Kristen G Schaefer1, Eva H Chittenden, Amy M Sullivan, Vyjeyanth S Periyakoil, Laura J Morrison, Elise C Carey, Sandra Sanchez-Reilly, Susan D Block. 1. Dr. Schaefer is director of education, Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and instructor, Department of Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Chittenden is associate director and director of education, Palliative Care Division, Department of Medicine, Massachusetts General Hospital, and assistant professor, Department of Medicine, Harvard Medical School, Boston Massachusetts. Dr. Sullivan is director for research, The Academy at Harvard Medical School, director for education research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Periyakoil is director of palliative care education and training and director, Internet-based Successful Aging and End of Life (iSAGE) mini-fellowship, Stanford University School of Medicine, and associate director of palliative care services, Veterans Administration Palo Alto Health Care System, Palo Alto, California. Dr. Morrison is director of hospice and palliative medicine education and director, Hospice and Palliative Medicine Fellowship, Department of Medicine, Section of Geriatrics, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut. Dr. Carey is chair, Section of Palliative Medicine, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota. Dr. Sanchez-Reilly is associate director for education and evaluation, Geriatric Research, Education Clinical Center, South Texas Veterans Health Care System, and clinical associate professor of geriatrics and palliative care, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Dr. Block is chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, codirector, Harvard Medical School Center for Palliati
Abstract
PURPOSE: Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. METHOD: Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. RESULTS: The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. CONCLUSIONS: This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.
PURPOSE: Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. METHOD: Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains. RESULTS: The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains. CONCLUSIONS: This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.
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