End-of-life care in the Dutch medical curricula

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Abstract

Introduction

Future doctors must be trained in giving appropriate care to terminal patients. In several countries, medical curricula have been reviewed for the attention devoted to end-of-life care (ELC). In the Netherlands, no formal review had been performed. Therefore, the aim of this study was to provide an overview of the Dutch medical curricula regarding ELC.

Methods

We formed a checklist based on international standards consisting of five domains of ELC education that are considered essential. Firstly, we studied the Dutch national blueprint on medical education. Secondly, using a questionnaire based on the checklist we studied the curricula of the eight medical faculties. A questionnaire was sent to all Dutch medical faculties to study the compulsory courses of the curricula. To assess the elective courses, we consulted the study guides.

Results

The national blueprint included four of the five domains of ELC. None of the eight medical faculties taught all domains specifically on ELC; they were taught within other courses. Most attention was given to the domains on psychological, sociological, cultural and spiritual aspects; communication and conversational techniques; and juridical and ethical aspects. One faculty taught an elective course that included all essential aspects of the international standards.

Discussion

Our study shows that ELC is currently insufficiently mentioned in the national blueprint and that none of the faculties fully integrated ELC as a part of their compulsory medical curricula. To improve ELC education, we recommend the Dutch Federation of University Medical Centres to add the five ELC domains to the national blueprint and we recommend the medical faculties to review their curricula and offer a separate and compulsory course on ELC to prepare their students for their future medical practice.

Electronic supplementary material

The online version of this article (10.1007/s40037-018-0447-4) contains supplementary material, which is available to authorized users.

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Most cited references 20

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Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians.

Ruth Piers (2011)

Clinicians in intensive care units (ICUs) who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout. This situation may jeopardize patient quality of care and increase staff turnover. To determine the prevalence of perceived inappropriateness of care among ICU clinicians and to identify patient-related situations, personal characteristics, and work-related characteristics associated with perceived inappropriateness of care. Cross-sectional evaluation on May 11, 2010, of 82 adult ICUs in 9 European countries and Israel. Participants were 1953 ICU nurses and physicians providing bedside care. Perceived inappropriateness of care, defined as a specific patient-care situation in which the clinician acts in a manner contrary to his or her personal and professional beliefs, as assessed using a questionnaire designed for the study. Of 1651 respondents (median response rate, 93% overall; interquartile range, 82%-100% [medians 93% among nurses and 100% among physicians]), perceived inappropriateness of care in at least 1 patient was reported by 439 clinicians overall (27%; 95% CI, 24%-29%), 300 of 1218 were nurses (25%), 132 of 407 were physicians (32%), and 26 had missing answers describing job title. Of these 439 individuals, 397 reported 445 situations associated with perceived inappropriateness of care. The most common reports were perceived disproportionate care (290 situations [65%; 95% CI, 58%-73%], of which "too much care" was reported in 89% of situations, followed by "other patients would benefit more" (168 situations [38%; 95% CI, 32%-43%]). Independently associated with perceived inappropriateness of care rates both among nurses and physicians were symptom control decisions directed by physicians only (odds ratio [OR], 1.73; 95% CI, 1.17-2.56; P = .006); involvement of nurses in end-of-life decision making (OR, 0.76; 95% CI, 0.60-0.96; P = .02); good collaboration between nurses and physicians (OR, 0.72; 95% CI, 0.56-0.92; P = .009); and freedom to decide how to perform work-related tasks (OR, 0.72; 95% CI, 0.59-0.89; P = .002); while a high perceived workload was significantly associated among nurses only (OR, 1.49; 95% CI, 1.07-2.06; P = .02). Perceived inappropriateness of care was independently associated with higher intent to leave a job (OR, 1.65; 95% CI, 1.04-2.63; P = .03). In the subset of 69 ICUs for which patient data could be linked, clinicians reported received inappropriateness of care in 207 patients, representing 23% (95% CI, 20%-27%) of 883 ICU beds. Among a group of European and Israeli ICU clinicians, perceptions of inappropriate care were frequently reported and were inversely associated with factors indicating good teamwork.

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Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients

David Hui, Sun Hyun Kim, Joyce Roquemore … (2014)

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Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development.

José Miguel Carrasco, Thomas Lynch, Eduardo Garralda … (2015)

The lack of palliative medicine (PM) education has been identified as a barrier to the development of the discipline. A number of international institutions have called for its implementation within undergraduate medical curricula.

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Author and article information

Contributors

Josefien de Bruin:

Bio :

Josefien de Bruin

MSc, obtained her master’s degree at Leyden Academy of Vitality and Ageing and was a medical student from Leiden University Medical Center. She is currently working as a member of the scientific staff at Leyden Academy. Her interests are medical education and terminal care.

Mary-Joanne Verhoef:

Bio :

Mary-Joanne Verhoef

MSc MD, studied the master Vitality and Ageing at Leyden Academy and Medicine at Leiden University Medical Center. She is interested in palliative care, terminal care and oncology. Currently, she is working as a PhD candidate at the Expertise Center on Palliative Care of Leiden University Medical Center.

Joris P. J. Slaets:

Bio :

Joris P.J. Slaets

MD PhD, is professor of geriatric medicine at the University of Groningen and director of Leyden Academy on Vitality and Ageing.

David van Bodegom: bodegom@leydenacademy.nl

Bio :

David van Bodegom

MA MD PhD, is a researcher at Leyden Academy on Vitality and Ageing and assistant professor of medicine at Leiden University Medical Center. His interests are medical education, healthy ageing and peer-coaching.

Journal

Journal ID (nlm-ta): Perspect Med Educ

Journal ID (iso-abbrev): Perspect Med Educ

Title: Perspectives on Medical Education

Publisher: Bohn Stafleu van Loghum (Houten )

ISSN (Print): 2212-2761

ISSN (Electronic): 2212-277X

Publication date (Electronic): 5 September 2018

Publication date PMC-release: 5 September 2018

Publication date (Print): October 2018

Volume: 7

Issue: 5

Pages: 325-331

Affiliations

[1 ]ISNI 0000 0004 5345 9309, GRID grid.491366.f, Leyden Academy on Vitality and Ageing, ; Leiden, The Netherlands

[2 ]ISNI 0000000089452978, GRID grid.10419.3d, Centre of Expertise Palliative Care, , Leiden University Medical Center, ; Leiden, The Netherlands

[3 ]ISNI 0000 0000 9558 4598, GRID grid.4494.d, University of Groningen, , University Medical Center Groningen, ; Groningen, The Netherlands

[4 ]ISNI 0000000089452978, GRID grid.10419.3d, Department of Public Health and Primary Care, , Leiden University Medical Center, ; Leiden, The Netherlands

Article

Publisher ID: 447

DOI: 10.1007/s40037-018-0447-4

PMC ID: 6191393

PubMed ID: 30187388

SO-VID: 02a05039-af70-4d0e-ade4-5083f4825b8b

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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ScienceOpen disciplines: Education

Keywords: end-of-life care,medical education,national blueprint

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ScienceOpen disciplines: Education

Keywords: end-of-life care, medical education, national blueprint

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End-of-life care in the Dutch medical curricula

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Abstract

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Electronic supplementary material

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Journal of Medical Education Research

Most cited references 20

Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians.

Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients

Palliative Care Medical Education in European Universities: A Descriptive Study and Numerical Scoring System Proposal for Assessing Educational Development.

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Cited by 5

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