Table 2.
Palliative Care Competencies for Graduating Medical Students, Developed from a Survey of 71 Palliative Care Experts, 2012a
| Competency | Essential for all, no. (%) | Important for all, no. (%) | Important for some, no. (%) |
|---|---|---|---|
| 1. Describes ethical principles that inform decision-making in serious illness, including the right to forgo or withdraw life-sustaining treatment and the rationale for obtaining a surrogate decision maker. (TCB)b | 48 (67.6) | 21 (29.6) | 2 (2.8) |
| 2. Reflects on personal emotional reactions to patients’ dying and deaths. (PCPP)b | 40 (58.0) | 25 (36.2) | 4 (5.8) |
| 3. Identifies psychosocial distress in patients and families. (PSC)b | 40 (57.1) | 25 (35.7) | 5 (7.1) |
| 4. Explores patient and family understanding of illness, concerns, goals, and values that inform the plan of care. (C)b | 39 (57.3) | 25 (36.8) | 4 (5.9) |
| 5. Defines the philosophy and role of palliative care across the life cycle and differentiates hospice from palliative care. (PCPP)b | 37 (53.6) | 30 (43.5)) | 2 (2.9) |
| 6. Demonstrates patient-centered communication techniques when giving bad news and discussing resuscitation preferences. (C)b | 36 (56.2) | 24 (37.5) | 4 (6.2) |
| 7. Assesses pain systematically and distinguishes nociceptive from neuropathic pain syndromes. (PSM)b | 35 (50.0) | 31 (44.3) | 4 (5.7) |
| 8. Describes key issues and principles of pain management with opioids, including equianalgesic dosing, common side effects, addiction, tolerance, and dependence. | 33 (47.1) | 30 (42.9) | 7 (10.0) |
| 9. Demonstrates basic approaches to handling emotion in patients and families facing serious illness. | 32 (46.4) | 32 (46.4) | 5 (7.2) |
| 10. Identifies common signs of the dying process and describes treatments for common symptoms at the end of life. | 28 (39.4) | 28 (39.4) | 15 (21.1) |
| 11. Identifies patients’ and families’ cultural values, beliefs, and practices related to serious illness and end-of-life care. | 24 (34.8) | 39 (56.5) | 6 (8.7) |
| 12. Describes disease trajectories for common serious illnesses in adult and pediatric populations. | 22 (32.8) | 34 (50.7) | 11 (16.4) |
| 13. Describes the communication tasks of a physician when a patient dies, such as pronouncement, family notification, and request for autopsy. | 21 (31.3) | 36 (53.7) | 10 (14.9) |
| 14. Describes an approach to the diagnosis of anxiety, depression, and delirium. | 19 (27.5) | 37 (53.6) | 13 (18.8) |
| 15. Assesses non-pain symptoms and outlines a differential diagnosis, initial work-up and treatment plan. | 18 (25.7) | 41 (58.6) | 11 (15.7) |
| 16. Identifies spiritual and existential suffering in patients and families. | 12 (18.2) | 41 (62.1) | 13 (19.7) |
| 17. Describes the roles of members of an interdisciplinary palliative care team, including nurses, social workers, case managers, chaplains, and pharmacists. | 9 (13.8) | 36 (55.4) | 20 (30.8) |
| 18. Describes normal grief and bereavement, and risk factors for prolonged grief disorder. | 7 (10.8) | 38 (58.5) | 20 (30.8) |
Abbreviations: C = communication; PSM = pain and symptom management; PCPP= palliative care principles and practice; PSC = psychosocial, spiritual, and cultural aspects of care; TCB = terminal care and bereavement.
a
Because of missing item-level data some rows contain fewer than 71 responses.
b
Competencies given a rating of “essential” by 50% or more of respondents.