Getting Started

Although more and more medical schools are beginning to include training on End of Life care and general pain management, there is still a great variety in the quantity and quality of such curricula. Students can play an important role as catalysts for accelerating the enhancement of their education in these areas. In most medical schools, there are untapped and unrecognized resources. The best strategy is to capitalize on these existing but unconnected resources. The dean for curriculum obviously is an important ally to have. A good approach is to do a little legwork in identifying resources inside and outside of the medical school, then approach the dean with an idea and plan. After getting support, putting the plan into action should be easier.

Who are these resources? An obvious place to start would be a local hospice medical director. Investigate what hospices operate in your area. Get in touch with their medical directors. Some may already have volunteer faculty appointments at the school, or may actually be full-time faculty. Also find out who in the Oncology division has a particular interest in palliative care. Other departments, including Surgery, Family Medicine and Internal Medicine may have faculty involved in this kind of work. Surprisingly, faculty from different departments, with similar interests, often doesn't connect with one another.

You can often look outside the medical school, e.g. in the Nursing School and even the Law School for advocates and potential teachers.

Once you identify some interested faculty, what to do? Don't expect to have a full course or clerkship up and running in one year. Start to work on some small projects and obtain financial support. The Dean's office, once impressed with your work may offer a budget. The local AMSA chapter usually has a budget for interest groups and worthy activities. Following are some suggestions for activities to get you started.

Advertise this to your fellow students. Find out who is interested in learning about End of Life Care (It is in large part about just being a good doctor!). Organize lunch-time talks on various topics, e.g. communication/breaking bad news, ethical and legal issues about end of life care; cultural issues in EOL; physician assisted suicide, pain management; etc. Arrange for a Saturday morning meeting at a local hospice where students can interact with physicians, nurses, volunteers, etc. Arrange with the hospice medical director to have students (from any year) spend a day in the field with the physician, nurse, social worker, or chaplain. If you have a good relationship with a hospice medical director, you can have a senior elective arranged. Get the support for this from the hospice then take it to the curricular dean. As more students show an interest and the value of this curriculum becomes apparent to the faculty and administration, more formalized courses may be developed. Courses where this material can be incorporated include: Introduction to Clinical Medicine, any clinical clerkship, sub-internship and ambulatory medicine.

Useful resources are the American Medical Association's curriculum on Educating Physicians on End of Life Care (EPEC) and the American Academy of Hospice and Palliative Medicine. At this website you will find a member directory and many useful links. Good Luck!

Mike Stellini, M.D., M.S.

Chief, Section of Palliative Medicine

Wayne State University

5C University Health Center

4201 St. Antoine

Detroit, MI 48201

313/577-0166

mstellini@med.wayne.edu