Educating Medical Students on End-of-Life Care
The Bay Area is making steady progress in educating not only the public, but the next generation of physicians. Its medical schools at Stanford and U.C. San Francisco have two of the nation’s leading palliative care centers. Aspects of palliative care are integrated into the core curricula and electives include training classes in communication and breaking bad news.
Palliative care specialist Dr. Brook Calton teaches a course at U.C. San Francisco in advance care planning and communication skills. Medical students in her class learn how to carry on conversations using role play. “Spoken word is the most important tool in medicine, while some may argue a cardio-catheter or a colonoscopy [are more important],” Calton told her class, “From my perspective, communication is something all of us do. We know that good communication skills can improve patient treatment and satisfaction.”
Carrying on end-of-life conversations with dying patients can be difficult and awkward at first. At Stanford’s School of Medicine, Dr. V.J. Periyakoil conducts video role plays with her medical students. Replaying the videos gives students the chance to watch their performance and learn from their mistakes. Periyakoil says it take skill and patience to find the right language. “You don’t know whether you can control your emotions, so it’s incredibly important to role-play this,” said Periyakoil, “The key is, they need to be able to voice these words out loud in a safe environment, where you’re not talking to a real patient and so the stakes are lower.”
At U.C. San Francisco’s School of Medicine, another elective course allows students to shadow physicians on their palliative care rounds. Second-year resident Margaret Lynch accompanied Dr. Wendy Anderson on her rotation. Anderson, a palliative care specialist and teacher at the medical school, was checking in on John, one of her patients. John was a young man with large masses below his eye and in his abdomen. The two masses were causing John severe pain and loss of appetite. Through palliative care, Anderson was trying to manage and control John’s pain symptoms. By observing Anderson on her rotation, Lynch was learning about pain management and how to communicate with dying and seriously ill patients. “Some of these difficult conversations about making medical decisions on care at the end of life—they’re the things I remember the most, the things I look back on and feel I was able to make a difference for a patient and their families,” said Lynch, “It’s really rewarding.”