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1-week required rotation in Palliative (EOL) care.


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1-week required rotation in Palliative (EOL) care . Frank A. Filipetto, DO and Lucia Beck Weiss, MS UMDNJ – SOM (Family Medicine). Janet M. Lieto, DO Samaritan Hospice. Educational Objectives / Participant Outcomes. We hope to identify for you:
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1-week required revolution in Palliative (EOL) care Frank A. Filipetto, DO and Lucia Beck Weiss, MS UMDNJ – SOM (Family Medicine) Janet M. Lieto, DO Samaritan Hospice

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Educational Objectives/Participant Outcomes We plan to recognize for you: palliative consideration turn segments and learner capabilities. the utilization of WebCT as a strategy for conveying and assessing educational modules. the advantages of recreated activities in upgrading relational abilities encompassing end-of-life issues. methodologies for joint effort with group and other social insurance suppliers and associations. turn results.

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Why an EOL Competency? Doctors: Are poor prognosticators 1 Delay establishment of palliative consideration 2 Prolong/empower vain consideration in view of undue good faith 3 1. Christakis et al, BMJ, 2000 2. Bolster Trial, JAMA 1995 3. Murphy et al, NEJM 1994

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Background Funded by HRSA (AAU) award One week required pivot inside Family Medicine clerkship year IV Follows or goes before a one week CPM revolution Variety of learning strategies Cultural and Interdisciplinary abilities Community assets (Hospice, memorial service homes)

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Palliative (EOL) Rotation Objectives Students on this clinical turn will have the capacity to: Define the ideas, objectives and destinations of Palliative Care Medicine. Comprehend the part of Hospice in conveying palliative consideration. Know how to oversee torment, heaving, dyspnea, emissions, unsettling, hiccoughs, misery and obstruction. Perceive prognostic signs and side effects of sicknesses requiring foundation of palliative consideration. Comprehend the importance of DNR/DNI, explanations behind DNI request and contrasting options to intubation, dangers and advantages of CPR, dangers and advantages of intubation, and how to talk about these issues with patients/relatives. Talk about end-of-life issues with patients and their families, quite Truth-Telling and Informed Consent. Comprehend Interdisciplinary Team Work (IDTW) statutes. Value the part of society on death and passing on. Access writing and Web-CT based assets to recover pertinent data about Palliative Medicine.

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Rotation Components Orientation On Line Pre/Post Test of Knowledge 15 WebCT modules/Fast Facts (EPERC)* Readings and composed task Home visits, Inpatient hospice, Interdisciplinary gatherings, Funeral Director Standardized Patient experiences On Line Final Exam and assessment *End of Life/Palliative Education Resource Center-Med. School of WI

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Faculty and Components 1 Week Palliative Care Rotation Web-CT Samaritan Hospice House and Funeral home visits Standardized Patient Encounters

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Schedule for Palliative Week Monday 8:00 AM Orientation and/or Pre-test Make Phone Calls to game plan Funeral Home Visits Afternoon – WebCT (must be checked on for Tuesday) Tuesday 9:00 AM Tuesday PM Samaritan Hospice In-patient Samaritan Hospice 5 Eves Drive, Virtua Memorial Hospital   Suite 300 175 Madison Avenue Marlton, NJ 08053 Mount Holly NJ, 08060 Wednesday Funeral Home Visit and finish composed task Web-CT, Readings and Assignments Thursday 8:30 am Home Visits with Dr. Herring (or option game plans) PM Funeral Home Visits; Web-CT; Complete "States of mind and Concepts of Death and Dying" Worksheet Friday 1:15 PM - Standardized Patient Cases

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On-Line Course

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Web-CT Development of online course Looked at existing assets EPERC – End of Life/Palliative Education Resource Center – Med. School of WI http://www.eperc.mcw.edu/Acquired educational programs including: 15 early on modules PowerPoint presentations Fast Facts Evaluation Instruments

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Overview-Dying-in-America   Hospice Breaking-Bad-News Family-Conference Culture-and-End-of-Life-Care Treatment-Goals DNR Artificial-Nutrition Depression Constipation Dyspnea-and Delirium Nausea-and-Vomiting Pain-Assessment Pain-Drug-Therapy Pain-or-Addiction Modules

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Let's Visit the Website www.umdnj.edu/webct

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Tracking Tools

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Instructor Tools

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Evaluation Instruments Pre-test - mean – 61.4 Post-test - mean – 75.6 46 thing instrument Final Exam – mean 84.9 32 addresses arbitrarily created by the PC from a bank of 80 things Student must score above 70% to pass revolution } 23% expansion

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Test Item Analysis A nitty gritty thing investigation uncovered: Items with high pre-test scores – 16 Items with huge change – 18 Items with low change – 12 Items requiring change concentrated on patient independence, basic leadership capacity, force of-lawyer, and propelled mandate. Things indicating huge change concentrated on torment administration and patient solace issues.

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Student Feedback – n=92 78 understudy demonstrated that the pivot met its expressed goals 79 understudies showed that the clinical experience is a viable approach to find out about this subject. 72 understudies showed that the on-line course is a powerful approach to introduce essential data about this theme. 79 understudies showed that the on-line course is easy to understand and simple to explore. 80 understudies demonstrated that the substance of this turn was fitting for my learning. 75 understudies showed that their own particular pre-revolution points of view on Chronic Pain and Palliative Care changed as a consequence of this pivot.

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Student Comments It's great that we had this pivot as a component of our educational modules since we most likely could never take in this again. You ought to give more opportunity for the end of the year test, I felt somewhat hurried thank you for sending us places where we were wanted...everywhere I went, individuals were lovely - this is an irregularity The WebCT bit of the course and our introduction to the pivot where exceptionally very much composed. Much thanks to you for your diligent work. Clinical involvement with the Hospice was incredible. I thought the visit to the Funeral homes were pointless. I truly loved the self-coordinated learning module for palliative consideration.

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Funeral Home Assignment

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Standardized Patient Encounters CASE OVERVIEW You are a family doctor going to see your patient of 5 years, Mr. Carl Wagner. You had been seeing him consistently or two for checkups. You last saw him 6 months back when he came in griping of a constant hack. A mid-section x-beam uncovered an extensive apical tumor, All treatment choices have been exhaused. He has been alluded back by his oncologist for treatment to keep him agreeable. He told the attendant he has expanding torment, which is keeping him up during the evening. CASE OVERVIEW You are the going to doctor for Lloyd Jones, a 65 year old man of his word whose needle biopsy today uncovered inoperable growth. Your inhabitant has officially addressed the girl, Gwen Jones, and advised her of her fathers' poor guess with and without treatment. Ms. Jones has asked for to see you ASAP, and you've heard that she is demanding that nobody educate her dad concerning his conclusion. You are going to see her in a little healing center gathering space to address her worries.

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Partnering with Samaritan Hospice

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Partnering with Samaritan Hospice What makes it work Regional pioneer and not-for-benefit 30,000 families served following 1980 Service for more than 30,000 families since 1980 Clinical initiative: full time DO, MD, APN Inpatient Unit housed in a doctor's facility Complementary Therapies

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Partnering with Samaritan Hospice What makes it work Samaritan Center for Grief Support Specialized projects Tender Hearts Jewish Hospice Catholic Ministry Veterans Outreach Wound Care Team Pediatric Palliative Care Transitions (PreHospice Program)

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Partnering with Samaritan Hospice What makes it work Institute for Education and Research Values Evidence Based Medicine >300 expert and group training program/year Patient Reported Outcomes Measures (PROM) in association with Hospice Pharmacia Passionate staff who affection to instruct

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Partnering with Samaritan Hospice Students Experience Interdisciplinary Team Meeting Physician Nurses (RN, LPN) Social laborer Chaplain Bereavement Complementary treatments

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Partnering with Samaritan Hospice Students Experience Debriefing Students After Team History of Hospice directions Hospice criteria Certification Physician's obligations' Hospice and subspecialties (THIS MEANS YOU!!!) Answer all inquiries

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Partnering with Samaritan Hospice Students Experience: Inpatient Unit Interdisciplinary Team Rounds Hands on patient assessments Spiritual and enthusiastic variables Family concerns Psychosocial elements

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Pain-Pain-Pain Dyspnea Nausea and spewing Constipation Delirium Hiccups Cachexia Seizures Anxiety Depression Muscle fits Insomnia Agitation Pain-Pain-Pain Samaritan Inpatient Unit Aggressive Symptom Management

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Samaritan Inpatient Unit Actively Dying Patients Signs and indications Management of patient Terminal fomentation Dealing with families Palliative sedation Caring for staff

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Questions Thank you!