University of Pittsburgh School of Medicine Receives NCI Grant for Palliative Care Curriculum
PITTSBURGH, July 2, 2001 — The University of Pittsburgh School of Medicine has received a $750,000 grant from the National Cancer Institute to integrate end-of-life issues into the school's curriculum so that medical students can better learn how to care for dying patients and their families.
Nearly 2.5 million Americans die each year, most of whom are 65 years of age or older. Research has shown that a large number of dying patients and their families suffer needlessly, both psychologically and physically, because physicians are not adequately trained to care for people near the end of life.
"We want to change not only the medical school curriculum but also the culture of medical education," said David Barnard, Ph.D., professor in the department of medicine, and director of Palliative Care Education, Center for Bioethics and Health Law. "Physicians find caring for dying patients stressful, and their own attitudes toward emotional or psychosocial aspects of such care contribute to their avoidance of these issues. Physicians often report feelings of sadness, helplessness, failure, disappointment and loneliness when dealing with end-of-life patients, and many times this has a negative affect on patient care."
"We recognize the challenge and responsibility of providing the same high-quality care to patients who are near the end of life as to patients whose conditions can be cured," said Arthur S. Levine, M.D., senior vice chancellor for the Health Sciences and dean of the University of Pittsburgh School of Medicine. "We have made a significant commitment to improving end-of-life care through support of the Palliative Care Service. This initiative gives us the opportunity to extend this commitment, thoroughly and systematically, to the educational domain."
According to Dr. Barnard, curriculum changes in the first two years of medical school can improve physician attitudes and knowledge related to end-of-life care, which will lead to greater acquisition of end-of-life skills and ultimately to improved patient and family outcomes.
The long-term goals of the new curriculum are: to increase students' exposure to the scientific and humanistic knowledge necessary for excellent end-of-life care, to develop and implement learning experiences that provide students with prolonged exposure to dying patients, and to increase the number of faculty who have completed programs to improve their skills in teaching end-of-life care to medical students.
"Physicians, patients and families often find it difficult to talk about preferences for treatment near the end of life and to respect those preferences," said Robert Arnold, M.D., the Leo H. Criep, M.D., Professor in Patient Care and director of the UPMC Comprehensive Palliative Care Program. "Historically, medical schools have not spent much time on the management of pain and other common symptoms at the end of life or attending to psychological, spiritual and existential concerns of patients. Our primary goal is a four-year medical school program in which each year makes the optimal, appropriate contribution to effective and compassionate care of patients near the end of life."
Curriculum changes will be phased in over a period of several years. A new course beginning in the fall of 2001 for first-year medical students will allow students to visit critically ill and dying patients in their homes over the course of an entire semester.
"With these in-home visits, students will learn directly from patients and their families what it is like to have a life-threatening illness, and it will help the students to develop skills in listening to patients about the impact of illness on life," Dr. Barnard said. Additional course material will be introduced into the required first- and second-year curricula beginning in the fall of 2002.
Dr. Barnard and Dr. Arnold are national leaders in palliative care education. Dr. Barnard co-chaired a national consensus conference on medical education for end-of-life care, the proceedings and publication of which set forth specific guidelines for curricular content as well as implementation strategy. He also has extensive experience with curriculum development as the former chair of the department of humanities at the Pennsylvania State University College of Medicine, one of the most respected medical humanities programs in the country.
He is the co-author of a book (Crossing Over: Narratives of Palliative Care, New York: Oxford University Press, 2000) that presents vivid ethnographic narratives of 20 families and their caregivers, going through the experiences of death, loss and bereavement in hospice or palliative care programs.
Dr. Arnold is a Project on Death in America faculty scholar and directs the nationally recognized Palliative Care Service at the University of Pittsburgh Medical Center (UPMC). He is currently responsible for organizing the national meeting of the American Society of Hospice and Palliative Medicine, the leading physician-membership palliative care organization in the United States. As the holder of the Dr. Leo H. Criep Chair in Patient Care, Dr. Arnold has a central role in the medical school's communication curriculum. He is currently on a steering committee to formulate an integrated four-year doctor-patient relationship curriculum.
The Palliative Care Service at UPMC was established in 1998 and provides comprehensive, coordinated services to terminally ill patients and their families. The service emphasizes relief from pain and other distressing symptoms, integration of physical, psychological and spiritual aspects of patient care, and development of a support system, both to help patients live as actively as possible until death and to help the family cope during the patient's illness and in bereavement.