This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Status Report and Future Directions

J. Andrew Billings, MD; Susan Block, MD

JAMA. 1997;278(9):733-738.

Abstract
Objective.—
To describe the status of palliative care education in the under-graduate medical curriculum and to offer recommendations for improvement.

Data Sources.—
Review of literature on palliative care and of recently submitted grants on medical education for end-of-life care.

Study Selection.—
English-language reports of educational programs targeted toward medical students were examined, as well as surveys of medical schools.

Data Extraction.—
Studies were reviewed by the authors to assess the quality of the educational program, evaluation methodology, and conclusions. From over 9000 citations on palliative care and related topics that were retrieved from MEDLINE searches from 1980 through 1995, and from reviewing 14 palliative care journals published from 1985 through 1996, 310 articles were identified that addressed medical education for end-of-life care, and 180 were carefully examined.

Data Synthesis.—
While nearly all medical schools offer some formal teaching about end-of-life care, there is considerable evidence that current training is inadequate, most strikingly in the clinical years. Teaching about palliative care is received favorably by students, positively influences student attitudes, and enhances communication skills. However, curricular offerings are not well integrated; the major teaching format is the lecture; formal teaching is predominantly preclinical; clinical experiences are mostly elective; there is little attention to home care, hospice, and nursing home care; role models are few; and students are not encouraged to examine their personal reactions to these clinical experiences.

Conclusions.—
The increasing attention to palliative care education has created major opportunities for improving education about care at the end of life. Educational programs should be rigorously evaluated to identify best educational practices.

Author Affiliations
From the Palliative Care Service, Massachusetts General Hospital and Harvard Medical School (Dr Billings) and the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care and the Division of Psychiatry, Brigham & Women's Hospital (Dr Block), Boston, Mass.

Footnotes
Earlier versions of this article were presented at the 1995 Annual Meeting of the Association of Canadian Medical Colleges, Association of Canadian Teaching Hospitals, and Canadian Association for Medical Education, Quebec City, Quebec, May 2, 1995, sponsored in part by the Canadian Society of Palliative Care Physicians, and at the Project on Death in America Faculty Scholars' Retreat, Snoqualamie, Wash, July 9, 1995. A final, longer version was prepared, in part, for the National Consensus Conference on Medical Education for Care at the End of Life, May 16-17, 1997, sponsored by the Project on Death in America and the Robert Wood Johnson Foundation.

Reprints: J. Andrew Billings, MD, Palliative Care Service, Founders' House 600, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2698 (e-mail: jbillings@hms.harvard.edu).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

End-of-life Care: An Interdisciplinary Perspective
Viola et al.
AM J HOSP PALLIAT CARE 2009;26:75-78.
ABSTRACT  

Effectiveness of an Integrated Ward-based Program in Preparing Medical Students to Care for Patients at the End of Life
Ellman et al.
AM J HOSP PALLIAT CARE 2009;26:18-23.
ABSTRACT  

Palliative care education in Swiss undergraduate medical curricula: a case of too little, too early
Pereira et al.
Palliat Med 2008;22:730-735.
ABSTRACT  

No Relief in Sight: Postgraduate Training in Pain Management
Ogle et al.
AM J HOSP PALLIAT CARE 2008;25:292-297.
ABSTRACT  

Effect of end of life education on medical students' and health care workers' death attitude
Hegedus et al.
Palliat Med 2008;22:264-269.
ABSTRACT  

Pain Management in Hospitalized Cancer Patients: A Systematic Review
Goldberg and Morrison
JCO 2007;25:1792-1801.
ABSTRACT | FULL TEXT  

Evaluating an End-of-Life Curriculum in a Medical Residency Program
Yacht et al.
AM J HOSP PALLIAT CARE 2007;23:439-446.
ABSTRACT  

Impact of a postgraduate six-month rotation in palliative care on knowledge and attitudes of junior residents
Duong and Zulian
Palliat Med 2006;20:551-556.
ABSTRACT  

Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases: American College of Chest Physicians Position Statement
Selecky et al.
Chest 2005;128:3599-3610.
ABSTRACT | FULL TEXT  

Striving for Excellent End-of-Life Care
Hughes et al.
Chest 2005;128:465-466.
FULL TEXT  

Development and Testing of a New Instrument for Measuring Concerns about Dying in Health Care Providers
Mazor et al.
Assessment 2004;11:230-237.
ABSTRACT  

Patient-physician communication about end-of-life care for patients with severe COPD
Curtis et al.
Eur Respir J 2004;24:200-205.
ABSTRACT | FULL TEXT  

A palliative medicine program in a community setting: 12 points from the first 12 months
Cowan et al.
AM J HOSP PALLIAT CARE 2003;20:415-433.
ABSTRACT  

Meaning and Agency in Discussing End-of-Life Care: A Study of Elderly Veterans' Values and Interpretations
Young et al.
Qual Health Res 2003;13:1039-1062.
ABSTRACT  

End-of-life care education in United States pharmacy schools
Herndon et al.
AM J HOSP PALLIAT CARE 2003;20:340-344.
ABSTRACT  

A Good Death: Not Just an Abstract Concept
Gazelle
JCO 2003;21:95s-96.
FULL TEXT  

Antemortem care in an afternoon: A successful four-hour curriculum for third-year medical students
Jackson et al.
AM J HOSP PALLIAT CARE 2002;19:338-343.
ABSTRACT  

Palliative medicine in a United States cancer center: A prospective study
Cowan et al.
AM J HOSP PALLIAT CARE 2002;19:240-250.
ABSTRACT  

The Inner Life of Physicians and Care of the Seriously Ill
Meier et al.
JAMA 2001;286:3007-3014.
ABSTRACT | FULL TEXT  

End-of-Life Care Content in Textbooks
RABOW and McPHEE
Am. J. Psychiatry 2001;158:2090-2091.
FULL TEXT  

End-of-Life Literature
Rabow and McPhee
Chest 2001;120:1426-1427.
FULL TEXT  

End-of-Life Care
Rabow and McPhee
Pediatrics 2001;108:1051-1051.
FULL TEXT  

Promoting end-of-life content in cardiology and other textbooks
Rabow and McPhee
J Am Coll Cardiol 2001;38:921-921.
FULL TEXT  

Patients' Needs at the End of Life
Rabow and McPhee
JCO 2001;19:3585-3585.
FULL TEXT  

Pharmacy student training in United States hospices
Herndon et al.
AM J HOSP PALLIAT CARE 2001;18:181-186.
ABSTRACT  

Terminal Sedation, Self-Starvation, and Orchestrating the End of Life
Loewy
Arch Intern Med 2001;161:329-332.
FULL TEXT  

A Good Death: Not Just an Abstract Concept
Gazelle
JCO 2001;19:917-918.
FULL TEXT  

Professional education in end-of-life care: a US perspective
Aulino and Foley
JRSM 2001;94:472-476.
FULL TEXT  

Finding Our Way--Perspectives on Care at the Close of Life
McPhee et al.
JAMA 2000;284:2512-2513.
FULL TEXT  

Recent advances: Palliative care
Billings
BMJ 2000;321:555-558.
FULL TEXT  

The Market Pushes Education From Ward to Office, From Acute to Chronic Illness and Prevention: Will Case Method Teaching-Learning Change?
Stoeckle
Arch Intern Med 2000;160:273-280.
FULL TEXT  

End-of-Life Care Content in 50 Textbooks From Multiple Specialties
Rabow et al.
JAMA 2000;283:771-778.
ABSTRACT | FULL TEXT  

Changing Attitudes About End-of-Life Decision Making of Medical Students During Third-Year Clinical Clerkships
Hayes et al.
Psychosomatics 1999;40:205-211.
ABSTRACT | FULL TEXT  

A 44-Year-Old Woman With Severe Pain at the End of Life
Foley
JAMA 1999;281:1937-1945.
FULL TEXT  

End-of-Life Care in Medical Textbooks
Carron et al.
ANN INTERN MED 1999;130:82-86.
FULL TEXT  

Educational Needs Among Pediatricians Regarding Caring for Terminally Ill Children
Khaneja and Milrod
Arch Pediatr Adolesc Med 1998;152:909-914.
ABSTRACT | FULL TEXT  

Predominance of the Curative Model of Medical Care: A Residual Problem
Fox
JAMA 1997;278:761-763.
ABSTRACT