative Care Activities…Czech Republic • Regular multi-disciplinary meetings in Cancer Institute,  referrals • New website for Czech Society of Palliative Care • Palliative medicine recognized as new medical specialty

  35. Palliative Care Activities…Africa • Integrating PC into medical, nursing & dental schools • Integrate palliative care in 10 hospitals in country • Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies

  36. Palliative Care Activities…Vietnam • First Dept. PC Ho Chi Minh Cancer Center • Beginning home care • New PC unit Hanoi • Vietnamese E-learning in PC

  37. International Scholar-in-ResidenceDr. Staffan LundströmStockholm, Sweden

  38. International Reach 2003 – 2015 Patients Participants Each Lives • Presentations > 10,000 100 1 M • Courses > 500 2000 1 M • Fellows 11 + 20 10,000+ .3 M+ • Leaders 19 + 23 10,000+ .4 M+ > 2,7 M+

  39. Key Message A consistent, planned approach to education interventions and evaluation over 5-10 years changesbehaviors and the experiences ofpatients and families, organizations and societies

  40. Mohammad Bushnaqat End of Fellowship… “ Overall, I can say it very clear that: my experience with palliative care not only changed my career, but also the way I am looking to the life, the way I communicating with people,the way I am trying to understand others, and how you can be a happy person by working for noble ideas…

  41. …Mohammad Bushnaq “ I truly believe that palliative care is NOT limited to terminally ill patients, or even for sick person; but also it is the answer for all people on earth, for nations as a language to replace the language of conflict between nations we hear everyday in the media.

  42. Call to Action in Sweden • Education • Standardized curricula • Trainees - students, residents • Practicing professionals • Specialty recognition • Fellowship training

  43. “ The standards of practice we createand the people we trainwill look after uswhen it’s our turn to receive care… ”Will Sweden be ready ?

  44. You must be the change you want to see in the world Gandhi www.PalliativeMed.org www.IPCRC.net

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