coursework, but it is overwhelmingly in broader courses, not in required courses on end-of-life topics (Table 9-1). More than half the schools do not offer even one elective course devoted to end-of-life issues. The survey provides no information on how much time was spent on relevant topics or how they were covered but does suggest that there are substantial gaps. For instance, 30 percent of the schools appear to have no required instruction on at least one of the three topics asked about in 1997–1998. The 1998– 1999 survey also asked about direct experience with patients in hospice care (or other settings in which the focus was on end-of-life or palliative care) (Table 9-2). At 20 percent of the schools, such experience was required, and at another 20 percent, it was not available at all. No information was gathered on the percentage of students who took advantage of the elective opportunity offered in the remaining three-fifths of the schools.

AAMC MEDICAL SCHOOL GRADUATION QUESTIONNAIRE The AAMC annual survey asks graduating medical students to rate the adequacy of instruction in various areas. In 1998, they were asked about death and dying, and pain

TABLE 9-1 LCME Annual Medical School Questionnaire—Course Content (125 Schools=100%)

Type of Course

Required Course No. (%)

Some Material in Required Course No. (%)

Elective Course No. (%)

1997–1998 Survey

Death and dying

4 (3%)

121 (97%)

34 (27%)

Pain management

1 (1%)

105 (84%)

34 (27%)

Palliative care

1 (1%)

97 (78%)

24 (19%)

At least one of above 3

 

125 (100%)

 

None of above

 

 

69 (55%)

1 item only

 

15 (12%)

30 (24%)

2 items only

 

22 (18%)

17 (14%)

All 3 items

 

88 (70%)

9 (7%)

1998–1999 Survey

Symptom control

NR

96 (77%)

NR

Advance directives

NR

108 (86%)

NR

Communication with patients and families

NR

118 (94%)

NR

Ethical issues

NR

122 (98%)

NR

All 4 items

NR

90 (72%)

NR

NOTE: NR=not reported.

SOURCE: Barzansky et al., 1999.



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