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4. A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education.

Author

Reidy, Jennifer A., Chan, Stephanie H., Boelitz, Kris M., Chavez, Melissa, Clark, Melissa A., Epstein, Scott K., Gosline, Anna, Healy, Rose, Livne, Emma, Peirce, Hayden, Schaefer, Kristen G., Streid, Jocelyn, Vesel, Tamara, Young, Megan E., Zehm, April, and Garg, Priya S.

Subjects
EDUCATION of physicians, COLLEGE teachers, FAMILIES, CATASTROPHIC illness, UNDERGRADUATES, LEARNING strategies, MEDICAL schools, COMMUNICATION, RESEARCH funding, INTERPROFESSIONAL relations, CLINICAL competence, DESCRIPTIVE statistics, CURRICULUM planning, PATIENT care, MEDICAL education, EDUCATIONAL attainment
Abstract

Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. The Massachusetts Medical Schools' Collaborative was created to ensure that students receive foundational SIC training in undergraduate medical education. This Collaborative developed a curriculum-mapping tool to assess SIC at four medical schools. Objective: We aimed to understand existing educational activities across four medical schools and identify opportunities to build longitudinal, developmentally based curricular threads in SIC. Design: From July 2019 to April 2021, faculty, staff, and medical students assessed current educational activities related to five core competencies in SIC, adapted for students from national competencies for palliative medicine fellows, using a curriculum mapping tool. Measurements: The group selected 23 keywords and collected metrics to describe the timing, instruction and assessment for each school's educational activities. Results: On average, there were only 40 hours of required curricula in SIC over four years. Over 80% of relevant SIC hours occurred as elective experiences, mostly during the postclerkship phase, with limited capacity in these elective experiences. Only one school had SIC educational activities during the clerkship phase when students are developing clinical competencies. Assessment methods focused on student participation, and no school-assessed clinical performance in the clerkship or postclerkship phase. Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Development of Objectives to Inform a National Standardized Primary Palliative Care Curriculum for Health Professions Students

Author

Zehm, April, primary, Smith, Sherilyn, additional, Schaefer, Kristen G., additional, Jonas, Danielle, additional, Bullock, Karen, additional, Edwards, Rebecca L., additional, Reville, Barbara, additional, Jaramillo, Carolina, additional, Webb, Amy Carol, additional, Rydberg, Jonathan, additional, and Merel, Susan E., additional

Published
2023
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8. Specialty-Aligned Palliative Care: Responding to the Needs of a Tertiary Care Health System

Author

Gelfand, Samantha L., primary, Lakin, Joshua R., additional, Sciacca, Kate R., additional, Rivkin, Emily R., additional, Eves, Jessica C., additional, Anderson, Shelly, additional, Mandel, Ernest I., additional, Desai, Akshay S., additional, Jain, Nelia, additional, Landzberg, Michael J., additional, Lever, Natasha M., additional, Schaefer, Kristen G., additional, Leiter, Richard E., additional, and Tulsky, James A., additional

Published
2022
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9. Palliative Care

Author

Schaefer, Kristen G., primary, Abrahm, Janet L., additional, and Wolfe, Joanne, additional

Published
2018
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10. Contributors

Author

Abdel-Wahab, Omar, primary, Abrahm, Janet L., additional, Adams, Sharon, additional, Adewoye, Adeboye H., additional, Allen, Carl, additional, Ambinder, Richard F., additional, Anasetti, Claudio, additional, Anastasi, John, additional, Anderson, Julia A., additional, Antin, Joseph H., additional, Antony, Aśok C., additional, Araten, David J., additional, Armand, Philippe, additional, Armstrong, Gillian, additional, Armstrong, Scott A., additional, Arnold, Donald M., additional, Artz, Andrew S., additional, Awan, Farrukh T., additional, Baglin, Trevor P., additional, Benson, Don M., additional, Benz, Edward J., additional, Berliner, Nancy, additional, Bhagat, Govind, additional, Bhardwaj, Nina, additional, Bhatia, Ravi, additional, Bhatia, Smita, additional, Bhatt, Mihir D., additional, Bhatt, Vijaya Raj, additional, Bitan, Menachem, additional, Blinderman, Craig D., additional, Bollard, Catherine M., additional, Braun, Benjamin S., additional, Brenner, Malcolm K., additional, Brittenham, Gary M., additional, Brodsky, Robert A., additional, Brown, Myles, additional, Broxmeyer, Hal E., additional, Brummel-Ziedins, Kathleen, additional, Brunner, Andrew M., additional, Buadi, Francis K., additional, Burkhardt, Birgit, additional, Burns, Melissa, additional, Byrd, John C., additional, Caimi, Paolo F., additional, Caligiuri, Michael A., additional, Canavan, Michelle, additional, Cantor, Alan B., additional, Carcao, Manuel, additional, Carroll, Michael C., additional, Carty, Shannon A., additional, Castillo, Jorge J., additional, Chan, Anthony K.C., additional, Chapin, John, additional, Chiu, April, additional, Chute, John P., additional, Clark, David B., additional, Coates, Thomas D., additional, Cogle, Christopher R., additional, Connell, Nathan T., additional, Cooke, Elizabeth, additional, Cooley, Sarah, additional, Corradini, Paolo, additional, Creager, Mark A., additional, Creger, Richard J., additional, Cromwell, Caroline, additional, Crowther, Mark A., additional, Cushing, Melissa M., additional, Cutler, Corey, additional, Dang, Chi V., additional, Danial, Nika N., additional, Dave, Sandeep S., additional, DeCaprio, James A., additional, Dinauer, Mary C., additional, Dinner, Shira, additional, Diz-Küçükkaya, Reyhan, additional, Dodd, Roger Y., additional, Donato, Michele L., additional, Dorshkind, Kenneth, additional, Dotti, Gianpietro, additional, Dror, Yigal, additional, Dunleavy, Kieron, additional, Dvorak, Christopher C., additional, Ebert, Benjamin L., additional, Eck, Michael J., additional, Eikelboom, John W., additional, Epperla, Narendranath, additional, Ershler, William B., additional, Evans, William E., additional, Faderl, Stefan, additional, Ferrara, James L.M., additional, Filipovich, Alexandra Hult, additional, Fischer, Martin, additional, Fredenburgh, James C., additional, Friedman, Kenneth D., additional, Fuchs, Ephraim, additional, Fuller, Stephen J., additional, Gailani, David, additional, Galipeau, Jacques, additional, Gallagher, Patrick G., additional, Ganapathi, Karthik A., additional, Gardner, Lawrence B., additional, Gee, Adrian P., additional, Gerson, Stanton L., additional, Gertz, Morie A., additional, Giardina, Patricia J., additional, Gibson, Christopher J., additional, Golan, Karin, additional, Golub, Todd R., additional, Gonzales, Matthew J., additional, Gotlib, Jason, additional, Gottschalk, Stephen, additional, Grant, Marianne A., additional, Graubert, Timothy A., additional, Gregg, Xylina T., additional, Gribben, John G., additional, Gross, Dawn M., additional, Gruber, Tanja A., additional, Guitart, Joan, additional, Gurbuxani, Sandeep, additional, Gur-Cohen, Shiri, additional, Gutierrez, Alejandro, additional, Hamadani, Mehdi, additional, Hari, Parameswaran N., additional, Hartwig, John H., additional, Hayman, Suzanne R., additional, Hayward, Catherine P.M., additional, Hebbel, Robert P., additional, Heslop, Helen E., additional, Hillis, Christopher, additional, Hillyer, Christopher D., additional, Ho, Karin, additional, Hockenbery, David M., additional, Hoffman, Ronald, additional, Hogg, Kerstin E., additional, Holtan, Shernan G., additional, Horny, Hans-Peter, additional, Hsu, Yen-Michael S., additional, Hunter, Zachary R., additional, Huntington, James A., additional, Iancu-Rubin, Camelia, additional, Iqbal, Ali, additional, Isenman, David E., additional, Israels, Sara J., additional, Italiano, Joseph E., additional, Jaffe, Elaine S., additional, Jaffer, Iqbal H., additional, Jagannath, Sundar, additional, Jäger, Ulrich, additional, Jain, Nitin, additional, James, Paula, additional, Jeha, Sima, additional, Jordan, Michael B., additional, Josephson, Cassandra D., additional, Jung, Moonjung, additional, Kager, Leo, additional, Kambayashi, Taku, additional, Kanakry, Jennifer A., additional, Kantarjian, Hagop M., additional, Kaplan, Jason, additional, Karafin, Matthew S., additional, Karsan, Aly, additional, Kaufman, Randal J., additional, Kaufman, Richard M., additional, Keller, Frank G., additional, Kelly, Kara M., additional, Kessler, Craig M., additional, Key, Nigel S., additional, Keyzner, Alla, additional, Khandoga, Alexander G., additional, Khanna-Gupta, Arati, additional, Khatib-Massalha, Eman, additional, Klein, Harvey G., additional, Knoechel, Birgit, additional, Kollet, Orit, additional, Konkle, Barbara A., additional, Kontoyiannis, Dimitrios P., additional, Koreth, John, additional, Koretzky, Gary A., additional, Kotecha, Dipak, additional, Kremyanskaya, Marina, additional, Kumari, Anju, additional, Kuzel, Timothy M., additional, Küppers, Ralf, additional, Lacy, Martha Q., additional, Ladas, Elana, additional, Landier, Wendy, additional, Lapid, Kfir, additional, Lapidot, Tsvee, additional, Larson, Peter J., additional, Levi, Marcel, additional, Lewis, Russell E., additional, Liebman, Howard A., additional, Lillicrap, David, additional, Lim, Wendy, additional, Lin, Judith C., additional, Lindblad, Robert, additional, Lip, Gregory Y.H., additional, Little, Jane A., additional, Lohr, Jens G., additional, López, José A., additional, Luscinskas, Francis W., additional, Maciejewski, Jaroslaw P., additional, Majhail, Navneet S., additional, Manches, Olivier, additional, Mandle, Robert J., additional, Mann, Kenneth G., additional, Manno, Catherine S., additional, Marcogliese, Andrea N., additional, Mariani, Guglielmo, additional, Marincola, Francesco M., additional, Mascarenhas, John, additional, Massberg, Steffen, additional, McEver, Rodger P., additional, McGrath, Emer, additional, McKinney, Matthew S., additional, Mehta, Rohtesh S., additional, Mentzer, William C., additional, Merlini, Giampaolo, additional, Merryman, Reid, additional, Michel, Marc, additional, Migliaccio, Anna Rita, additional, Miller, Jeffrey S., additional, Mims, Martha P., additional, Mondoro, Traci Heath, additional, Moorehead, Paul, additional, Muniz, Luciana R., additional, Munshi, Nikhil C., additional, Najfeld, Vesna, additional, Nayak, Lalitha, additional, Nazy, Ishac, additional, Neff, Anne T., additional, Ness, Paul M., additional, Notarangelo, Luigi D., additional, O'Brien, Sarah H., additional, O'Connor, Owen A., additional, O'Donnell, Martin, additional, Olson, Amanda, additional, Orkin, Stuart H., additional, Pai, Menaka, additional, Pai, Sung-Yun, additional, Paidas, Michael, additional, Panch, Sandhya R., additional, Pande, Reena L., additional, Papayannopoulou, Thalia, additional, Parikh, Rahul, additional, Petersdorf, Effie W., additional, Peterson, Shane E., additional, Pittaluga, Stefania, additional, Ponce, Doris M., additional, Popolo, Laura, additional, Prchal, Josef T., additional, Pui, Ching-Hon, additional, Puigserver, Pere, additional, Rak, Janusz, additional, Ramos, Carlos A., additional, Rand, Jacob H., additional, Rand, Margaret L., additional, Rao, Dinesh S., additional, Ravandi, Farhad, additional, Rawlings, David J., additional, Reddy, Pavan, additional, Reding, Mark T., additional, Reiter, Andreas, additional, Rice, Lawrence, additional, Riese, Matthew J., additional, Ritchey, Arthur Kim, additional, Roberts, David J., additional, Roman, Elizabeth, additional, Rooney, Cliona M., additional, Rosen, Steven T., additional, Rosenthal, David S., additional, Rossmann, Marlies P., additional, Rot, Antal, additional, Rowley, Scott D., additional, Rubnitz, Jeffrey E., additional, Rydz, Natalia, additional, Salama, Mohamed E., additional, Sauk, Steven, additional, Saunthararajah, Yogen, additional, Savage, William, additional, Scadden, David, additional, Schaefer, Kristen G., additional, Schiffman, Fred, additional, Schneidewend, Robert, additional, Schrier, Stanley L., additional, Schuchman, Edward H., additional, Scullion, Bridget Fowler, additional, Selvaggi, Kathy J., additional, Senoo, Keitaro, additional, Shaheen, Montaser, additional, Shaz, Beth H., additional, Shelburne, Samuel A., additional, Shpall, Elizabeth J., additional, Shurin, Susan B., additional, Siegal, Deborah, additional, Silberstein, Leslie E., additional, Silberstein, Lev, additional, Silverstein, Roy L., additional, Sloan, Steven R., additional, Smith, Franklin O., additional, Smith, James W., additional, Smith, Katy, additional, Steensma, David P., additional, Steinberg, Martin H., additional, Stock, Wendy, additional, Storry, Jill R., additional, Stramer, Susan L., additional, Strauss, Ronald G., additional, Stroncek, David F., additional, Taylor, Justin, additional, Thota, Swapna, additional, Treon, Steven P., additional, Tulpule, Anil, additional, Valdes, Roberto Ferro, additional, Valent, Peter, additional, Vedantham, Suresh, additional, Vercellotti, Gregory M., additional, Verneris, Michael R., additional, Vichinsky, Elliott P., additional, von Andrian, Ulrich H., additional, Vose, Julie M., additional, Wagner, Andrew J., additional, Wang, Ena, additional, Wang, Jia-huai, additional, Warkentin, Theodore E., additional, Wasserstein, Melissa P., additional, Webster, Ann, additional, Weisdorf, Daniel J., additional, Weitz, Jeffrey I., additional, Westhoff, Connie M., additional, Wheeler, Allison P., additional, Widick, Page, additional, Wiley, James S., additional, William, Basem M., additional, Williams, David A., additional, Wilson, Wyndham H., additional, Wolfe, Joanne, additional, Wolgast, Lucia R., additional, Wood, Deborah, additional, Wu, Jennifer, additional, Yahalom, Joachim, additional, Yee, Donald L., additional, Younes, Anas, additional, Young, Neal S., additional, and Zeller, Michelle P., additional

Published
2018
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26. Left Ventricular Assist Device Withdrawal: Ethical, Psychological, and Logistical Challenges.

Author

Slavin, Samuel D., Allen, Larry A., McIlvennan, Colleen K., Desai, Akshay S., Schaefer, Kristen G., and Warraich, Haider J.

Subjects
HEART failure treatment, LEFT heart ventricle, TERMINAL care, MEDICAL device removal, HEART assist devices
Abstract

The article offers information on left ventricular assist device (LVAD) technology. Topics include considered that the element of this process is more visceral or immediate than the act of withdrawing LVAD support, particularly for a patient awake and interactive; and examines that the study deepens understanding of current LVAD withdrawal as highly variable and dynamic process with substantial implications for patients' care.

Published
2020
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28. Raising the Bar for the Care of Seriously Ill Patients

Author

Schaefer, Kristen G., primary, Chittenden, Eva H., additional, Sullivan, Amy M., additional, Periyakoil, Vyjeyanth S., additional, Morrison, Laura J., additional, Carey, Elise C., additional, Sanchez-Reilly, Sandra, additional, and Block, Susan D., additional

Published
2014
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33. Contributors

Author

Abrahm, Janet L., Abrams, Charles S., Abrams, Donald I., Ackerman, Steven J., Adams, Sharon, Adewoye, Adeboye H., Allen, Carl, Ambinder, Richard F., Anasetti, Claudio, Anastasi, John, Anderson, Julia A., Andreeff, Michael, Antin, Joseph H., Antony, Aśok C., Apostolakis, Stavros, Armstrong, Scott A., Arnold, Donald M., Artz, Andrew S., Awan, Farrukh T., Banchereau, Jacques, Barker, Juliet N., Baum, Linda G., Benson, Don M., Jr., Benz, Edward J., Jr., Berliner, Nancy, Bhagat, Govind, Bhalla, Kapil N., Bhardwaj, Nina, Bhatia, Ravi, Bhatia, Smita, Blinderman, Craig D., Bollard, Catherine M., Brenner, Malcolm K., Brittenham, Gary M., Brodsky, Robert A., Broxmeyer, Hal E., Brummel-Ziedins, Kathleen, Buadi, Francis K., Butterfield, Joseph H., Byrd, John C., Caimi, Paolo F., Caligiuri, Michael A., Campagnaro, Erica, Canaani, Jonathan, Canavan, Michelle, Cantor, Alan B., Carcao, Manuel, Carroll, Michael C., Carty, Shannon A., Champlin, Richard E., Chan, Anthony K.C., Choate, Jacquelyn D., Chung, Peter, Chute, John P., Cines, Douglas B., Clark, David B., Coates, Thomas D., Cogle, Christopher R., Connell, Nathan T., Cooke, Elizabeth, Cooley, Sarah, Corradini, Paolo, Creager, Mark A., Creger, Richard J., Cromwell, Caroline, Cunningham, Regina S., Cushing, Melissa M., Cutler, Corey, Dahl, Gary V., Dang, Chi V., Danial, Nika N., Dave, Sandeep S., DeAngelo, Daniel J., Desai, Madhav V., Dey, Bimalangshu R., Diehl, Volker, Dinauer, Mary C., Diz-Küçükkaya, Reyhan, Donato, Michele L., Dorshkind, Kenneth, Dotti, Gianpietro, Dror, Yigal, Dunleavy, Kieron, Ebert, Benjamin L., Eck, Michael J., Eichenauer, Dennis A., Eikelboom, John W., Engert, Andreas, Ershler, William B., Esmon, Charles T., Esmon, Naomi L., Evans, William E., Faderl, Stefan, Ferrara, James L.M., Filipovich, Alexandra Hult, Freedman, Melvin H., Fuller, Stephen J., Gailani, David, Gallagher, Patrick G., Gardner, Lawrence B., Gee, Adrian P., Gerson, Stanton L., Gertz, Morie A., Giardina, Patricia J., Golan, Karin, Golub, Todd R., Gottschalk, Stephen, Grant, Steven, Green, David L., Gribben, John G., Guitart, Joan, Gur-Cohen, Shiri, Gurbuxani, Sandeep, Gutierrez, Alejandro, Hari, Parameswaran, Harlan, John M., Hartwig, John H., Hayman, Suzanne R., Hayward, Catherine P.M., Hebbel, Robert P., Heslop, Helen E., Hillyer, Christopher D., Hockenbery, David M., Hoffman, Ronald, Horowitz, Mary, Horwitz, Edwin M., Hromas, Robert A., Huang, Franklin W., Isenman, David E., Italiano, Joseph E., Jr., Jaffe, Elaine S., Jagannath, Sundar, Jäger, Ulrich, Jain, Nitin, James, Paula, Jeha, Sima, Jordan, Michael B., Josephson, Cassandra, Jung, Moonjung, Kager, Leo, Kamdar, Kala Y., Kanakry, Jennifer A., Kantarjian, Hagop M., Karafin, Matthew S., Karsan, Aly, Katz, Louis M., Kaufman, Randal J., Kaufman, Richard M., Keller, Frank G., Kelly, Kara M., Kelton, John, Kessler, Craig M., Key, Nigel S., Khandoga, Alexander G., Khanna-Gupta, Arati, Klein, Harvey G., Kollet, Orit, Konkle, Barbara A., Kontoyiannis, Dimitrios P., Koreth, John, Koretzky, Gary A., Kremyanskaya, Marina, Küppers, Ralf, Kuzel, Timothy M., Kwak, Larry W., Lakshmanan, Viswanathan, Landier, Wendy, Lapid, Kfir, Lapidot, Tsvee, Larson, Peter J., Lechner, Klaus, Lee, Andrea, Lee, William M.F., Levi, Marcel, Lewis, Russell E., Liebman, Howard A., Lillicrap, David, Lim, Wendy, Lin, Thomas S., Lindblad, Robert, Lip, Gregory Y.H., Little, Jane A., Loh, Mignon L., Look, A. Thomas, López, José A., Luscinskas, Francis W., Macartney, Christine A., Maciejewski, Jaroslaw P., Maitta, Robert W., Majhail, Navneet S., Manches, Olivier, Mandle, Robert, Mann, Kenneth G., Manno, Catherine S., Marchi, Enrica, Mariani, Guglielmo, Marincola, Francesco M., Marks, Peter W., Mascarenhas, John, Massberg, Steffen, Mauch, Peter M., McCorkle, Ruth, McCrae, Keith R., McEver, Rodger P., McGrath, Emer, McKinney, Matthew S., Meacham, Amy, Menitove, Jay E., Merlini, Giampaolo, Migliaccio, Anna Rita, Miller, Jeffrey S., Mims, Martha P., Mondoro, Traci Heath, Moorehead, Paul, Munshi, Nikhil C., Najfeld, Vesna, Nazi, Ishac, Neff, Anne T., Ness, Paul M., Ng, Andrea K., Notarangelo, Luigi D., O'Brien, Sarah H., O'Connor, Owen A., Donghaile, Diarmaid Ó, O'Donnell, Martin, Otis, Stavroula, Ou, Zhishuo, Pai, Sung-Yun, Palucka, Karolina, Pande, Reena L., Papayannopoulou, Thalia, Pardanani, Animesh, Paredes, Nethnapha, Patriquin, Christopher, Petersdorf, Effie W., Pittaluga, Stefania, Plow, Edward F., Ponce, Doris M., Popolo, Laura, Powell, Leland D., Price, Elizabeth A., Pui, Ching-Hon, Puigserver, Pere, Quintás-Cardama, Alfonso, Rak, Janusz, Ramos, Carlos A., Rand, Jacob H., Ravandi, Farhad, Rawlings, David J., Reddy, Pavan, Reding, Mark T., Rhee, Charles, Rice, Lawrence, Riese, Matthew J., Ritchey, Arthur Kim, Rivella, Stefano, Roberts, David J., Romaguera, Jorge E., Roman, Elizabeth, Rooney, Cliona M., Rosen, Steven T., Rosenthal, David S., Rosovsky, Rachel, Rowley, Scott D., Rydz, Natalia, Sadler, J. Evan, Sandlund, John T., Jr., Sauk, Steven, Saunthararajah, Yogen, Scadden, David, Schaefer, Kristen G., Schiffman, Fred J., Schmaier, Alvin H., Schrier, Stanley L., Schuchman, Edward H., Scullion, Bridget Fowler, Selvaggi, Kathy J., Shaheen, Montaser, Shaz, Beth H., Sheehan, Andrea M., Shelburne, Samuel A., Shlomchik, Mark J., Shurin, Susan B., Silberstein, Leslie E., Silberstein, Lev, Silverstein, Roy L., Sloan, Steven R., Smith, Franklin O., Smith, James, Snyder, Edward L., Soff, Gerald A., Spitzer, Thomas R., Steinberg, Martin H., Stock, Wendy, Stone, Richard M., Storry, Jill R., Strauss, Ronald G., Stroncek, David F., Szczepiorkowski, Zbigniew M., Tiu, Ramon V., Toltl, Lisa J., Toms, Angela, Tormey, Christopher A., Treon, Steven P., Tulpule, Anil, Vedantham, Suresh, Verneris, Michael R., Vichinsky, Elliott P., von Andrian, Ulrich H., Wagner, Andrew J., Wang, Ena, Wang, Jia-huai, Wang, Michael, Warkentin, Theodore E., Wasserstein, Melissa P., Wei, Michael C., Weinstein, Howard J., Weisdorf, Daniel J., Weitz, Jeffrey I., Westhoff, Connie M., Wiley, James S., Williams, David A., Wilson, Wyndham H., Wolfe, Joanne, Wolgast, Lucia R., Wood, Deborah, Wu, YanYun, Yee, Donald L., Young, Ken H., Young, Neal S., Zeldenrust, Steven R., Zhang, Liang, and Zhou, Ming-Ming

Published
2013
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35. Promoting Student Wellness in Early Encounters with Seriously Ill and Dying Patients.

Author

Engel, Kirsten G., Byrne-Martelli, Sarah, Hayes, Barbara M., Goldhirsch, Jessica, Kowaleski, Jeff, Malecha, Patrick W., Schaefer, Kristen G., and Tolchin, Dorothy W.

Subjects
*STUDENT well-being, *CAREER development, *TEACHER development, *TERMINALLY ill, *SOCIAL workers, *INTERPROFESSIONAL education
Abstract

1. Participants will self-report an enhanced ability to describe preclinical medical and dental students' reactions to early observed encounters with seriously ill and dying patients. 2. Participants will self-report the ability to appraise and apply interprofessional approaches to supporting student wellness in the context of early clinical exposure. Preclinical medical and dental student responses to early observed clinical encounters with seriously ill and dying patients reveal opportunities for faculty to support student wellness. Interprofessional HPM clinician-educators utilize approaches involving validating, educating, and empowering learners following early experiences. Lessons learned from these approaches can inform faculty development around the lived student experience and strategies for proactively supporting student wellness. Previous work highlights the value of preclinical medical student exposure to the practice of hospice and palliative medicine (HPM) and indicates that students may experience strong or unanticipated emotion in early encounters with seriously ill or dying patients. To explore the nature of students' processing of early interactions with seriously ill patients and their families, as well as opportunities for HPM clinician-educators to support student wellness in the context of these experiences. In 2023, 167 first-year medical and dental students at a large urban medical school were assigned a written reflection following a half-day faculty-mentored HPM shadowing experience and debriefing session. An HPM clinician-educator (physician, nurse, social worker, or chaplain) provided a written response to each reflection. Qualitative analysis was utilized to identify themes arising from both student reflections and clinician-educator responses. 150/167 students (90%) submitted reflections; 150/150 reflections (100%) were provided written responses by an HPM clinician-educator. Three primary student content themes were revealed: 1) strong emotions related to witnessing difficult circumstances (e.g., uncontrolled symptoms; imminently dying patients; personally resonant situations), 2) acquisition of new HPM knowledge (e.g., palliative care is not reserved only for end of life), and 3) impact of the experience on anticipated future patient care (e.g., inspiration to build meaningful connections with patients). Primary faculty response themes included: 1) validation of emotion/strategies for self-care, 2) reinforcement of/expanded detail on HPM principles, and 3) sharing personal insights and opportunities for continued professional development. Students' written reflections suggest common themes in processing observations of clinical encounters with seriously ill and dying patients. HPM clinician-educators across professions shared an approach to supporting student wellness that involved validating, educating, and empowering. Lessons learned could inform faculty development around the lived student experience and opportunities to proactively support student wellness. Resilience / Well being / Interdisciplinary Teamwork / Professionalism [ABSTRACT FROM AUTHOR]

Published
2024
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36. Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial.

Author

O'Donnell AE, Schaefer KG, Stevenson LW, DeVoe K, Walsh K, Mehra MR, and Desai AS

Subjects
Aged, Female, Heart Failure psychology, Hospitalization, Humans, Male, Middle Aged, Patient Preference, Pilot Projects, Prognosis, Prospective Studies, Quality of Life, Heart Failure therapy, Palliative Care methods, Patient Care Planning, Social Work
Abstract

Importance: Palliative care considerations are typically introduced late in the disease trajectory of patients with advanced heart failure (HF), and access to specialty-level palliative care may be limited., Objective: To determine if early initiation of goals of care conversations by a palliative care-trained social worker would improve prognostic understanding, elicit advanced care preferences, and influence care plans for high-risk patients discharged after HF hospitalization., Design, Setting, and Participants: This prospective, randomized clinical trial of a social worker-led palliative care intervention vs usual care analyzed patients recently hospitalized for management of acute HF who had risk factors for poor prognosis. Analyses were conducted by intention to treat., Interventions: Key components of the social worker-led intervention included a structured evaluation of prognostic understanding, end-of-life preferences, symptom burden, and quality of life with routine review by a palliative care physician; communication of this information to treating clinicians; and longitudinal follow-up in the ambulatory setting., Main Outcomes and Measures: Percentage of patients with physician-level documentation of advanced care preferences and the degree of alignment between patient and cardiologist expectations of prognosis at 6 months., Results: The study population (N = 50) had a mean (SD) age of 72 (11) years and had a mean (SD) left ventricular ejection fraction of 0.33 (13). Of 50 patients, 41 (82%) had been hospitalized more than once for HF management within 12 months of enrollment. At enrollment, treating physicians anticipated death within a year for 32 patients (64%), but 42 patients (84%) predicted their life expectancy to be longer than 5 years. At 6 months, more patients in the intervention group than in the control group had physician-level documentation of advanced care preferences in the electronic health record (17 [65%] vs 8 [33%]; χ2 = 5.1; P = .02). Surviving patients allocated to intervention were also more likely to revise their baseline prognostic assessment in a direction consistent with the physician's assessment (15 [94%] vs 4 [26%]; χ2 = 14.7; P < .001). Among the 31 survivors at 6 months, there was no measured difference between groups in depression, anxiety, or quality-of-life scores., Conclusions and Relevance: Patients at high risk for mortality from HF frequently overestimate their life expectancy. Without an adverse impact on quality of life, prognostic understanding and patient-physician communication regarding goals of care may be enhanced by a focused, social worker-led palliative care intervention that begins in the hospital and continues in the outpatient setting., Trial Registration: clinicaltrials.gov Identifier: NCT02805712.

Published
2018
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