Training the Workforce: Description of a Longitudinal Interdisciplinary Education and Mentoring Program in Palliative Care.

CONTEXT: The rapid increase in demand for palliative care (PC) services has led to concerns regarding workforce shortages and threats to the resiliency of PC teams. OBJECTIVES: To describe the development, implementation, and evaluation of a regional interdisciplinary training program in PC. METHODS: Thirty nurse and physician fellows representing 22 health systems across the Chicago region participated in a two-year PC training program. The curriculum was delivered through multiple conferences, self-directed e-learning, and individualized mentoring by expert local faculty (mentors). Fellows shadowed mentors' clinical practices and received guidance on designing, implementing, and evaluating a practice improvement project to address gaps in PC at their institutions. RESULTS: Enduring, interdisciplinary relationships were built at all levels across health care organizations. Fellows made significant increases in knowledge and self-reported confidence in adult and pediatric PC and program development skills and frequency performing these skills. Fellows and mentors reported high satisfaction with the educational program. CONCLUSION: This interdisciplinary PC training model addressed local workforce issues by increasing the number of clinicians capable of providing PC. Unique features include individualized longitudinal mentoring, interdisciplinary education, on-site project implementation, and local network building. Future research will address the impact of the addition of social work and chaplain trainees to the program.

The Evolution and Dissemination of the Education in Palliative and End-of-Life Care Program.

BACKGROUND: Even with growing numbers of fellowship-trained palliative care providers, primary palliative care knowledge and skills are needed to meet the national demands for palliative care. The Education in Palliative and End-of-Life Care (EPEC) Program has been one model of training clinicians in primary palliative care skills. In our second 5 years of development and dissemination, we have focused on adapting EPEC to different specialties. OBJECTIVE: Our aim was to describe the development of EPEC adaptations and document the dissemination of our curriculum. METHODS: The study design was a survey of EPEC trainers and documentation of other dissemination efforts via literature and Internet searches. Our subjects were all EPEC trainers and end-learners of our curriculum. We measured dissemination and teaching efforts by our trainers and evidence of EPEC use via literature and EPEC's searches. RESULTS: In Internet second 5 years of active development, teaching, and dissemination, we have created five major adaptations (EPEC-Oncology, EPEC-Oncology-Canada, EPEC-Emergency Medicine, EPEC-India, and EPEC for Veterans) and trained more than 1000 trainers. Through the efforts of these Trainers and our online dissemination, more than 74,000 reported end-learners have been taught parts of the EPEC curriculum. In addition, we discovered multiple medical school courses, continuing medical education (CME), courses and specialty guidelines that have incorporated material from EPEC. CONCLUSIONS: In its second 5 years, EPEC remains a robust platform for adaptation to new specialties and for dissemination of primary palliative care knowledge.

Evidence of improved knowledge and skills after an elective rotation in a hospice and palliative care program for internal medicine residents.

There is compelling evidence that residents training in primary care need education in palliative care. Evidence for effective curricula is needed. The objective of this study was to test whether a clinical elective improves measures of knowledge and skill. Residents from three categorical training programs in internal medicine were recruited to an elective including clinical experiences in an acute hospital palliative care consultation service, on an acute hospice and palliative care unit, and in-home hospice care. A 25-question pre- and post-test and a videotaped interview with a standardized patient were used to assess communication skills and measure outcomes. Residents demonstrated a 10 percent improvement in knowledge after the four-week elective (p < 0.05). All residents demonstrated basic competency in communication skills at the end of the rotation. These results indicate that clinical rotation shows promise as an educational intervention to improve palliative care knowledge and skills in primary care residents. An important limitation of the study is that it is an elective; further studies with a required rotation and/or a control group are needed to confirm the findings.