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Simulated Death: An Innovative, Inter-Professional Teaching Method
Vol. 45 No. 2 February 2013
Schedule With Abstracts
Interdisciplinary Curriculum for Oncology Palliative Education (iCOPE) Barbara Head, PhD RN MSSW, University of Louisville School of Medicine, Louisville, KY. Mark Pfeifer, MD, University of Louisville School of Medicine, Louisville, KY. Tara Schapmire, PhD MSSW, University of Louisville School of Medicine, Louisville, KY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Develop and test an innovative, mandatory curriculum to be completed by students of all the four disciplines. 2. Utilize multiple learning modalities in creating an interactive curriculum during which students of the four disciplines learn together. 3. Students completing the curriculum will be able to communicate and work effectively in interdisciplinary teams. 4. Students will be able to apply palliative principles in generalist practice Background. Interdisciplinary education has been mandated by such groups as the Institute of Medicine and the World Health Organization as a means to develop medical practitioners capable of providing holistic, top quality and safe care. Palliative care has led the way in providing interdisciplinary care and should also lead initiatives to develop and test educational models. The University of Louisville has designed and is testing a mandatory, innovative curriculum teaching interdisciplinary palliative oncology care to third year medical students, senior nursing students, masters level social work students, and students in clinical pastoral education. Implement models for teaching such care to students of the healthcare professions. Methods. During the planning year, an interdisciplinary council representative of faculty from all four disciplines planned and created the curriculum which consists of topic-specific and casebased online didactic modules, an interactive case management and care planning activity, and a clinical rotation in palliative care. Learning Objectives and a comprehensive evaluation plan were also developed. Community partnerships were developed and clinical placement cites secured for all students. During the 2012e2013 academic year students will be required to participate as part of the established curriculum requirements.
387
Results. The development of the curriculum components and evaluation design required interdisciplinary cooperation and was often a challenging endeavor. Faculty members grew in their own respect for the contributions of other disciplines and their awareness of the challenges involved in interdisciplinary collaboration. It is estimated that 100 medical, 60 nursing, 40 social work, and 15 CPE students will complete the curriculum in the fall of 2012. Discussion. Interdisciplinary faculty collaboration in the development of curriculum requires patience, flexibility, and a willingness to overcome egocentric attitudes towards one’s own discipline. However, end results can guide a creative approach to hands-on interdisciplinary learning. If it is expected that healthcare professionals will work in teams and provide holistic care, it is essential that the various schools get out of their "silos" and work together to train students to respect each discipline, communicate effectively, and develop integrated care plans inclusive of the principles of palliative care. Conclusion. This session will demonstrate the components of such a curriculum and explain how four schools (medicine, nursing, social work, and chaplaincy) overcame multiple obstacles ("turf" issues, scheduling problems, other curriculum demands) to create and implement an interdisciplinary learning experience designed to develop practitioners capable of teamwork and effective patientand family-centered care planning and implementation built upon palliative care principles and practice.
Simulated Death: An Innovative, Inter-Professional Teaching Method Jessica Kalender-Rich, MD, University of Kansas School of Medicine, Kansas City, KS. Deon Hayley, DO, University of Kansas School of Medicine, Kansas City, KS. Kathee Long, RN MSNEd, University of Kansas School of Medicine, Kansas City, KS. (All authors listed above had no relevant financial relationships to disclose.) Objective To identify a novel method to educate learners in communication and end-of-life care.
388
Schedule With Abstracts
Background. The use of standardized patients to teach medical and nursing students has been well studied in the realms of communication and physical exam skills. In addition, it is accepted by the adult learner as interactive, experiential, and involves immediate feedback. With more curricular time devoted to end-oflife care, we have found that simulation of the dying patient is a useful way to teach and evaluate learner skills. We present our novel, multidisciplinary experience with an end-of-life patient simulation using role-playing. Methods. We will demonstrate a standardized patient encounter of a patient with end-stage multiple myeloma on hospice, who presents to the emergency department with distressed family for uncontrolled symptoms. During the encounter, the patient (mechanical simulator controlled electronically in real time) declines further and dies. Faculty observe and assess core skills performed. Immediately afterwards, students, faculty, and standardized patients discuss feedback of performance and learners complete a written assessment. Scenarios vary among medical and nursing students based on core skills desired. Results. Twenty-four medical students and 93 nursing students have completed the encounter. The experience was reported to be beneficial in 100% of the encounters. Discussion. This experience has been well received by the learners and provides the faculty with a clear picture of knowledge gaps in communication, family support, and symptom management. It also provides a new forum for inter-professional collaboration. We plan to expand the encounter beginning in July 2012 to include all 120 year 4 medical students and the entire nursing school class. In addition, we will begin collecting pre- and post-encounter data about attitudes and knowledge in end-of-life care. This experience has been well received by the learners and provides the faculty with a clear picture of knowledge gaps in communication, family support, and symptom management. It also provides a new forum for inter-professional collaboration. Conclusion. The use of the standardized patient to teach and evaluate end-of-life skills is useful and appreciated. We will share our experience and outcomes in teaching each desired core skill and provide a visual example of this reproducible teaching tool.
Vol. 45 No. 2 February 2013
Teaching Self-Care and Preventing Burnout During HPM Fellowship Sarah Harrington, MD, University of Arkansas for Medical Sciences, Little Rock, AR. Robin Devan, MD, University of Arkansas for Medical Sciences, Little Rock, AR. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe a self-care ‘‘boot camp’’ didactic given during the first week of fellowship. 2. Integrate a self-care learning-centered module into the HPM curriculum that keeps track of all fellowship requirements (including Accreditation Council for Graduate Medical Education, institutional, and program) and recommended content, in order to monitor self-care longitudinally. 3. Discuss ways to prevent burnout during fellowship with practical curriculum-based examples. Background. A hospice and palliative medicine (HPM) fellowship is usually 12 months of intensive learning and exposure to a high volume of patients with serious illness and those at the end of life. Fellows also learn to care for families during times of stress and high emotion. They learn that being a palliative care clinician requires a great deal of physical, emotional, and spiritual investment. Along with learning the basics of pain and symptom management, prognostication, and end-of-life care, equally important is learning professionalism, personal and professional boundaries, and self-care. Teaching self-care and encouraging self-reflection can be a challenge for faculty. This educational intervention describes how we approach teaching self-care in our HPM fellowship. Methods. After 3 years of our HPM fellowship, we discovered that teaching self-care and making it a top priority was essential for our trainees and faculty. We have also learned from experience how to teach and prevent burn-out for fellows using a structured approach. Results. Two classes of fellows have completed the patient care and self-reflection module and given it positive feedback. Faculty have consistently given positive feedback for the structured self-care portion of the curriculum. Discussion. The integrated curriculum created a heightened awareness and a more open dialogue about self-care among the HPM faculty, fellows, and staff. At the end of this academic
Schedule With Abstracts
Interdisciplinary Curriculum for Oncology Palliative Education (iCOPE) Barbara Head, PhD RN MSSW, University of Louisville School of Medicine, Louisville, KY. Mark Pfeifer, MD, University of Louisville School of Medicine, Louisville, KY. Tara Schapmire, PhD MSSW, University of Louisville School of Medicine, Louisville, KY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Develop and test an innovative, mandatory curriculum to be completed by students of all the four disciplines. 2. Utilize multiple learning modalities in creating an interactive curriculum during which students of the four disciplines learn together. 3. Students completing the curriculum will be able to communicate and work effectively in interdisciplinary teams. 4. Students will be able to apply palliative principles in generalist practice Background. Interdisciplinary education has been mandated by such groups as the Institute of Medicine and the World Health Organization as a means to develop medical practitioners capable of providing holistic, top quality and safe care. Palliative care has led the way in providing interdisciplinary care and should also lead initiatives to develop and test educational models. The University of Louisville has designed and is testing a mandatory, innovative curriculum teaching interdisciplinary palliative oncology care to third year medical students, senior nursing students, masters level social work students, and students in clinical pastoral education. Implement models for teaching such care to students of the healthcare professions. Methods. During the planning year, an interdisciplinary council representative of faculty from all four disciplines planned and created the curriculum which consists of topic-specific and casebased online didactic modules, an interactive case management and care planning activity, and a clinical rotation in palliative care. Learning Objectives and a comprehensive evaluation plan were also developed. Community partnerships were developed and clinical placement cites secured for all students. During the 2012e2013 academic year students will be required to participate as part of the established curriculum requirements.
387
Results. The development of the curriculum components and evaluation design required interdisciplinary cooperation and was often a challenging endeavor. Faculty members grew in their own respect for the contributions of other disciplines and their awareness of the challenges involved in interdisciplinary collaboration. It is estimated that 100 medical, 60 nursing, 40 social work, and 15 CPE students will complete the curriculum in the fall of 2012. Discussion. Interdisciplinary faculty collaboration in the development of curriculum requires patience, flexibility, and a willingness to overcome egocentric attitudes towards one’s own discipline. However, end results can guide a creative approach to hands-on interdisciplinary learning. If it is expected that healthcare professionals will work in teams and provide holistic care, it is essential that the various schools get out of their "silos" and work together to train students to respect each discipline, communicate effectively, and develop integrated care plans inclusive of the principles of palliative care. Conclusion. This session will demonstrate the components of such a curriculum and explain how four schools (medicine, nursing, social work, and chaplaincy) overcame multiple obstacles ("turf" issues, scheduling problems, other curriculum demands) to create and implement an interdisciplinary learning experience designed to develop practitioners capable of teamwork and effective patientand family-centered care planning and implementation built upon palliative care principles and practice.
Simulated Death: An Innovative, Inter-Professional Teaching Method Jessica Kalender-Rich, MD, University of Kansas School of Medicine, Kansas City, KS. Deon Hayley, DO, University of Kansas School of Medicine, Kansas City, KS. Kathee Long, RN MSNEd, University of Kansas School of Medicine, Kansas City, KS. (All authors listed above had no relevant financial relationships to disclose.) Objective To identify a novel method to educate learners in communication and end-of-life care.
388
Schedule With Abstracts
Background. The use of standardized patients to teach medical and nursing students has been well studied in the realms of communication and physical exam skills. In addition, it is accepted by the adult learner as interactive, experiential, and involves immediate feedback. With more curricular time devoted to end-oflife care, we have found that simulation of the dying patient is a useful way to teach and evaluate learner skills. We present our novel, multidisciplinary experience with an end-of-life patient simulation using role-playing. Methods. We will demonstrate a standardized patient encounter of a patient with end-stage multiple myeloma on hospice, who presents to the emergency department with distressed family for uncontrolled symptoms. During the encounter, the patient (mechanical simulator controlled electronically in real time) declines further and dies. Faculty observe and assess core skills performed. Immediately afterwards, students, faculty, and standardized patients discuss feedback of performance and learners complete a written assessment. Scenarios vary among medical and nursing students based on core skills desired. Results. Twenty-four medical students and 93 nursing students have completed the encounter. The experience was reported to be beneficial in 100% of the encounters. Discussion. This experience has been well received by the learners and provides the faculty with a clear picture of knowledge gaps in communication, family support, and symptom management. It also provides a new forum for inter-professional collaboration. We plan to expand the encounter beginning in July 2012 to include all 120 year 4 medical students and the entire nursing school class. In addition, we will begin collecting pre- and post-encounter data about attitudes and knowledge in end-of-life care. This experience has been well received by the learners and provides the faculty with a clear picture of knowledge gaps in communication, family support, and symptom management. It also provides a new forum for inter-professional collaboration. Conclusion. The use of the standardized patient to teach and evaluate end-of-life skills is useful and appreciated. We will share our experience and outcomes in teaching each desired core skill and provide a visual example of this reproducible teaching tool.
Vol. 45 No. 2 February 2013
Teaching Self-Care and Preventing Burnout During HPM Fellowship Sarah Harrington, MD, University of Arkansas for Medical Sciences, Little Rock, AR. Robin Devan, MD, University of Arkansas for Medical Sciences, Little Rock, AR. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe a self-care ‘‘boot camp’’ didactic given during the first week of fellowship. 2. Integrate a self-care learning-centered module into the HPM curriculum that keeps track of all fellowship requirements (including Accreditation Council for Graduate Medical Education, institutional, and program) and recommended content, in order to monitor self-care longitudinally. 3. Discuss ways to prevent burnout during fellowship with practical curriculum-based examples. Background. A hospice and palliative medicine (HPM) fellowship is usually 12 months of intensive learning and exposure to a high volume of patients with serious illness and those at the end of life. Fellows also learn to care for families during times of stress and high emotion. They learn that being a palliative care clinician requires a great deal of physical, emotional, and spiritual investment. Along with learning the basics of pain and symptom management, prognostication, and end-of-life care, equally important is learning professionalism, personal and professional boundaries, and self-care. Teaching self-care and encouraging self-reflection can be a challenge for faculty. This educational intervention describes how we approach teaching self-care in our HPM fellowship. Methods. After 3 years of our HPM fellowship, we discovered that teaching self-care and making it a top priority was essential for our trainees and faculty. We have also learned from experience how to teach and prevent burn-out for fellows using a structured approach. Results. Two classes of fellows have completed the patient care and self-reflection module and given it positive feedback. Faculty have consistently given positive feedback for the structured self-care portion of the curriculum. Discussion. The integrated curriculum created a heightened awareness and a more open dialogue about self-care among the HPM faculty, fellows, and staff. At the end of this academic