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Improving Palliative Care for Cancer
End-of-Life Care Education During Medical School and Residency Programs
The subject of “death and dying” first entered the medical school curriculum in the 1960s, as a topic of discussion in preclinical coursework. Movement toward integrating end-of-life and palliative care into the clinical curriculum has begun much more recently. In 1999, the Medical School Objectives Project identified “knowledge…of the major ethical dilemmas in medicine, particularly those that arise at the beginning and end of life…” and “knowledge about relieving pain and ameliorating the suffering of patients” as subjects that should be mastered by all undergraduate medical students (Medical School Objectives Writing Group, 1999).
Students in some programs may get the training and opportunities needed, but according to the most recent and most complete survey of medical school and residency end-of-life and palliative care curricula, most do not. Barzansky and colleagues (1999) used three annual surveys that collectively cover all medical school and residency programs to analyze end-of-life and palliative care content. Results for undergraduate medical education and residency programs are summarized separately.
Undergraduate Medical Education
Two surveys provide information on medical school curricula: the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaires for years 1997–1998 and 1998–1999, and the 1998 Association of American Medical Colleges (AAMC) Graduation Questionnaire. The LCME survey goes to the deans of all 125 LCME-accredited medical schools each year, and in the two years described here, all deans responded. The AAMC questionnaire went to all 14,040 students graduating from the 125 medical schools, of whom 88 percent responded.
The LCME survey asked different questions about end-of-life and palliative care in each of the two years. In 1997–1998, the question was whether selected topics related to end-of-life care were included in the curriculum as courses that were required, parts of required courses, electives, or a combination of these. In the second year, schools were asked (1) whether certain topics related to the care of terminally ill patients were covered in required lectures or conferences and (2) whether students spent time during required courses or clerkships in clinical units devoted to care of terminally ill patients. The 1998 AAMC survey asked students to rate the level of time devoted to end-of-life issues (among others) as either inadequate, appropriate, or excessive.
LCME SURVEYS At all schools, students have some exposure to end-of-life