palliative care skills

2°Expert skills

Palliative CareConsultants /

Teams

Palliative Care Skills...

Palliative Medicine Specialists • 2006 ABMS recognized subspecialty

10 of the 24 parent boards• 12 month US fellowship, > 71 graduates

Class of 2011 - 2012

2006 – Palliative Medicine Recognized as Subspecialty by American Board

of Medical Specialties

1. 1 year Fellowship orExperiential qualification( 2006 – 2013 only)

Oversight: American Committee Graduate Medical EducationAccreditation: American Academy of Family Practice

2. Certification examMultiple choiceABIM: American

Board of Internal Medicine

Internal Medicine

Family Medicine Anesthesiology

PediatricsSurgery

Emergency Medicine

OB / GYN

Physical Medicine & RehabRadiology (XRT)

Psychiatry & Neurology

10 Sponsoring Specialties

Hospice and

Palliative Medicine

Next Steps• Clinical

CompetenciesOutcomes

• Teaching skillsPresentationFacilitationBedside mentorship

• Leadership skills• Research project

360° Evaluation1. Patient and family care2. Medical knowledge3. Practice-based learning and

improvement4. Communication and interpersonal

skills related to process of providing care

5. Professionalism6. System based practice

IPM US Fellows Employment

7 San Diego10 Los Angeles

1 Hawaii1 New Zealand

Internal Medicine

Family Medicine Anesthesiology

PediatricsSurgery

Emergency Medicine

OB / GYN

Physical Medicine & RehabRadiology (XRT)

Psychiatry & Neurology

10 Sponsoring Specialties

Hospice and

Palliative Medicine

Palliative Medicine Fellowship… Developing Clinical Capacity

Hypothesis

Training palliative medicine specialists will advance

palliative care delivery and increase opioid consumption

Int’l Palliative Medicine Fellowship• Over 24 - 36 months

4 – 6 months at San Diego Hospice2 visit by IPM

Faculty in-countryCompetency-based Practical bedside

mentorship, not observership

International Fellows

Pilot: 11 Int’l Fellow Graduates• Demonstrated competencies to IPM faculty

All recognized as consultants 3 Jordan2 Georgia2 Mongolia1 Slovenia1 Spain2 Vietnam

King Hussein Cancer Center Jordan

• 2 fellow graduates consultants

King Hussein Cancer Center Jordan• Built palliative care program

2 palliative medicine consultants> 50 staff10-bed inpatient

unit ( of 140 beds )

Inpatient consultsAmbulatory

outpatient clinicsHomecareSaw > 2,000 patients in 5 years

( since October 2004 )

KHCCPallCareGrowth

280 335407

47828

813

41

0

100

200

300

400

500

600

2005 2006 2007 2008

Consultaion

Referral

178 171 126 186

99 129 16919923 31 75

82

812

50

52

0

100

200

300

400

500

600

2005 2006 2007 2008

6Month-1Year3Month-6Month3Week - 3Month1 Day-3 Week

New Patients

Length of Stay

KHCC Outpatient Opioid Consumption

2004 - 2.7 kg 2006 - 5.3 kg 2008 - 6.2 kg

Jordan OpioidConsumption

INCB 1980-2008 Morphine Use

in Jordan ( mg / capita )

≈ 11.8 kg4x

≈ 2.9 kg

Urska LunderLjubljana, Slovenia

• Medical Director, Palliative Care, Golnik Hospital19 bed unit, consultation service,

home care• MoH Pilot Pathway Project - 3 regions• Teaching extensively

Faculty European School of Oncology• European Union Research on EOL• IPM Leadership Development Initiative

Gantuya TserendorjUlaanbaatar, Mongolia

• Medical Director, Palliative Care, National Cancer Center16 bed unit, consultation service,

outpatient clinics• MoH agreed to pay for PC services• Teaching regularly across Mongolia• Member Board of Directors new

Foundation of First Lady of Mongolia dedicated to vaccination & palliative care

Mongolia June 2009

Reach of 11 FellowsDirect: If each cares / influences care

of 1,000 pts / yr, for 30 yr

Patients LivesEach Touched

11 Fellows 30,000 330,000 + families

Indirect: Teaching, research, advocacy

Next Step Expanded international pilot project

NCI R25E grant 2011 – 2015 20 Fellows

Cyprus 2 Ghana 2 Tanzania 2Egypt 1 ( + 1 ) Italy 1 ( + 1 )

Uganda 2Georgia 3 Peru 1

Others… Brazil, Colombia, Rwanda ? US pilot project

Address workforce shortage

Growing Global Leaders… Advancing Palliative Care

Cohort 2: 23 Leaders, 10 Mentors

Argentina South Africa

NigeriaUganda

4 India 2 Vietnam

AlbaniaArmeniaSerbia

Kenya

Turkey

Guatemala

ColombiaBrazil

Bangladesh

2 MongoliaNepal

Romania

Cohort 2: 23 Leaders, 10 Mentors

Argentina

UgandaIndia

Australia

BelgiumUKCanada

USAGermany

Sweden

5 Practices of Exemplary Leaders…

1. Model the way

2. Inspire a shared vision

3. Challenge the process

4. Enable others to act

5. Encourage the heart

Niche… Over 2 yearsDevelop Individual Development Plan ( IDP ) Build leadership skills ( self )

Residential courses - curriculumCoaching

Apply leadership skills in practical palliative care activitiesMentorship by senior palliative care leaders

Advance palliative care capacity locally, regionally, globally

Foster Leadership Skills

Attitudes about Leadership

Before Retrospective After1

2

3

4

5

Scor

e

Positive Negative

p = 0.0005

p = 0.05

Positive Negative

Before Retrospective After

Leadership Core Skills

BeforeRetrospective

After1

2

3

4

Mea

n(ñ

SEM

) Sco

re

Self

BeforeRetrospective

After

Organizational

BeforeRetrospective

After

Regional/InternationalAll p < 0.003

Self Organizational Regional /International

Sample outcomesto date…

Palliative Care Activities…Latin America

• New PC undergraduate medical education curriculum 2 universities

• Beginning interdisciplinary post-graduate courses

• Improving PC E-learning course for doctors & nurses

Palliative Care Activities…Czech Republic

• Regular multi-disciplinary meetings in Cancer Institute, referrals

• New website for Czech Society of Palliative Care

• Palliative medicine recognized as new medical specialty

Palliative Care Activities…Africa

• Integrating PC into medical, nursing & dental schools

• Integrate palliative care in 10 hospitals in country

• Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies

Palliative Care Activities…Vietnam

• First Dept. PC Ho Chi Minh Cancer Center

Beginning home care• New PC unit Hanoi• Vietnamese

E-learning in PC

International Scholar-in-Residence

Dr. Staffan LundströmStockholm, Sweden

International Reach 2003 – 2015Patients

Participants Each Lives

• Presentations > 10,000 100 1 M

• Courses > 500 2000 1 M

• Fellows 11 + 20 10,000+.3 M+

• Leaders 19 + 23 10,000+.4 M+

> 2,7 M+

Key Message

A consistent, planned approach to education interventions and evaluation

over 5-10 years changesbehaviors and the experiences of

patients and families, organizations and societies

Mohammad Bushnaqat End of Fellowship…

“ Overall, I can say it very clear that: my experience with palliative care not only changed my career, but also the way I am looking to the life, the way I communicating with people,the way I am trying to understand others, and how you can be a happy person by working for noble ideas…

…Mohammad Bushnaq“ I truly believe that palliative care is NOT

limited to terminally ill patients, or even for sick person; but also it is the answer for all people on earth, for nations as a language to replace the language of conflict between nations we hear everyday in the media.

Call to Action in Sweden Education

Standardized curriculaTrainees - students, residentsPracticing professionals

Specialty recognitionFellowship training

“ The standards of practice we createand the people we train

will look after uswhen it’s our turn to receive care… ”

Will Sweden be ready ?

www.PalliativeMed.org www.IPCRC.net

You must be the change you want to see in the worldGandhi