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Teaching palliative care—a new paradigm
Palliative Care Education in US Medical Schools. Howowitz R et al. Medical Education 2014; 48: 59-66.
Reviewed by Amy Creel


What was the study question?
Marking the 50th anniversary of both the modern Hippocratic Oath and the contemporary hospice and palliative care movement in the USA, the authors seek to determine the state of palliative care education in US medical schools. They offer summary and reflection on current practices and goals for the future.

How was the study done?
The authors reviewed individual institution descriptions of palliative care curricula and multi-institution surveys outlining attitudes toward palliative care education and describing current practices. Instruction in palliative care in medical schools outside the US was also reviewed.

What were the results?
There is a consensus that education in palliative care is universally important and desired by medical educators, governing bodies and medical students. However, medical student exposure to palliative care is extremely variable in depth ranging from 2 hours of didactics to weeks of direct patient contact. Most training is limited to end of life care only, with little training in the broader goals and applications of palliative care.

What are the implications of these findings?

Absent sufficient formal instruction in medical schools, palliative care education may be left to informal instruction or to "hidden" curriculum. Given the many other competing demands on medical curricula, the authors suggest:

  1. Integration into existing courses
  2. Teaching developmentally appropriate palliative knowledge and skills
  3. Definition of appropriate competencies by national leaders
  4. Integrated national curricula standards with local interpretation and integration
  5. Palliative care education should not be limited to electives

Editor's Note: The authors point out correctly that there isn't enough time and there aren't enough palliative care specialists to create new courses or even required clinical experiences in most medical schools. But it isn't difficult to imagine how we might change the focus slightly of our existing courses and clerkships (including pediatrics) to incorporate palliative care principles and experiences for all medical students (JG).

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