September 08, 2004
Medical school deans see need for better training in end-of-life care
Amy Sullivan, EdD
Medical students in the United States generally don't receive adequate training in end-of-life care, and medical schools should take steps to incorporate such instruction into their curricula, according to a survey of medical school curriculum leaders conducted by Dana-Farber researchers.
The survey, whose results were published in the August issue of Academic Medicine, involved associate deans for medical education or curricular affairs at 62 accredited medical schools in the U.S. Eighty-four percent of the respondents agreed that end-of-life care education is "very important," and 67 percent indicated that their curricula currently do not devote enough time to it. Most of the deans favored integrating such instruction into existing courses or clerkships, rather than creating new courses.
"The results suggest that leaders in medical education strongly support programs to train students in caring for terminally ill patients, and believe that such programs should be incorporated into current courses," says Dana-Farber's Amy Sullivan, EdD, first author of the study. Co-authors were DFCI's Matthew Lakoma and senior author Susan Block, MD; Harvard Medical School students Anne Warren and David Hwang; and Massachusetts General Hospital psychiatry resident Karen Liaw, MD.
The new study follows a 2001 survey of students, residents, and faculty at medical schools around the country, which found that although students had a strong desire to learn about care for patients at the end of life, their coursework afforded them little opportunity to do so. Students felt that the prevailing medical culture wasn't supportive of education in end-of-life care, and that dying patients were not considered appropriate teaching cases.
To get a fuller picture of the issue, the current study queried associate deans for medical education or curricular affairs because they're apt to have the best handle on academic offerings and climate within their institutions, Sullivan notes. "Our hope was to gauge institutional and faculty attitudes about end-of-life care education and understand the obstacles to change, so that we could increase learning opportunities for students."
While it found that academic deans recognize the value of education in caring for terminally ill patients, the survey also revealed that the deans underestimate, by half, students' own interest in gaining these skills. The deans agreed that while current training programs in this area are inadequate, the key to improving them is faculty leadership and development efforts.
"A successful program requires that faculty from a variety of courses be prepared to teach end-of-life care within their disciplines," Sullivan remarks. "Our findings highlight the need to develop and support faculty leaders with a particular interest and expertise in this area to drive ongoing efforts for change."
