Medical school expands teaching of palliative care

A program at the University of Pittsburgh targets third-year medical students, weaving end-of-life skills into clinical rotations.

By Myrle Croasdale — Posted Dec. 19, 2005

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Ryan Li routinely visited a patient with amyotrophic lateral sclerosis during his first year at the University of Pittsburgh School of Medicine. What he learned was invaluable.

"It gave me a dose of reality," said Li, now in his second year of medical school. "It was a real eye-opener for me to see how terminal illness affects everyday life. It inhibits you from doing so much, but I also saw how the patient and caregiver are still living and still have plenty to do."

Li is one of a limited number of medical students at the University of Pittsburgh who have elected to learn about end-of-life issues. But by the 2007-08 academic year, every third-year student in the medical school will get hands-on experience in palliative care. Armed with a $1.1 million four-year grant from the National Cancer Institute, the school is about to integrate technology, informational text and palliative care experts into clinical rotations. As far as the school is aware, this is the first initiative of its kind.

David Barnard, PhD, director of the university's Institute to Enhance Palliative Care, hopes the project will prove effective in changing the culture of medicine, which often focuses on finding cures while neglecting the dying. Third-year students will be the target group, but Dr. Barnard expects that the residents and attending physicians who work alongside the students will learn new end-of-life skills as well.

"We're still learning how to teach this well," Dr. Barnard said. "There are a lot of barriers to teaching about end-of-life care in hospitals. We've designed this particular project to swat as many of the barrier flies as we can."

Many physicians will welcome the training. A 1997 national survey of medical students, residents and faculty physicians found that almost all lacked confidence in their own abilities to provide end-of-life care. A 2000 survey of Michigan residency programs found that fewer than half offered formal end-of-life training. Among those that offered training, most programs didn't use published curricula on the topic. Also, few residencies offered specific clinical training, such as hospice care, according to the survey that family physician Karen Ogle, MD, conducted.

"This area has not been taught much, so physicians are understandably uncomfortable with it," said Dr. Ogle, a professor at Michigan State University. "Death feels like a failure, so we stay away from it."

Bedside learning

Dr. Barnard, along with James B. McGee, MD, head of the educational technology lab developing the tools for the University of Pittsburgh project, want to change this.

Their work will piggyback on the school's electronic system used to keep tabs on the variety of patients students see. When a student visits a patient, he or she enters information about the patient's condition into a log. If a student says that he or she has seen a patient with an advanced illness, a computer program is set to send the student background material on palliative care. A student will be able to reply with further questions, and the palliative care faculty will respond with supplementary material tailored to the situation.

The supervising resident and attending physician also will receive this information.

The next day, a palliative care faculty member will join the student's group on rounds to field questions or demonstrate relevant techniques.

"You can put lectures in the curriculum until you're blue in the face, but unless students see these issues brought up on rounds in the hospital, they'll not take it seriously," Dr. Barnard said.

Dr. McGee said that by relating the teaching to an actual case, the learner is more likely to recall and apply the information in the future. Under the current system, he said, there often is no physician experienced with end-of-life issues at rounds.

Dr. Barnard said it's important that residents and attendings are learning, because one of the barriers to getting end-of-life training to students is that practicing physicians often say they don't feel they're prepared to teach it.

"Once you give a clinician the techniques to use, they do tend to use them," Dr. Barnard said. "We're using the student as a good excuse to bring these topics up."

The big picture

While the initiative will expand palliative care training for the University of Pittsburgh's medical students, the leaders of the project intend to share the technology so that training in end-of-life care will improve nationwide.

For the University of Pittsburgh's medical school, the project will provide data to aid further fine-tuning.

"For the first time we'll know across the entire third year which of the end-of-life tasks students have been exposed to and which they haven't," Dr. Barnard said. "Our goal is to have a portrait of how much exposure we're actually giving our students over the year."

They also expect to uncover which clerkships give the most exposure and how often individual faculty are teaching it.

"This will help us to know if we're doing well or if the hidden curriculum is overwhelming all of our efforts," Dr. Barnard said.

This is all good news for Li, who would love to see all medical students experience how patients and their families cope with terminal illness.

"I came to medical school with my own firm beliefs about life and death," he said. "But it's very important to understand how patients accept death, and how they cope with it."

Back to top


End-of-life care

The University of Pittsburgh School of Medicine is gearing up to train all third-year students on how to care for patients who are facing death. A pilot version of the program will run in 2006-07. Through written material and with palliative care faculty members joining rounds, program leaders aim to teach the students, supervising residents and attending physicians who are involved how to:

  • Communicate bad news to patients.
  • Learn a patient's goals of care when a cure is no longer realistic.
  • Assess and treat common physical symptoms of advanced disease.
  • Recognize emotional, existential and spiritual distress in patients and their families.

Source: University of Pittsburgh's Institute to Enhance Palliative Care

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn