Featured Article

2017; Volume 18, No 7, July

Featured Article

ITES – An initiative to transform the system – Iniciativa Transformando el Sistema

Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to our newsletter. This month, it is the turn of Dr. Roberto Wenk. Roberto is a member of the IAHPC Board of Directors and a past Chair. As a physician and the Director of the Programa de Medicina Paliativa-Fundación FEMEBA, Argentina, he has combined care of patients and families with graduate teaching for many years.

Here, Dr. Wenk talks about the ITES project that is transforming medical and nursing education in palliative care and making a significant contribution to the development of palliative care in Latin America.

ITES – An initiative to transform the system (or in Spanish, Iniciativa Transformando el sistema) was developed by Liliana De Lima, IAHPC, Tania Pastrana, University of Aachen, and myself, Roberto Wenk, of the Fundación FEMEBA. We started the project in 2013 after the incorporation in 2010 of palliative care as an elective subject in the clinical years of the medical degree in Universidad Austral, Argentina.

We were motivated to start an activity that aimed to promote and include palliative care in the curricula of Latin American medical and nursing schools for four reasons:

We have carried out the ITES project in two countries: Colombia and Argentina. In both cases, the projects were developed in similar stages: contact and promotion (meeting with academic authorities, faculty and students to promote the undergraduate teaching of palliative care), workshops to achieve consensus on the palliative care competencies for undergraduate medical and nursing schools, and workshops on teaching and evaluation methods, (Kolb stiles, curriculum design, learning outcomes, Bloom's taxonomy, etc.)

In Colombia, contact and promotion with representatives of six universities took place in March 2014. The first two-day workshop, attended by 36 participants, was held in November 2015 followed by the second two-day workshop, in Cali and Bogota, with 40 participants in total, held in December 2015 (pictured here).

In Argentina, contact and promotion with representatives of six universities took place in May 2016. Then in Buenos Aires in April 2017, we held a two-and-a-half-day workshop, combining consensus on palliative care competencies and educational methods, with 29 participants. (pictured here).

Both activities achieved similar consensus on the following competencies (in alphabetical order).

Colombia Argentina
  • Definition and principles of palliative care
  • End-of-life care
  • Ethical and legal issues
  • Identification and control of symptoms: pain, respiratory, gastrointestinal, insomnia, delirium
  • Psychosocial and spiritual issues
  • Teamwork.
  • Caregiver and family care
  • Communication and therapeutic relationship
  • Definition and principles of palliative care
  • Ethical and legal issues
  • Control of symptoms 1: gastrointestinal, insomnia, delirium
  • Control of symptoms 2: pain, respiratory
  • Models of care
  • Psychosocial / emotional issues
  • Spiritual issues
  • Teamwork.

In both cases, the following questions were asked at the end of the activity. Responses were assessed on a Likert 0 to 5 scale.

Colombia Argentina

Response rate 80 %

Total score of 4.7 / 5.0 (SD = 0.426) average range 4.6/5.0 and 4.8/5.0

Response rate 69 %

Total score of 4.3 / 5.0 (SD = 0.333) average range 3.8/5.0 and 4.9/5.0

We are currently starting a survey among Colombian participants on the effect of ITES after two years on the integration of palliative care in the undergraduate curricula of their universities.

What did we learn from these experiences?

We are convinced that ITES is making a significant contribution to the development of palliative care in Latin America and could be applicable in other regions of the world.

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