Obstetrics/Gynecology
End of Life Content
- Problem Based Learning Case of a Hispanic woman who develops AIDS following blood transfusions given at the time of uterine rupture during VBAC. As patient approaches death, accepting patient's previously expressed advance directive vs following wishes of power of attorney for health care is in conflict.
Students are required to submit written responses to the case with follow-up discussion in PBL session
- “It will be our intent during the conduct of our clerkship, when appropriate, to give the student-physicians feedback when they have the opportunity to demonstrate appropriate skills and strategies for communication during difficult situations, eg giving ‘bad news'”.
- “We will ensure that our student physicians are sensitive to the various culture of our patients (African American culture in Maywood has values that may differ from those of Latinas living on the Westside) by having them demonstrate an understanding of how family, culture, and religious beliefs can influence healthcare decisions.”
- “We will stress the importance of the use of preventive strategies such as Papanicolaou smears and screening mammogram. It has been shown by some studies that the use of these preventives in a population may be extremely cost effective through the mechanism of reducing the prevalence of death or extending the years of productive life. In the same vein, we will ensure that our student physicians are sensitive to the fact that many in our society are at risk for inadequate healthcare because the are uninsured or underinsured.
- “We have begun an education initiative within the clerkship to help student-physicians be able to identify women and their children who may be at risk for domestic violence”.
Assessment
Communication skills will be documented, when practicable, in the evaluation of the student via the “Floor performance” segment of the grade for the clerkship
End of Life Curriculum Goals and Objectives Addressed
Goal #2 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.
- demonstrate appropriate skills and strategies for communication during difficult situations, such as giving bad news
Goal #3 Professionalism
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.
- advocate at all times the interest of patients over personal interests
Goal #4 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.
- conflicts of interest
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.
- develop an awareness of state, region and system-specific legal guidelines regarding end of life issues including physician assisted death
- demonstrate knowledge of the American healthcare system including reimbursement mechanisms, the roles of government and private sector, and the ways patients pay for healthcare
- demonstrate an understanding that some individuals in our society are at risk for inadequate healthcare, including the poor, uninsured, underinsured, children, unborn, single parents, elderly, racial minorities, immigrants, refugees, physically disabled, mentally disabled, chemically dependent, and those with incurable diseases
- implement strategies to access healthcare services for patients who need advocacy and assistance
- demonstrate knowledge of non-biological determinants of poor health, such as child abuse and domestic violence and the economic, psychological, social, and cultural factors that contribute to their development and continuation
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