Eduardo Mutto received an IAHPC Traveling Scholarship to train with Dr Carlos Centeno at the Clínica Universitaria de Navarra, Pamplona, Spain. Eduardo’s visit servedas part of the preparation for his PhD thesis, which he explains in this article.
Education in palliative care had never been included in the curricula in any medical school in Argentina until the year 2010 when, as part of this thesis, 1 a pilot study was conducted in the Faculty of Biomedical Sciences of Austral University.
In 2005, we decided to look at the teaching of palliative care in medical schools in Argentina. The goals of this study were to evaluate:
A validated survey was administered to students in the first and last year in schools of medicine and nursing, comprising seven universities in the city of Buenos Aires and surrounding areas. Data from 730 students were analyzed.
Our observations showed that nursing and medical undergraduate students: (a) come in direct contact with TIPs and perceive their suffering; and (b) have a highly positive attitude toward these patients, even though some of them referred to that relationship as arduous and, in some cases, they tended to avoid emotional involvement. We also found that (c) this wish for avoidance was increased in final-year medical and nursing students; and (d) students unanimously manifested the opinion that the teaching about caring of TIPs should be included in the curricula.
A second step of our work was a comparison survey on undergraduate palliative care education at medical schools in three countries. We enrolled 380 first- and sixth-year medical students from Universidad Austral (Argentina), Universidad de Navarra (Spain), and Università Campus Biomedico di Roma (Italy). Answers to the questions were similar among the three universities. Students acknowledged interacting directly with dying patients in all cases. Students spontaneously requested more training in end-of-life care. Ninety-eight percent of students considered that death and helping patients to have a good death should be included in their training. Students’ attitudes revealed high interest and poor training in end-of-life issues.
Finally, we initiated a pilot study at the School of Medicine of Austral University incorporating palliative care as an elective in the undergraduate medicine curriculum during 2010-2013. We analyzed the experience and results after four years of teaching palliative care. We compared students who chose palliative care as an elective subject (PC Group) with students who did not (Non-PC Group). We focused on the experience of contact with palliative care patients and self-perceived attitudes. Additionally, the impact produced by palliative care education in knowledge, self-perceived attitudes, and comfort was evaluated. All the students tested completed a questionnaire on their attitude when exposed to dying patients. Students in the PC Group completed an additional questionnaire to assess their level of knowledge and their self-perceived comfort when interacting with patients.
After testing 146 students our results showed that all students in the PC Group and 95.2% in the Non-PC Group considered that specific death issues ought to be part of the curriculum. Some students indicated that they could be present in a mandatory course. Before taking their elective, students in the PC Group confirmed a lack of technical training to understand palliative care patients, as did those students in the Non-PC Group. After taking a palliative care elective students expressed an improvement in self-perceived attitudes toward suffering and there was a significant increase in knowledge. They also expressed an improvement in comfort levels in evaluation and treatment of pain. More than 95% of the students in the PC Group rated the experience as valuable and perceived the content as not available elsewhere in their training. Our results show that palliative care education provides opportunities to improve attitudes not specific to this discipline: interprofessional collaboration, holistic care, patient-centered care, self-awareness, and humanism. We conclude that an exposure to palliative care improved students’ perceptions about the complexities of dying patients and their care.
For all these reasons, we consider that the teaching of caregiving to TIPs in the academic degree programs of nursing and medicine should not be presented as a marginal issue.
1. Eduardo Mario Mutto. Los estudiantes de medicina frente al paciente en situación de enfermedad terminal y el aprendizaje de cuidados paliativos. PhD thesis. Facultad de Ciencias Biomédicas, Universidad Austral Pilar, República Argentina, 2014.