Preparation for palliative care: teaching about death,dying and bereavement in UK medical schools 2000-2001

AIM: To examine changes in formal teaching about death, dying and bereavement in undergraduate medical education in UK medical schools. METHODS: A short questionnaire based on one used in 2 previous surveys in 1983 and 1994 was sent to all UK medical schools. FINDINGS: All schools with clinical teaching provided teaching in this area. The amount of such teaching varied widely and appeared in the curriculum in a variety of manners, times and places. Specialists in palliative medicine, general practitioners and nurse specialists were most frequently involved in teaching, with decreased involvement of non-practitioners since 1983. Most schools covered a wide range of topics, with all addressing attitudes towards death and dying and symptom relief in advanced terminal illness. Some schools used terminally ill patients directly in their teaching and most included hospice participation. As the surveys conducted in 1983 and 1994 indicated, many schools do not address the evaluation of palliative care learning. ANALYSIS: Changes in undergraduate medical education, especially in terms of more integrated curricula, mean that for many schools, palliative care teaching is integrated into learning in other areas. This should help students apply their palliative care learning to other contexts. The increase in teaching about the management of physical symptoms that has occurred since the previous surveys seems to reflect the establishment of palliative medicine as a speciality and the current emphases within palliative care practice in the UK. CONCLUSION: The preparation for palliative care work provided for current undergraduate medical students appears to be of a better quality than that provided in 1983.     

Undergraduate teaching in palliative care in Irish medical schools: a questionnaire survey

INTRODUCTION: The Association for Palliative Medicine of Great Britain and Ireland published an official curriculum for undergraduate teaching in 1993. This study was conducted in order to establish the current status of undergraduate teaching in this important discipline in Irish medical schools. METHODS: A questionnaire survey was sent to 26 individuals identified as having responsibility for palliative care teaching in the five Irish medical schools. The questionnaire asked about aspects of the curriculum covered, the years and setting in which teaching occurs, and the teaching and assessment methods used. RESULTS: Identification of the relevant teachers proved to be difficult; most appeared to be unaware of what teaching other than their own was occurring within their medical schools in this discipline. In no school is the teaching centrally co-ordinated. All five medical schools have specific time dedicated to the teaching of palliative care; in two cases this is one day or less. All schools covered most of the topics outlined in the curriculum. The majority of the teaching is by didactic lecture; there is some use of group discussion and case studies. Other teaching methods are rarely used. All schools have some teaching in the hospice setting. Four medical schools offer elective clinical rotations in palliative care; uptake of these by students is very poor. Assessment is usually as part of a written paper in medicine. CONCLUSIONS: The teaching of palliative care in Irish medical schools appears to fulfil the suggested curriculum. Co-ordination of this teaching should be improved.     

Teaching public health to medical students in the United Kingdom--are the General Medical Council's recommendations being implemented?

BACKGROUND: Despite frequent calls to improve undergraduate medical public health teaching, little is known about whether curricula have changed. We report a survey of undergraduate public health teaching in UK medical schools in 1996. The survey aimed to assess whether the General Medical Council's 1993 recommendations to strengthen undergraduate medical education in public health have been implemented. METHODS: We asked heads of academic departments of public health at all 26 UK medical schools to complete a questionnaire and provide supporting documentation for each undergraduate public health course or module. We compared results from the 1996 survey with those from a similar survey in 1992. RESULTS: Twenty-one out of 26 (81 per cent) medical schools responded. All responding medical schools included public health teaching within their curriculum. The median number of public health courses per medical school was unchanged since 1992. A wide variety of topics were taught. Core public health subjects were taught at most schools, though over a quarter of medical schools did not cover some core topics. Between 1992 and 1996 the proportion of time devoted to teaching by lectures decreased, whereas the following all increased: teaching by small group methods; the proportion of courses using methods of assessment encouraging active learning; and the contribution of public health courses to the final degree assessment. CONCLUSION: The findings suggest that many of the General Medical Council's recommendations for improving the delivery of undergraduate education are being addressed by public health teaching in UK medical schools. However, addressing the gaps in undergraduate public health teaching revealed in this survey is a continuing challenge for academic public health departments. Medical schools should review the content of their undergraduate public health teaching to ensure that tomorrow's doctors are adequately equipped with public health knowledge and skills.     

Teaching end-of-life issues: current status in United Kingdom and United States medical schools

Our objective was to determine how broadly end-of-life issues are represented in the undergraduate medical school curricula of the United Kingdom (UK) and the United States (US). Mailed surveys yielded response rates of 100 percent in the UK and 92 percent in the US. With one exception, all medical schools in the survey offered some exposure to dying, death, and bereavement and most addressed the topic of palliative care. Hospice involvement was found in 96 percent of UK medical schools but in only 50 percent of US schools. Overall, the UK appears to provide more exposure to end-of-life issues in medical schools, although the US appears to be moving in that direction.     

Education for palliative care: formal education about death, dying and bereavement in UK medical schools in 1983 and 1994

Between 1983 and 1994 the amount and variety of teaching about death, dying and bereavement in UK medical schools has grown considerably. Twenty-seven of the 28 UK medical schools now have some formal teaching in this area, and a number of schools have substantial programmes of teaching. A wider range of topics is now taught, with most schools providing formal teaching about physical therapy, teamwork and ethical issues in terminal/palliative care. A greater range of teachers are involved, presumably providing a wider range of perspectives and expertise. The influence of the hospice movement is particularly noticeable, with the majority of schools using their local hospice as a teaching resource. It seems that the General Medical Council's proposed 'new curriculum' for undergraduate medical education will result in a further expansion of teaching about palliative care in many schools. However, rigorous evaluation of the effectiveness of such teaching is largely absent.     

Undergraduate teaching of geriatric medicine in the United Kingdom: changes in the years 1981-1986

A follow-up survey of undergraduate teaching of geriatric medicine was carried out in 1986. All 27 clinical medical schools responded. Geriatric medicine is taught to all medical students in 25 and to only a proportion of students in two. Fifty-nine per cent of schools have academic departments teaching for a mean of 89 hours compared with 33 hours in non-academic departments--an overall mean of 68 hours. The subject is taught by various methods with 70% of teaching time spent on bedside clinical instruction. Other aspects of institutional and community care are often covered. The subject is examined in 18 schools. New academic departments are planned at four schools, and an increase in teaching time planned in five. To meet the needs of the population of the next century, reconsideration of curricula in some of the medical schools is recommended.     

Incorporating palliative care into undergraduate curricula: lessons for curriculum development

Context  It is well recognised that teaching about palliative care, death and dying should begin at undergraduate level. The General Medical Council in the UK has issued clear recommendations for core teaching on the relieving of pain and distress, and care for the terminally ill. However, whereas some medical schools have incorporated comprehensive teaching programmes, others provide very little. The reasons underpinning such variability are unknown.
Objectives  The aim of this study was to explore the factors that help or hinder the incorporation of palliative care teaching at undergraduate level in the UK.
Methods  Semi-structured interviews were carried out with a purposive sample of coordinators of palliative care teaching in 14 medical schools in the UK. Transcribed interviews were analysed using principles of grounded theory and respondent validation.
Results  There are several factors promoting or inhibiting palliative care teaching at undergraduate level that are common to the development of teaching about any specialty. However, this study also revealed several factors that are distinctive to palliative care. Emergent themes were 'need for an individual lead or champion', 'the curriculum', 'patient characteristics and exposure', 'local colleagues and set-up of service', 'university support' and 'the influence of students'.
Conclusions  The incorporation of palliative care into the medical undergraduate curriculum involves a complex process of individual, institutional, clinical, patient and curricular factors. These new findings could help medical schools to incorporate or improve such teaching.     

Undergraduate medical education accreditation as a driver of lifelong learning

We describe the accreditation of medical education programs that lead to the Doctor of Medicine degree in the United States and Canada. We identify select accreditation standards that relate directly to the preparation of medical school graduates, as required for the supervised practice of medicine in residency training and for developing the skills of self-directed, independent learning. With standards that promote flexibility and encourage innovation, the Liaison Committee on Medical Education utilizes a continuous improvement model for the accreditation of undergraduate medical education with standards that promote flexibility and encourage innovation. The standards focus on curricula to meet learning objectives that address the current context of medical care. In undergraduate and graduate medical education, the relevance of the hospital as the predominant learning environment is challenged; in continuing medical education, traditional lectures are called into question for failing to change physician behavior and improve health care outcomes. To improve medical education from undergraduate through continuing medical education, all the relevant accrediting agencies must collaborate for success.     

UK consensus statement on the content of communication curricula in undergraduate medical education

Context The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world. Objectives This paper is intended to assist curriculum planners in the design, implementation and review of medical communication curricula. The document will also be useful in the education of other health care professionals. Designed for undergraduate education, the consensus statement also provides a baseline for further professional development. Methods The consensus statement, based on strong theoretical and research evidence, was developed by an iterative process of discussion between communication skills leads from all 33 UK medical schools conducted under the auspices of the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education. Discussion How this framework is used will inevitably be at the discretion of each medical school and its implementation will be determined by different course designs. Although we believe students should be exposed to all the areas described, it would be impractical to set inflexible competency levels as these may be attained at different stages which are highly school‐dependent. However, the framework will enable all schools to consider where different elements are addressed, where gaps exist and how to generate novel combinations of domains within the communication curriculum. It is hoped that this consensus statement will support the development and integration of teaching, learning and assessment of clinical communication.     

Current status of teaching on spirituality in UK medical schools

OBJECTIVE: To investigate the current status of teaching on spirituality in medicine in UK medical schools and to establish if and how medical schools are preparing future doctors to identify patients' spiritual needs. METHODS: We carried out a national questionnaire survey using a 2-part questionnaire. Section A contained questions relating to the quantity of teaching on spirituality and the topics covered. Section B contained questions relating to teaching on alternative health practices. Medical educators from each of the 32 medical schools in the UK were invited to participate. RESULTS: A response rate of 53% (n = 17) was achieved. A total of 59% (n = 10) of respondents stated that there is teaching on spirituality in medicine in their curricula. On extrapolation, at least 31% and a maximum of 78% of UK medical schools currently provide some form of teaching on spirituality. Of the respondents that teach spirituality, 50% (n = 5) stated that their schools include compulsory teaching on spirituality in medicine, 80% (n = 8) include optional components, and 88% stated that teaching on complementary and alternative medicine is included in the curriculum. CONCLUSIONS: Although 59% (n = 10) of respondent medical schools (the actual UK figure lies between 31% and 78%) currently provide some form of teaching on spirituality, there is significant room for improvement. There is little uniformity between medical schools with regard to content, form, amount or type of staff member delivering the teaching. It would be beneficial to introduce a standardised curriculum on spirituality across all UK medical schools.     

Review of ethics curricula in undergraduate medical education

Medical ethics education, it has been said, has 'come of age' in recent years in terms of its formal inclusion in undergraduate medical curricula. This review article examines the background to its inclusion in undergraduate curricula and goes on to examine the consensus that has arisen on the design of ethics curricula, using Harden's curriculum and S.P.I.C.E.S models as templates. While there is consensus on content for undergraduate medical ethics education, there is still significant debate on learning and teaching methods. Despite the broad agreement on the need to apply adult education principles to ethics teaching, there would appear to be some tension between balancing the need for experiential learning and achieving the 'core curriculum'. There are also as yet unresolved difficulties with regards to resources for delivery, academic expertise, curriculum integration and consolidation of learning. Assessment methods also remain contentious. Although there is consensus that the ultimate goal of medical ethics, and indeed of medical education as a whole, is to create 'good doctors', the influence of the 'hidden curriculum' on students' development is only beginning to be recognized, and strategies to counteract its effects are in their infancy. The need for proper evaluation studies is recognized. It is suggested that the areas of debate appearing in the literature could be used as a starting point for evaluation studies, which would form the empirical basis of future curriculum development.     

Undergraduate public health education in UK medical schools - struggling to deliver

INTRODUCTION: Recent policy initiatives in the United Kingdom (UK) have underlined the importance of public health education for health care professionals. We aimed to describe teaching inputs to medical undergraduate curricula, to identify perceived challenges in the delivery of public health teaching and strategies that may overcome them. METHODS: We undertook a cross-sectional survey; questionnaires were sent electronically to 28 teaching leads in academic departments of public health in UK medical schools. These were followed-up by telephone interviews. RESULTS: We obtained a 75% response rate. We found a great deal of variability between schools in teaching methods, curricular content and resources used. In 76% of medical schools, public health and clinical teaching were integrated to some extent. The proportion of teaching delivered as lectures is decreasing and that of self-directed learning is increasing. A range of methods is used to assess students and in 33% of schools these assessments contributed to final Medical School marks. More than half the medical schools had difficulty finding teachers and staffing levels had deteriorated in 55% of schools. Many interviewees felt that their contributions were undervalued. Few were aware of the level of funding received to support teaching. DISCUSSION: There is a need to increase the supply of well-trained and motivated teachers and combine the best traditional teaching methods with more innovative, problem-based approaches. Faculties need to share 'learning about what works' and teaching resources across medical schools as well as addressing a culture of neglect of teaching in some departments. Suggestions are made as to how undergraduate public health teaching can be strengthened.     

The philosophy of palliative medicine: a challenge for medical education

The hospice movement has admirably improved management of the dying under its care. However, the majority of medical care of the terminally and chronically ill remains in the hands of practitioners outside hospices and is often open to criticism. This paper reviews the philosophy and practice of palliative medicine from the perspective of general practice and the shortcomings of present medical education in this area. Proposals are made for a radical shift in medical undergraduate teaching through an organized interdepartmental contribution by enthusiastic teachers to all years in training.     

Accreditation of medical laboratories

In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the official acceptance of ISO 15189 the clauses of this harmonized guideline fulfill the requirements of the new international standard as well. Accreditation of medical laboratories in Hungary may not only facilitate quality improvement of laboratory services, but also the development of a quality-based purchasing and reimbursement policy of the health insurance fund.     

Introducing complementary medicine into the medical curriculum.

We surveyed the deans of British medical schools to determine the provision of complementary medicine in the undergraduate curriculum. We also sampled medical students at one British medical school to determine their knowledge of, and views on instruction in, complementary medicine. There is little education in complementary medicine at British medical schools, but it is an area of active curriculum development. Students' levels of knowledge vary widely between different therapies. Most medical students would like to learn about acupuncture, hypnosis, homoeopathy and osteopathy. We conclude that complementary medicine should be included in the medical undergraduate curriculum. This could be done without a great increase in teaching of facts, and could serve as a vehicle to introduce broader issues, as recommended by the General Medical Council.     

Current perspectives on medical education in China

CONTEXT: China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs. OBJECTIVES: The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine. METHODS: It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3-8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools. DISCUSSION: Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured.     

Family planning training in medical schools

In order to gather information of the extent and quality of family planning training in medical schools throughout Europe and the Near East, the IPPF Central Medical Committee circulated questionnaires to the deans of all medical schools in that area. Only 45% of the schools responded, and the responses were not representative of the whole region since, while most of the schools in same countries did respond, only a very small percentage of schools in other countries did. Anatomy and physiology of reproduction were included in the curricula of 93% of the schools; public health and population studies were taught by 66% of the schools; 54% of the respondents included in their curricula the motivational and socioeconomic aspects of family planning; contraceptive techniques were taught in 87% of the schools. Similar studies are being carried out in other regions of the IPPF.     

Recommendations for undergraduate medical electives: a UK consensus statement

Introduction

Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council (MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well‐being) are usually different from those associated with ‘home’ clinical placements.

Aim

The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe.

Method

This paper reports the results of the formation of a sub‐group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools.

Recommendations

The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre‐departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease.

Conclusion

We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally.