Creating enduring change: demonstrating the long-term impact of a faculty development program in palliative care

Creating enduring change, both in clinician behavior and patient outcomes, is the overarching goal of continuing education in the health professions. Current methods of education and evaluation, however, often show disappointing results in achieving meaningful and lasting change among clinicians in practice.1,2 With some notable exceptions,3,4 continuing professional education programs tend to be limited in scope and method: most address narrowly defined clinical content, and most are delivered using noninteractive teaching methods that have been shown to lack effectiveness in generating learning and change.5–9 Evaluation methods also tend to be restricted in range, relying on satisfaction measures or single group, conventional pre- and postdesigns measuring short term and possibly transient outcomes, thus limiting generalizability and validity of the results.2,10–12 Improving professional education is of particular concern in the rapidly growing field of palliative care, where the need for leaders in clinical care and education far outweighs supply,13–15 and, except for full-time fellowship programs, there are relatively few educational experiences available for clinicians.3,16,17 Deficiencies in care for the dying have been well-documented,18,19 and national organizations have endorsed palliative care as a priority for training.20–29 This report describes an evaluation of the long-term impact of the Harvard Medical School Program in Palliative Care Education and Practice (PCEP), an intensive, learner-centered, interdisciplinary faculty development program that aims to build the field of palliative care by enhancing clinical expertise, pedagogic competencies, and organizational skills among a cadre of physician and nurse educators. The program is distinguished by its close integration of clinical and educational skills training, attention to the broad sweep of professional practice, including organizational change and professional development, and emphasis on affective, interactive, and relational dimensions of clinical work and teaching. In a study of short-term outcomes of PCEP, we found statistically significant improvements with large effect sizes in educational practice, attitudes, and self-reported preparation to provide and teach end-of-life care.30 Because the real merit of an educational program lies in its lasting impact on learners, we carried out a long-term follow-up of graduates, assessing preprogram, immediate postprogram, and long-term (6, 12, or 18 months) outcomes in: (1) palliative care teaching behaviors and attitudes; (2) clinical practice and self-assessed competencies; (3) palliative care program development and organizational change; and (4) professional development activities and attitudes related to palliative care.