Palliative care in undergraduate medical education. Status report and future directions.
OBJECTIVE
To describe the status of palliative care education in the undergraduate medical curriculum and to offer recommendations for improvement.


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


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


METHODS
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.


RESULTS
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.
Billings
J A
JA
Palliative Care Service, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2698, USA. jbillings@hms.harvard.edu
Block
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D018864:Cultural Diversity; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000639:trends*; D036262:Empirical Research; D005544:Forecasting; D006699:Home Care Services; D006801:Humans; D010166:Palliative Care / Q000639:trends; D026684:Personal Autonomy; D012922:Social Change; D013727:Terminal Care / Q000639:trends; D014481:United States