SSOM End of Life Vertical Curriculum
“To Cure Sometimes, to Relieve Often, to Comfort Always – this is our work”
Anonymous, 15th century
“End of Life” refers to that part of the life cycle when the possibility of death becomes a major concern for the patient and his or her family. It is a time when addressing the physical, emotional, social and spiritual aspects of a patient’s care is paramount.
Palliative care aims to relieve suffering and improve quality of life for patients with advanced illness and their families.
There is no clear demarcation between active treatment of an illness and the end of life.
Goal #1 Medical Knowledge
Students must demonstrate knowledge about the medical aspects of death and dying, as well as the skills and attitudes necessary to use this knowledge effectively as a physician. Students will know:
- death is a natural part of the life cycle
- the concepts and philosophy of palliative care
- the pathophysiology and management of the common symptoms encountered at end of life, including:
- pain
- nausea and vomiting
- constipation
- delerium
- dyspnea
- the physiologic changes that occur as patients are dying
Goal #2 Interpersonal and Communication Skills
Students must demonstrate knowledge of the principles of communication and the skills and attitudes that allow effective interactions with patients, families, healthcare workers, and others who affect the well-being of patients at the end of life. Students will be able to:
- demonstrate appropriate skills and strategies for communication of goals of care with patients and their families
- demonstrate an understanding of the impact of life-threatening illness on patients and their families
- demonstrate appropriate skills and strategies for communication during difficult situations, such as giving bad news
- demonstrate appropriate skills and strategies for developing advance directives with patients and their families
- demonstrate an understanding of how family, culture, and religious beliefs can influence healthcare decisions and outcomes at the end of life
- respectfully and effectively communicate issues of end of life patient care with non-physician healthcare workers, including clergy
Goal #3 Professionalism, Moral Reasoning, and Ethical Judgement
Students must demonstrate a combination of knowledge, skills, attitudes, and behaviors necessary to function as a member of the health care team caring for the dying. Students will be able to:
- identify the major obligations of physicians to their patients at the end of life
- work collaboratively as members of a healthcare team in a variety of settings
- reflect on personal and professional experiences around death and loss
- identify and use resources to develop personal strategies to cope with death and loss
Goal #4 Clinical Skills and Patient Care
Students must use their knowledge, skills, and attitudes to provide patient care at the end of life that is appropriate, effective and sensitive to the psychological, sociologic, cultural and spiritual aspects of death and dying. Students will be able to:
- identify the multiple determinants of suffering: physical, psychological, social, cultural and spiritual
- develop and implement a care plan for patients when cure is no longer a rational goal and health services are most appropriately directed at comfort
- apply knowledge to effectively evaluate and manage the most common physical symptoms encountered at the end of life
- apply knowledge of the points of consensus and controversy to make reasonable judgements regarding the following ethical aspects of end of life care:
- withholding treatment
- withdrawing treatment
- euthanasia
- pain management
- non-abandonment of patients
- access of patients to high quality palliative and end of life care
Goal #5 Lifelong Learning, Problem Solving, and Personal Growth
Students should demonstrate the knowledge, skills, and attitudes needed to be able to begin to evaluate their method of practice, use appropriate tools of evidence to analyze clinical practice, and understand concepts of quality in healthcare and quality improvement for patients and their families at the end of life. Students should be able to:
- search, evaluate, and critically review scientific evidence appropriate to the care of individual patients with chronic debilitating illness and at the end of life.
- recognize that research and evidence based practice of quality symptom palliation and end of life medicine are growing fields
- demonstrate an awareness of information resources for providers, patients and families
Goal #6 Social and Community Context of Healthcare
Students must demonstrate the knowledge, skills, attitudes necessary to function within the larger healthcare system in which they will receive further training and identify resources available to provide high-quality care for their patients. Our students will:
- demonstrate knowledge of the philosophy of hospice and the services provided by a hospice program
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