Are We Making Progress? One Medical School’s Assessment of an Evolving Integrated Palliative Medicine Curriculum

摘要

Background: In 2002-2004, the University of New Mexico School of Medicine (UNMSOM) implemented an evolving four year integrated palliative medicine curriculum. Six assessment tools were used to assess the palliative medicine curriculum.Objective and design: This paper describes the assessment tools, findings and limitations associated with this evaluation process. We selected tools focused on students’ attitudes, self-confidence in palliative medicine, and perceptions of curriculum. Measurements: Cohorts of students from 2005-2009 completed three validated questionnaires: Concerns about Dying, Physicians’ End -of-Life Care Attitude Scale and Competencies, and Concerns in End-of-Life Care for Physician Trainees. Other measures used were to the UNMSOM Cross Cutting Themes Survey, Death Rounds Questionnaire and the AAMC Graduation Questionnaire. Results: The data demonstrates that after implementation of the curriculum, students rated themselves more competent (33% pre versus 60% post) in their end-of- life knowledge and skills and they held more positive attitudes towards interacting with dying patients. Over 85% of them suggest including more palliative medicine education. As the curriculum evolved, students reported being less anxious in communicating with patients and families at the end-of-life, and rated themselves as more able to perform ten end-of -life medical care skills higher. Conclusions: The UNMSOM assessment process of the curriculum implementation process focused on students’ enhanced self- efficacy and attitudes in palliative medicine. Used alone, the evaluation tools are helpful but observed skills and knowledge acquisition measures are recommended. Assessment of a palliative medicine curriculum needs to occur in conjunction with authentic clinical experiences Background In 2007, Palliative Medicine became a recognized medical subspecialty 1 and since 1996 has been a mandated curriculum for medical schools by many national accrediting organizations. 2-5 Systematic reviews of palliative medicine curricula in medical schools document diverse, non standardized formats. 6-9 Although more U.S. medical schools are incorporating palliative medicine curriculum, in 2007 American Association of Medical Education(AAMC) surveys showed 20-23 % of all graduating medical students reporting palliative medicine, pain management and end-of- life care training as inadequate. 10, In addition, assessment of palliative medicine curriculum is uneven or lacking. 8To support the above observation, in 2007, we conducted a PubMed(MEDLINE) MeSH search using the terms “End of Life Care” & “Hospice Care” & “Palliative Care” and “ Education “ for the dates of 2001-2006. Palliative medicine curriculum assessment tools and outcomes were noted in 35 articles. The strategies included: pre/post tests of knowledge, self assessed attitudes and skills and programmatic assessments; Multiple Choice Questions knowledge tests; personal reflections of student and physician mentors; student reflection papers; Objective Structured Clinical Examination (OSCE); and the author’s qualitative assessment. The palliative medicine curriculum and methods of assessment varied greatly and did not allow for comparisons across institutions.In 2002-2004, the University of New Mexico School of Medicine (UNMSOM) implemented an evolving four year integrated palliative medicine curriculum embracing the UNMSOM’s desired “Six Core Competencies” (based on American College of Graduate Medical Education (ACGME) competencies): (1) Medical Knowledge, Integration and Critical Reasoning, (2) Patient Care, (3) Interpersonal and Communications Skills, (4) Professionalism, (5) Ethics and Self Assessment, and (6) Community and Systems Based Practice. This paper will address the assessment tools, findings and limitations of this evaluation process.Integrated Palliative Medicine Educational Program At the UNMSOM, the four year curriculum is divided into three Phases. Phase I, the preclerks