in the medical curriculum. This committee acknowledges the pressures on educators to add a long list of new topics—ranging from attention-deficit and hyperactivity disorder to the ethics of genetic screening—to an already crowded curriculum. It believes, however, that strengthening education in end-of-life care will not impose an undue burden. As argued by an earlier group (IOM, 1997, p. 212):

First, palliative care is not a special interest issue; its principles of whole-patient care and teamwork provide a model for many other areas. Second, curriculum change need not be just an expensive addition but can also be an enrichment of established educational content and formats. Third, the use of existing program models and sharing of information can reduce the curriculum development burden on any single school. Fourth, the need to look beyond the hospital setting for educational opportunities is not unique to end-of-life care, but can be considered as part of a more general effort to develop non-hospital arrangements for improved training in primary care, chronic care, and outpatient care.

Moreover, many of the concepts, principles, and research findings that guide education for professionals who care for adults are broadly relevant to the education of those who care for children and their families. Some adaptations in educational goals and content will, however, be necessary to reflect the special needs of infants, children, and adolescents with life-threatening illnesses. For example, education in pain assessment, prevention, and management will have to consider the particular challenges of assessing symptoms in infants and preverbal children and in prescribing analgesic medications given the frequent lack of research-based information on doses for children at different developmental stages.

The development of a group of specialists in pediatric palliative care clearly has begun, often with support from the larger group of palliative care specialists who focus on adult care. These pediatric palliative care specialists are already helping to focus the attention of other clinicians, educators, professional societies, research funders, managers, and policymakers on strengthening educational and organizational resources for pediatric palliative care and enlarging the scientific foundation for that care. Consistent with the 1997 IOM report, this committee strongly supports the continued evolution of palliative care “as a defined and accepted area of teaching, research, and patient care expertise” (IOM, 1997, p.227).

At any level, professional competence has intellectual, interpersonal, and moral elements (Papadatou, 1997; Epstein and Hundert, 2002). It evolves as a professional accumulates training and experience and develops the capacity to integrate knowledge and awareness gained in varied clinical, organizational, and social contexts. Box 9.1 lists a set of basic competencies in four areas: (1) scientific and clinical knowledge; (2) interpersonal and other skills; (3) ethical and professional principles of care; and (4) organiza-



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