MEDU-4098 - Online Palliative Elective

MEDU-4098 - Online Palliative Elective

Elective Title: Online Palliative Elective
Course Number: MEDU-4098
Elective Type: career Duration/Weeks: 2 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Jose A. Mendoza, MD Periods Offered: 1-13 including holiday period 8 Offered 100% Online
Coordinator: Other Faculty:
Location to Report on First Day:
Virtual, contact coordinator, Victoria Garcia ( questions

Students will develop basic understanding of what Palliative Medicine is, as well as how to incorporate the essentials of Palliative Medicine into clinical encounters, such as engaging in difficult conversation and discussing advance directives. This will be accomplished through completion of online modules developed by the Center to Advance Palliative Care (CAPC) and the Institute for Health Care Improvement (IHI). Students will utilize course to build a foundation for practicing patient-centered care understanding key aspects of an interdisciplinary team model.

At the completion of this course, student should be able to:
1. Gain deeper understanding of the growing field of Hospice and Palliative Medicine, including basic interdisciplinary team structure and role.
2. Ascertain knowledge on how to approach patients and their families to discuss
end-of-life care issues using specific communication techniques.
3. Explore personal feelings with respect to death and the end-of-life.
4. Discover resources available to address the difficulties doctors face with respect to patient death, loss, grief, and the recurring aspect of these.
5. Complete a basic overview of the pathophysiology and pharmacology of end-of-
life and palliative care.
6. Understand how to deliver patient-centered care

Description of course activities
Complete the following CAPC modules:
1. An In-Depth Look at Palliative Care and It's Services: About Palliative Care
2. Communication Skills: Delivering Serious News, Discussing Prognosis, Clarifying Goals of Care, Conducting a Family Meeting & Advanced Care Planning Conversations
3. Symptom Management Courses: Anxiety in Patients with Serious Illness, Constipation in Patients with Serious Illness, Depression in Patients with Serious Illness, Dyspnea in Patients with Serious Illness, Nausea and Vomiting in Patients with Serious Illness
4. Pain Management Courses: Comprehensive Pain Assessment, Matching the Drug Class to the Pain, Prescribing an Opioid

Complete the following:
1. PFC 102: Key Dimensions of Patient and Family Centered Care
2. PFC 201: A Guide to Shadowing: Seeing Care Through the Eyes of Patients and Families (1 lesson)
3. PFC 202: Having the Conversation: Basic Skills for Conversations about End-of-Life Care (4 lessons)

Movie Reflection:
Submit a 250 - 500 word reflection on one of the choices below:
1. "How to Die in Oregon" (available on Amazon Prime Video)
2. TED talk- BJ Miller -
3. TED talk- Timothy Ihrig -
4. TED Talk- Kathy Hull - Kathy Hull: Stories from a home for terminally ill children

Complete an Advance Directive:
PREPARE for your care is greater resource to direct patients to when discussing completing an advance directive and to facilitate a discussion with family members regarding goals of care. Navigate to the website below and complete an AD online, print, and provide a copy to your loved ones. To receive credit for completing, upload a copy to Blackboard.

Type of students who would benefit from the course
Any student interested in learning more about the specialty of Palliative Medicine would benefit from this foundational course. Students hoping to improve communication skills, comfortably identify and treat end of life symptoms, safely treat complex pain, and learn coping skills when experiencing death of a patient would also benefit.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM

 Average number of patients seen per week: N/A
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Students are not observed clinically in this course
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    A 250-500 word reflection on one of 4 videos will be required. Additionally, students will complete an advance directive on and upload to Blackboard.
  B. Format - What guidelines are set for the student's written work?
    The faculty member will grade reflection with a pass/fail. Grading will be based on relevance to respective video watched, plan to personally apply material to clinical interactions in the future, and style of reflection (ensuring no grammatical errors). Advance directive is pass/fail based on completion.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Reflection, 250 - 500 word essay
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student may select video to base reflection from list of 4 options
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Faculty will evaluate students based on completion of modules and uploaded certificates to Blackboard. Students will also upload personal reflection and advance directive to Blackboard.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Faculty will evaluate students based on completion of modules and uploaded certificates to Blackboard. Students will also upload personal reflection and advance directive to Blackboard.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.