14 Professional education and training

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Professional Education and Training

This section will deal with:

1. Pre-service training of staff

No matter how well qualified and experienced in palliative care, new staff members should have a short period of training before they start work in the palliative care service, whether it is an in-patient one, a community one or a day care unit. For some it need be no more than a few days, for others less experienced, 3-4 weeks. So important is administration and management, this applies also to non-clinical staff whose courses will be tailored to their need

The topics covered should include:

Different disciplines may need additional subjects, depending on their work, past experience and the responsibilities they will have:

In-service staff training
 Topics that might usefully be included in sessions held every 6 - 8 months include:

In addition members of staff may be sent for further training in patient handling, counselling, teaching technology and methodology, computer skills, bereavement work, time utilisation, and other topics raised by members of staff with their line managers.
If, as is recommended, each member of staff has a record book covering all the time they work in the palliative care service (in addition to records routinely kept on data bases of Management) they can record all the additional information felt needed, and then raise it in their in-service study days.
Tutorial staff for pre-service and in-service training
All the above training can be organised and taught by heads of departments – nursing, medical, and administration. It need not be the responsibility of education staff.
Training for volunteers will always be under the direction of the Volunteer Service Manager (VSM) with co-opted tutors for special topics.(See separate chapter)

2. Education in the palliative care unit for health care professionals

It is common for those planning a palliative care service to focus exclusively on the clinical aspects of the work and to ignore education. Only after the clinical work has been progressing for several years do they begin to think about their responsibility to educate others. This is a bad policy. The palliative care needs of the world will only be met when sufficient doctors and nurses are aware of and practise its principles. Education needs advance planning, space allocation, appropriate staffing, budgeting, equipment and well negotiated cooperation with other educationists. The time to start planning is when the palliative care service itself is being planned.
Key questions to be asked in the early planning days
Which professional groups will need to be taught?

It is immediately apparent that a decision will need to be made about priorities! (see later).
It might be clinical (using patients and at the bedside), theoretical in a tutorial room or in the community in patient’s homes.
 The talks / lectures might be formal didactic or informal workshops and discussions. They each need different types / sizes of rooms. [Contrary to what many people say, patients in hospices and palliative care units much appreciate being asked to speak with and share their experiences and insights with students and are highly effective teachers.]
 Will there be bedside instruction?
 At this stage of planning this decision need not be made except if there is a question about a tutorial room being provided near the patient care area. It can often be multi-functional doubling as a team meeting room, a library reading room.
 What space and equipment will be needed for educational activities?
This is a crucially important question at the planning stage.
 Ideally there needs to be:

Useful but not essential is a heated food trolley for serving meals.
It should be noted that the ‘lecture room’, provided its use is well planned, can be used for staff meetings, committees, research groups, board meetings, fund-raising events, and much else in addition to its educational role

What staff will be needed?
 Provided use is made of the clinical and teaching skills of doctors, senior nurses, therapists, pastoral care staff and social worker a very large comprehensive educational programme can be run with
One nurse lecturer/ tutor
One clerical assistant / administrator
How will this education relate to other educational centres?
 When there are so few palliative care workers and so many to educate and train it is essential to use the limited resources carefully and

In other words find what others are doing. Identify gaps in education n and training. Find if you can employ staff able to fill those gaps. Start small and let the work grow.
 Other questions often asked at this planning stage
 Are there curricula and syllabi already available?
 Yes, look at the websites listed in Getting Started. Excellent syllabi have been drawn and are in use in Europe, Asia, Africa, Eastern Europe and Latin America.  There is no need to produce a new one for your unit!
 How can doctors and nurses learn how to teach?
 Several short courses (1-2 weeks in length) are run for this purpose. Details can be obtained from national palliative care organisations, Help the Hospices and the IAHPC. They are often called "Teaching the Teachers" courses. In that short time future teachers / lecturers learn

Who makes the decisions about whom to teach and train?
 Ideally there should be an education team / committee / group within every hospice / palliative care service. The members would be the senior doctor, the senior nurse, the tutor and a manager. They should have the responsibility of

Are external advisers useful?
 Much is said elsewhere in Getting Started of the benefits of having a Professional Advisory Committee (PAC) for all clinical and professional matters. A subgroup of the PAC can act as education and training advisors, just as yet another small group can advise on research. Having such external experts to advise also raises the profile, credibility and authority of the hospice / palliative care service when fellow professionals and academics see the calibre of those lending it their support and expertise.  It is seldom difficult to recruit them for terms of service not exceeding three years.
 What are the dangers and “risk” implications of doing educational work?

Is it a useful thing to have junior medical and nursing staff (and even experienced family physicians) working in the hospice / palliative care service to gain valuable experience?
 This question can be left until the service is up and running. The experience can be a very valuable one for them, and their contribution to the service a useful one butthey must be supervised, taught, have time to ask questions and to study, and statutory time off.  That can add greatly to the work load of the senior professional staff.
 Is there one message that best describes the aim of education and training in palliative care for health care professionals?
Yes. 
Strive to change attitudes rather than instilling facts and figures.

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