21.1 (4.2) Teaching and training in palliative medicine

Question 1

Research suggests that what type of person is needed in order to successfully integrate PC teaching into a busy undergraduate curriculum

Answer 1

Champion

Question 2

The palliative education assessment tool recommended that seven domains are presented in undergraduate education on PC. What are those domains?

Answer 2

palliative care
perspective at EOL

pain
neuropsychological symptoms
other symptoms

patient/family/non-clinical caregiver 

clinical communication skills

ethics and the law

Question 3

In competency based education the objectives of training drive assessment and assessment drives learning. Based on that what five things should the objectives of training be?

Answer 3

specific
measurable
achievable
relevant
timely

SMART

Question 4

You are part of an undergraduate curriculum planning committee and are looking at ways to increase exposure to PC. List 3 ways that PC KNOWLEDGE can be transmitted

Answer 4

lectures
tutorials
group based discussion

Question 5

You are part of an undergraduate curriculum planning committee and are looking at ways to increase exposure to PC. List 3 ways that PC SKILLS can be transmitted

Answer 5

problem based learning
role play
goldfish bowl discussions
consultation with simulated patients
supported observed hospice visits
clincal attachments

Question 6

Not all physicians work closely with patients who face death and dying. However four basic skills are felt to be reasonable knowledge for all types of doctors. What are these skills?

Answer 6

• communication skills
• assessing a patient’s needs and preferences
• advance care planning
• symptom control

Question 7

Newly qualified doctors do not feel adequately trained to take over the care of patients with PC needs. What are 3-5 aspects of care that doctors do not feel comfortable with?

Answer 7

lack confidence in breaking bad news

empathizing

discussing prognosis

symptom control

managing distress and social issues

Question 8

What are the four steps to acquiring skills as laid out in Millar’s pyramid?

Answer 8

bottom -> top

Knows - MCQ
Knows how - matching questions
Shows how - OSCE, SIM
Does - multisource feedback

Question 9

What is the relationship between material covered on an examination and its perceived importance? What impact has this had on PC teaching?

Answer 9

tend to see areas not covered on examinations as less important

assessment of PC skills is critical in improving students and doctors attitudes towards and skills in PC

Question 10

You are part of a committee that is trying to determine if a new PC training program in undergraduate medical education was successful. The goal of the program was to reduce the number of pain crises that patients on a clinical teaching unit experience.

What are the four levels of assessment that can be reviewed

Answer 10

level 1 - learner’s reaction to teaching
level 2 - changes in knowledge attitudes skills the learner has acquired
level 3 - the degree to which the learner applies what they have learned to practice
level 4 - whether the desired outcomes occur because of the learning acquired at the learner or organizational level

Learner rxn -> knowledge -> application
Clinical changes

Question 11

What is the relationship between physician self assessment of communication skill and family perception of the quality of communication

Answer 11

the more confident the trainee the lower the family rating was

Question 12

What professional attitudes negatively impact the delivery of palliative care

Answer 12

seeing death as a failure
therapeutic nihilism in patients with cancer or other end stage disease
wishing to avoid dying patients
fears about opioids

Question 13

What ways can you change professional attitudes about palliative care

Answer 13

• increase knowledge
• role modeling
• facilitated discussion and reflection following clinical encounters