continuing education_dr sylvia

7/31/2019 Continuing Education_Dr Sylvia

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Continuing Education in

Palliative Care

Is enough

being done?

Dr Sylvia McCarthy

Hospis Malaysia


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Are we doing enough?

The answer is always no!

Enough for what?

What is the aim of CME?

To improve established clinical practice in palliative care

To increase access to palliative care

To ensure that all patients with life limiting illness can have an

palliative approach to management


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Do our working practices

foster CME?

Many physicans work in isolation

Participating in hospital based education

Nursing structures

Psychologists


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Push for palliative care

education

Part of curriculum requirement

Hospital accreditation programs


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Who needs the Education?

Ability to disseminate palliative care depends on enthusiastic

individuals often working alone with little support and

sometimes opposition

Education at an organisational level.

Support for the individuals


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Education Needs

Central information re availability of training education

Current resources

Who can teach?

What should we teach?

Who needs to know?

What do they know at the moment?


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Where are Patients receiving

palliative care?

At home carers

Nursing homes nursing staff and carers

General wards general medical training

Specialist Palliative Care Units


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Palliative care is about Quality

of Life Medical undergraduate teaching

Nursing basic diploma & degree courses

Nursing oncology post basic diploma

Nursing post basic palliative care

But

psychologists

Dieticians

Physiotherapists

Occupational therapists

Social workers


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Integrating palliative careeducation in current health

professionals training

Training for healthcareprofessionals who have had littleprior exposure to palliative care

CME


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Palliative Care as a component

of other disciplines

Most end of life care and decision making happens in general

hospitals and primary care.

Palliative care should be part of basic training both for all

health care professionals


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Interprofessional or by

discipline

Interprofessional education reflects the ethos of palliative care

ie a multidisciplinary approach.

But It may be more practical to teach within disciplines ie

make palliative care a component of already established

teaching curricula


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Interprofessional education

Physiotherapists

Occupational

therapists

Psychologists

Nurses

Doctors

Pharmacists

Holistic care requires

skills in many areas

Physical

Psychosocial Spiritual

Multi

disciplinary/multiskill

ed


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Conferences

Networking

Knowledge

Concepts Workshops

Knowledge

Skills

Attitudes

networking

Clinical attachments

skills

attitude

Distance learning Knowledge

reflection

E learning

Knowledge

reflection


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CME for those practicing

palliative care

Journal Club

Conference Attendance

local

regional

International

Involvement in research


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Whose responsibility is it to providepalliative care education/CME?

Universities

Ministry of Health

NGOs

Pharmaceutical companies


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At what level

Undergrad

Preclinical/clinical

If we concentrate on the ethical considerations and

understanding death and dying, students may fail to make the

connection with the need for good clinical skills and continue to

view palliative care as a soft option

postgrad


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Training the trainers

Is Palliative Care

education different?

Our effective is the

education we are

currently delivering?


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Need to be adaptive and creative

Challenging group dynamics

Enjoy working with patients

desperation based medicine more than evidence-basedmedicine.

Enjoyed watching the interaction between participants

Facilitators learn too.

Exhausting!


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What are we teaching?

Attitudes

Skills

Knowledge


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What do they need to know

Symptom assessment and management

Diagnosing dying

Prognostication

End of life care/planning

But

Communication

Imparting information

Emotional support

Ethical

Frameworks

When to intervene/act

Nursing skills

Care of a dying patient


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What do they already know

Hopeless

Depressed

Giving Emotional Support

Emotions

Quality of life

But

Clinical skills

Ethical frameworks

Communication skills


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How are we teaching?

Lectures

Workshops

Clinical attachments

Lecture cant address

attitudes and skills

Effective learning canonly occur in

conjunction with

clinical exposure


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Challenges for learners

Communication

Emotions

Talking about Death

Soft subject

Failure medicine


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Challenges for teachers

Balancing the need to provide clinical services with education

requirements

Clinical experiences without debriefing leave an emotional

void


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Financing CMEF

Who is paying for CME?

Pharmaceutical

companies

NGOs

Universities

Government

Who should be paying?


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Place of teaching

Community

Hospital based


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What Drives Our Learning?

I dont know what to do?

I have to learn it

I will get into trouble

I need CME points

Someone sent me


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Involving Patients and Family

in Teaching


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Using IT

E learning

Emails

Case based teaching


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Art and Palliative Care

Reading lists

Viewing recomendations


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Need to evaluate our education

programs

Knowledge

Satisfaction surveys

Ratings versus comments


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Where

Here or abroad


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Collaborations to Enhance

Education

Using foreign expertise

2 way process

Willingness to learn the cultural setting

Adapt teaching methods


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Quality or Quantity?

Do we want many participants learning a little bit

Or

A few well trained practitioners able to practice competently

and independantly?


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And So

We are doing quite a lot

It is never enough

Co ordination of palliative care education

Prioritising

Clear aims

Measuring outcomes

Pooling resources

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