Curriculum

Competency: Medical Knowledge

• Identify practical “emergencies” in end-of-life care and treatment options, including pain crises, hemorrhage, seizures, airway obstruction or severe dyspnea, acute delirium, superior vena cava obstruction, spinal cord compression, bone fractures, or other unrelieved symptoms
• Distinguish between emergency treatment in general medical care (where death is to be prevented), and emergency treatment in end-of-life care (where death is expected and inappropriate intervention could cause additional suffering)
• Discuss how to evaluate patient and family/caregiver desires for care during palliative care emergencies

Competency: Patient & Family Care

• Evaluate data related to end-of-life care in the U.S., including common cause of death, cost of care, and where people die
• Describe the normal grief reaction and bereavement process
• Identify/differentiate characteristics of a dysfunctional grieving process, including depression, anxiety, guilt, and substance abuse for family/caregivers

Competency: Medical Knowledge

• Describe natural history, including death, of various diseases, including pediatric conditions
• Understand the limitations of prognosticating on the basis of survival or length of life
• Propose additional potential outcomes of interest when prognosticating
• Distinguish between common tools used for prognostication and limitations of each tool

Competency: Medical Knowledge

Pain management

• Describe concept of “total” pain
• Understand how to assess pain
• Understand opioid pharmacologic options for pain management, including indications, clinical pharmacology, alternate routes, analgesic conversions, toxicities, and common side effects
• Understand non-opioid pain options including adjuvant medications (NSAIDs, steroids, antidepressants)
• Understand non-pharmacologic pain treatment modalities, including physical (physical therapy, massage, TENS, acupuncture) and psychosocial (relaxation, psychotherapy, peer support, counseling).

Non-pain symptom management

• Describe assessment methods and treatments for common physical symptoms of advanced disease: dyspnea, nausea and vomiting, constipation, diarrhea, cough, oral secretions, bladder dysfunction and anorexia
• Describe assessment and treatment of psychiatric symptoms associated with advanced disease: depression, anxiety, insomnia, and delirium

Competency: Medical Knowledge

• Review options and evidence base for nutrition and hydration in terminally ill, including artificial feeding and intravenous fluids
• Summarize physiological bases for withholding feeding and fluids
• Explain indications for antibiotics and risks of prescribing antibiotics for the terminally ill
• Model patient-centered communication to patients and families/caregivers regarding hydration, nutrition and antibiotics in end-of-life care

Competency: Professionalism

• Describe ethical and legal issues in palliative care and their clinical management
• Discuss ethical principles and frameworks for addressing clinical issues
• Understand when clinical ethicist consult is necessary
• Define common legal issues at end-of-life, include assessing a patient for capacity, advance directives, do-not-resuscitate (DNR) orders, durable power of attorney for healthcare, living will, physician orders for life-sustaining treatment (POLST) forms, withholding and withdrawing life support, pronouncement of death and completion of death certificate

Competency: Patient & Family Care

• Demonstrate how to incorporate a  psychosocial history and spiritual history into the assessment of a dying patient
• Recognize common social problems experienced by patients and families facing life-threatening conditions
• Recognize common experiences of distress around spiritual, religious and existential issues for patients and families facing life-threatening conditions
• Describe the role of hope, despair, and meaning in the context of severe and chronic illness
• Identify the indications for referral to other allied health professionals (social work, chaplains)

Competencies: Professionalism, Systems-Based Practice

• Describe the fundamental principles of patient safety and quality improvement.
• Discuss models for improving healthcare quality and be familiar with techniques to measure their efficacy.
• Appreciate how the culture of safety can impact quality improvement efforts.
• Become familiar with the mechanisms for detecting, reporting and learning from medical errors
• Discuss how to report an adverse event to a patient and their family/caregivers

Competency: Systems-Based Practice

• Understand relationship between hospice and palliative care
• Understand myths of hospice and Hospice Medicare Benefit
• Understand indications and eligibility guidelines for hospice care

Competencies: Interpersonal & Communication Skills, Systems-Based Practice

• Identify elements of care important for successful patient handoff
• Discuss patient safety issues related to handoffs and poor continuity of care
• Demonstrate how to perform a safe, effective, and complete handoff

Competencies: Practice-Based Learning & Improvement, Professionalism

• Describe characteristics of resilience
• Identify signs of physician burn-out and identify methods to prevent burn-out
• Discuss fatigue management and normal sleep requirements, the causes and signs of fatigue and its effects on human performance.

Competencies: Practice-Based Learning & Improvement, Professionalism

• Identify how to effectively manage resources
• Discuss how to gain a balance between professional goals and personal time

Competency: Interpersonal & Communication Skills

• Describe ideal behaviors of a consultant
• Distinguish between role of consultant and treating team
• Identify roles of interdisciplinary team members in the palliative care consult

Competencies: Patient & Family Care, Medical Knowledge, Interpersonal & Communication Skills

• Construct an appropriate comfort care plan for symptoms encountered by patients
• Recognize components of management for the syndrome of imminent death
• Identify common symptoms, signs, complications and variations in the normal dying process and describes their management
• Describe strategies to communicate with the patient and family about the dying process and to provide support

Competency: Practice-Based Learning & Improvement

• Define, describe and discuss principles of evidence-based medicine, including developing focused clinical questions and using electronic databases to locate quality information
• Define different statistical tests and terms commonly used in research
• Define challenges in conducting palliative care research
• Classify types of study designs
• Describe how to critically review literature

Competency: Interpersonal & Communication Skills

Patient-centered communication

• Recognize challenges in communicating effectively with dying patients and their families/caregivers
• Demonstrate how to use patient-centered communication to enhance the physician-patient relationship
• Communicate with team members and consulting providers in supportive fashion

Introduction to communication and teamwork for health-care professionals

• Describe the importance of inter-professional teamwork in palliative care and the characteristics of effective team players
• Review reasons for poor communication and teamwork in the current healthcare system
• Identify how poor communication can lead to adverse patient outcomes