End of Life Education End of Life Education at Touro Universityat Touro University

Kenneth Leong, OMS II

Current curriculumCurrent curriculum

Breaking bad news lectureBreaking bad news to a standardized

patientMedical ethics lectureDNR/DNI lecture2-hour lecture on End-of-Life care by a

hospice physicianElective 3rd yr rotation with Dr. West,

Sutter Medical Director.

GoalsGoals

Establish a EOL curriculum at Touro University

Nurture interest about EOL issues in students to partake in EOL elective (Colleen Fitzgerald)

Have students become active in the EOL medical community

Chronological ApproachChronological Approach

Start Middle End•Begin with 4 cases and discussing with the class what you would do if this is your family member.

o Case 1 - An 70 yo patient w/ no advance directive and never spoke of wishes. Had an MI 5 years ago.

o Case 2 - elderly patient w/ no

advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state.• What do you do?

o Case 3 - patient with

metastatic GI cancer with mets to lungs. Patient has gone through chemo and radiation. Patient appears dyspnic, nausea and vommiting, and a distended abdomen. Pain is at a 10.

•Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older.

o Feeding. Show what a PEG tube looks like.

o Constellation of problems seen during end of life • Show what pressure

sores look like• Contracted• Aspiration• Thrush• Delirium vs. dementia

•Address morphine stigma

•What are the costs and benefits of placing a feeding tube?

•What happens physically when a person dies?

o Scan the blue book “Gone From My Sight” into a PowerPoint

•Organize students to attend the annual AAHPM meeting. •Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year.

•Establish an end-of-life elective course

Start Middle EndWhat happens when you code?oParticipants - Dr, RN's, RT, Lab, medical students, gawkers, crowd controloCPR w/ patient with osteopeniaoPics of central line or video of putting in oneoVideo of PEG tube

Introduce Hospice as a modality of careoWhat is hospice and what makes a patient hospice-appropriate?oWhat is the hospice philosophy?oWhat role does each member of the interdisciplinary team play?

What happens to you when you survive a code?

StartStart

Begin with 4 cases and discussing with the class what you would do if this is your family member.

Case 1 - elderly patient w/ no advance directive and never spoke of wishes. Had atrial fibrillation and a CVA that led to irreparable brain dmg and in a persistent vegetative state.

Case 2 - patient with metastatic GI cancer with mets to lungs. Patient has gone through numerous rounds of chemo and radiation. The oncologist insists upon a new trial drug that may be effective. Patient has nausea, vomiting, and has pain at a 9. Patient expresses that he is “sick and tired of feeling sick.”

Case 3 – Latino female patient who has colon cancer that has metastasized to the liver. Although she is enrolled on hospice, her family insists that she must NOT be informed of this.

Case 4 – You see in the hospital an 85 yo white male with end stage CHF. Patient has Alzheimer's dementia and was admitted to the hospital for fluid in his lungs and edema. He is on the following meds:Lovastatin, carvedilol, aspirin, Cardura,

furosemide, jet nebulized albuterol & atrovent, roxanol, senna, dulcolax, robutussin.

Start (cont’d)Start (cont’d)

What happens when you code?oParticipants - Dr, RN's, RT, Lab, medical students, gawkers,

crowd controloCPR w/ patient with osteopeniaoVideo of a central line being placedoVideo of PEG tube

What happens when you survive a code?

MiddleMiddle

Paint a picture to students about what curative treatment is like and how some of the treatments may not be appropriate when you are older.◦ Parenteral feeding◦ Constellation of problems seen during end of life

Decubiti Contracted Aspiration Thrush Delirium vs. dementia

Address morphine stigma

What are the costs and benefits of placing a feeding tube?

What happens physically when a person dies?◦ Scan the blue book “Gone From My Sight” into a PowerPoint◦ View the movie “Wit” as either an elective course (Colleen), or advertised as a school

event. Introduce Hospice as a modality of care

◦ What is hospice and what makes a patient hospice-appropriate?◦ What is the hospice philosophy?◦ What role does each member of the interdisciplinary team play?

EndEnd

Establish an end-of-life elective course

Have students become active in the EOL medical community and attend the annual AAHPM assembly

Because of our new curriculum, we have flexibility in shaping our education. Establish ECE opportunities as soon as the first year.

ConclusionConclusion

End-of-life issues are poorly addressed in medical education—Touro University is no exception. With the aid of generous aid from AMSA and VITAS, my goal is to create a comprehensive curriculum that addresses this need.