The pathway toward a Palliative Medicine specialty
The modern hospice movement started in the United Kingdom in the 1960s. Most of the clinical hospice programs were community or inpatient based. During the 1970s palliative care consult teams were established in acute care facilities in Canada and the United Kingdom. Since then, palliative medicine has further evolved with the establishment of acute palliative care units and outpatient palliative care centers. Palliative care is now found in academic medical centers where it is possible to conduct research and education. This has considerably expanded our body of knowledge on the assessment and management of physical and emotional distress in patients and their families. It also has allowed palliative care physicians to teach these skills to medical students and residents from other specialties as well as to develop palliative medicine fellowships.
In the United Kingdom, Canada, Australia, the United States and a number of other European countries palliative medicine is now recognized as a medical subspecialty. In most countries such as the United States, physicians who could demonstrate a full time, or intensive part time, practice in palliative care were allowed to take a board certifying exam to become palliative medicine subspecialists up until October 2012 (for the US). After this deadline, only physicians who complete a full fellowship in palliative medicine were able to take the board certifying exam.
Through the exam, physicians are able to demonstrate the presence of particular skills which is important for obtaining academic positions or full time employment at major institutions.
This process of development into a medical subspecialty has been critical for the development for specialties such as emergency medicine and critical care medicine. Once a subspecialty status has been attained, it is possible for academic departments to be created, specialty fellowships established, and finally provides many opportunities to access the curriculum in medical and graduate schools. Because of this, the overall development of the specialty accelerates considerably.
Unfortunately, the process of developing a specialty is time consuming and expensive. The development of a certifying exam can take a very long time and it is particularly difficult in developing countries where physicians may have two or three jobs and very limited support. The process of studying for the board certifying exams can also be very expensive if physicians need to travel, stay in hotels, and are unable to work for several days while preparing for the exams.
The Department of Palliative Care and Rehabilitation Medicine at The University of Texas MD Anderson Cancer Center has been organizing one of the most successful annual intensive board review courses in the United States. This very intense course consists of approximately of 8 hours of lectures for three days covering all aspects of the American specialty board exam. For the first time last year a webinar version of the course was offered to 41 physicians from the United States and other regions in the world. This webinar course allowed physicians to receive the full content of the course live through their computers at home or at their workplace. Participants were also able to ask questions via e-mail. This year’s course is set for October 11-12. For additional information on the webinar, please contact Maureen Valenza, Program Coordinator, Department of Palliative Care & Rehabilitation Medicine. Her e-mail is [email protected]
After the completion of the webinar, the participants were able to access the materials stored in a password protected site for further review until the day of the exam.
This educational method may be particularly appropriate for those physicians who reside in the developing world and are unable to travel long distances to participate in educational activities.
However, the webinar course only provides a certificate of participation. The course does not provide an exam that would allow participants to demonstrate that they have acquired all the required knowledge.
Our Department of Palliative Care and Rehabilitation Medicine will collaborate with the board of IAHPC to start a pathway toward offering the webinar to physicians from the developing world and we will also start conversations with IAHPC that might lead to the development of an international exam for participants from the developing world.
Such an exam would be very useful for individuals working in the vast majority of the developing world where the subspecialty of palliative medicine does not exist and it is unlikely to develop for many years to come. Passing an exam would allow physicians to apply for academic positions and to help further develop the specialty in their own countries.
The Web offers an enormous opportunity to increase the access of our colleagues from around the world to high quality education at affordable prices where our two organizations have the capability to demonstrate leadership in this important area.
Eduardo Bruera, MD, is F.T. McGraw Chair in the Treatment of Cancer, and Chair, Department of Palliative Care and Rehabilitation Medicine - Unit 1414, at The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Dr. Bruera is a Member of the IAHPC Board since insert his start date. His bio may be found here.
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