2°Expert skills
Palliative CareConsultants /
Teams
Palliative Care Skills...
Palliative Medicine Specialists • 2006 ABMS recognized subspecialty
10 of the 24 parent boards• 12 month US fellowship, > 71 graduates
Class of 2011 - 2012
2006 – Palliative Medicine Recognized as Subspecialty by American Board
of Medical Specialties
1. 1 year Fellowship orExperiential qualification( 2006 – 2013 only)
Oversight: American Committee Graduate Medical EducationAccreditation: American Academy of Family Practice
2. Certification examMultiple choiceABIM: American
Board of Internal Medicine
Internal Medicine
Family Medicine Anesthesiology
PediatricsSurgery
Emergency Medicine
OB / GYN
Physical Medicine & RehabRadiology (XRT)
Psychiatry & Neurology
10 Sponsoring Specialties
Hospice and
Palliative Medicine
Next Steps• Clinical
CompetenciesOutcomes
• Teaching skillsPresentationFacilitationBedside mentorship
• Leadership skills• Research project
360° Evaluation1. Patient and family care2. Medical knowledge3. Practice-based learning and
improvement4. Communication and interpersonal
skills related to process of providing care
5. Professionalism6. System based practice
IPM US Fellows Employment
7 San Diego10 Los Angeles
1 Hawaii1 New Zealand
Internal Medicine
Family Medicine Anesthesiology
PediatricsSurgery
Emergency Medicine
OB / GYN
Physical Medicine & RehabRadiology (XRT)
Psychiatry & Neurology
10 Sponsoring Specialties
Hospice and
Palliative Medicine
Palliative Medicine Fellowship… Developing Clinical Capacity
Hypothesis
Training palliative medicine specialists will advance
palliative care delivery and increase opioid consumption
Int’l Palliative Medicine Fellowship• Over 24 - 36 months
4 – 6 months at San Diego Hospice2 visit by IPM
Faculty in-countryCompetency-based Practical bedside
mentorship, not observership
International Fellows
Pilot: 11 Int’l Fellow Graduates• Demonstrated competencies to IPM faculty
All recognized as consultants 3 Jordan2 Georgia2 Mongolia1 Slovenia1 Spain2 Vietnam
King Hussein Cancer Center Jordan
• 2 fellow graduates consultants
King Hussein Cancer Center Jordan• Built palliative care program
2 palliative medicine consultants> 50 staff10-bed inpatient
unit ( of 140 beds )
Inpatient consultsAmbulatory
outpatient clinicsHomecareSaw > 2,000 patients in 5 years
( since October 2004 )
KHCCPallCareGrowth
280 335407
47828
813
41
0
100
200
300
400
500
600
2005 2006 2007 2008
Consultaion
Referral
178 171 126 186
99 129 16919923 31 75
82
812
50
52
0
100
200
300
400
500
600
2005 2006 2007 2008
6Month-1Year3Month-6Month3Week - 3Month1 Day-3 Week
New Patients
Length of Stay
KHCC Outpatient Opioid Consumption
2004 - 2.7 kg 2006 - 5.3 kg 2008 - 6.2 kg
Jordan OpioidConsumption
INCB 1980-2008 Morphine Use
in Jordan ( mg / capita )
≈ 11.8 kg4x
≈ 2.9 kg
Urska LunderLjubljana, Slovenia
• Medical Director, Palliative Care, Golnik Hospital19 bed unit, consultation service,
home care• MoH Pilot Pathway Project - 3 regions• Teaching extensively
Faculty European School of Oncology• European Union Research on EOL• IPM Leadership Development Initiative
Gantuya TserendorjUlaanbaatar, Mongolia
• Medical Director, Palliative Care, National Cancer Center16 bed unit, consultation service,
outpatient clinics• MoH agreed to pay for PC services• Teaching regularly across Mongolia• Member Board of Directors new
Foundation of First Lady of Mongolia dedicated to vaccination & palliative care
Mongolia June 2009
Reach of 11 FellowsDirect: If each cares / influences care
of 1,000 pts / yr, for 30 yr
Patients LivesEach Touched
11 Fellows 30,000 330,000 + families
Indirect: Teaching, research, advocacy
Next Step Expanded international pilot project
NCI R25E grant 2011 – 2015 20 Fellows
Cyprus 2 Ghana 2 Tanzania 2Egypt 1 ( + 1 ) Italy 1 ( + 1 )
Uganda 2Georgia 3 Peru 1
Others… Brazil, Colombia, Rwanda ? US pilot project
Address workforce shortage
Growing Global Leaders… Advancing Palliative Care
Cohort 2: 23 Leaders, 10 Mentors
Argentina South Africa
NigeriaUganda
4 India 2 Vietnam
AlbaniaArmeniaSerbia
Kenya
Turkey
Guatemala
ColombiaBrazil
Bangladesh
2 MongoliaNepal
Romania
Cohort 2: 23 Leaders, 10 Mentors
Argentina
UgandaIndia
Australia
BelgiumUKCanada
USAGermany
Sweden
5 Practices of Exemplary Leaders…
1. Model the way
2. Inspire a shared vision
3. Challenge the process
4. Enable others to act
5. Encourage the heart
Niche… Over 2 yearsDevelop Individual Development Plan ( IDP ) Build leadership skills ( self )
Residential courses - curriculumCoaching
Apply leadership skills in practical palliative care activitiesMentorship by senior palliative care leaders
Advance palliative care capacity locally, regionally, globally
Foster Leadership Skills
Attitudes about Leadership
Before Retrospective After1
2
3
4
5
Scor
e
Positive Negative
p = 0.0005
p = 0.05
Positive Negative
Before Retrospective After
Leadership Core Skills
BeforeRetrospective
After1
2
3
4
Mea
n(ñ
SEM
) Sco
re
Self
BeforeRetrospective
After
Organizational
BeforeRetrospective
After
Regional/InternationalAll p < 0.003
Self Organizational Regional /International
Sample outcomesto date…
Palliative Care Activities…Latin America
• New PC undergraduate medical education curriculum 2 universities
• Beginning interdisciplinary post-graduate courses
• Improving PC E-learning course for doctors & nurses
Palliative Care Activities…Czech Republic
• Regular multi-disciplinary meetings in Cancer Institute, referrals
• New website for Czech Society of Palliative Care
• Palliative medicine recognized as new medical specialty
Palliative Care Activities…Africa
• Integrating PC into medical, nursing & dental schools
• Integrate palliative care in 10 hospitals in country
• Medication campaign to identify morphine stock-outs & resistance to guaranteed supplies
Palliative Care Activities…Vietnam
• First Dept. PC Ho Chi Minh Cancer Center
Beginning home care• New PC unit Hanoi• Vietnamese
E-learning in PC
International Scholar-in-Residence
Dr. Staffan LundströmStockholm, Sweden
International Reach 2003 – 2015Patients
Participants Each Lives
• Presentations > 10,000 100 1 M
• Courses > 500 2000 1 M
• Fellows 11 + 20 10,000+.3 M+
• Leaders 19 + 23 10,000+.4 M+
> 2,7 M+
Key Message
A consistent, planned approach to education interventions and evaluation
over 5-10 years changesbehaviors and the experiences of
patients and families, organizations and societies
Mohammad Bushnaqat End of Fellowship…
“ Overall, I can say it very clear that: my experience with palliative care not only changed my career, but also the way I am looking to the life, the way I communicating with people,the way I am trying to understand others, and how you can be a happy person by working for noble ideas…
…Mohammad Bushnaq“ I truly believe that palliative care is NOT
limited to terminally ill patients, or even for sick person; but also it is the answer for all people on earth, for nations as a language to replace the language of conflict between nations we hear everyday in the media.
Call to Action in Sweden Education
Standardized curriculaTrainees - students, residentsPracticing professionals
Specialty recognitionFellowship training
“ The standards of practice we createand the people we train
will look after uswhen it’s our turn to receive care… ”
Will Sweden be ready ?
www.PalliativeMed.org www.IPCRC.net
You must be the change you want to see in the worldGandhi
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