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End of Life Curriculum Enhancements at the University of Michigan Medical School

End of Life Curriculum Enhancements at the University of Michigan Medical School. Matt Ambrose July 30, 2004. Current Curriculum. Clinical Foundations course “Sharing” bad news lecture Focuses on communication and exam skills Longitudinal Cases One case per organ-based sequence

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End of Life Curriculum Enhancements at the University of Michigan Medical School

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  1. End of Life Curriculum Enhancements at the University of Michigan Medical School Matt Ambrose July 30, 2004

  2. Current Curriculum • Clinical Foundations course • “Sharing” bad news lecture • Focuses on communication and exam skills • Longitudinal Cases • One case per organ-based sequence • So far, only one brief mention of hospice • Standardized Patient Interviews • Stated goal is to help students “master communication skills in challenging contexts” • “Bad news” session in M3 year

  3. Potential Curricular Changes • Encourage broader discussion of hospice and EOL care in the longitudinal cases • Using a “case patient,” role-play a family meeting similar to the one we did here, discussing the possibility of hospice involvement • Work to include a pain-management lecture in a sequence during M2-year • Possibly oncology or the Clinical Foundations courses spaced throughout • Maybe for this year, as oncology scheduled for Jan.

  4. Extra-Curricular Activities • At UMMS, “weeks” dedicated to certain issues (i.e. Women’s Health, the Uninsured, etc.) are popular • Free lunch served at lectures, seminars and forums during this time

  5. Monday of EOL Week • Theme: What is Hospice? • Learning Objectives: • The Medicare hospice benefit, qualifications • Different caregiver model – TEAM of caregivers (equals) with patient comfort paramount • Barriers to comfort at EOL • How does hospice address these barriers? • Format: 30-40 minute lecture with time for questions

  6. Tuesday of EOL Week • Theme: Pain and Palliative Care • Learning Objectives: • Pain is…? Whatever the patient says it is. • Types of pain – somatic, visceral, neuropathic • Myths about narcotic use • Safe administration of narcotics – escalation supplemented with breakthrough doses • Format: 30-40 minute lecture with time for questions

  7. Wednesday of EOL Week • Popular lecture series highlighting medical specialties on Wednesdays • Instead, evening viewing of “Wit” followed by discussion, facilitated either by myself or a local hospice physician or nurse

  8. Thursday of EOL Week • Theme: Legal and Ethical Issues at EOL • Learning Objectives: • Who decides? DNRs, Advanced Directives, caregiver heirarchy • Gain a perspective on the hospice-mentality • “giving up hope” vs. “re-directing hope” • Hospice vs. PAS vs. euthanasia • Law of “double effect” • Format: 10-15 minute lecture followed by forum discussion with hospice representative, hospital legal counsel, hospital ethics board member(s)

  9. Friday of EOL Week • Theme: Addressing Spiritual Needs • Learning Objectives: • Why take a spiritual history? • When? Appropriate situations • How? FICA and other methods • Format: 10-15 minute lecture followed by forum discussion with hospice or hospital chaplain(s) and director of Clinical Foundations course

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