Abstract
Dear Editor:
Despite being home to one of the nation's largest elderly population, the state of Florida has no formal program or comprehensive plan to address palliative care. In response, a steering group from 30+ clinical organizations formed the Florida Palliative Care Coalition (FPCC). Its mission is to “promote better quality of life for those living with serious, chronic, or advanced illness through research, education, advocacy, and access to holistic healthcare.” 1 The inaugural summit held this year marked an important milestone in advancing palliative care in Florida. The goal is to create a multiyear action plan that addresses key areas needed to improve access to palliative care, including quality, public policy, consumer awareness, medical education, and workforce development.
Community-based and population-focused interventions are essential to increase public awareness and education about palliative care. A 2019 study revealed that 71% of Americans had never heard of palliative care. 2 Many in the public and health care field mistakenly equate palliative care with end-of-life care. The FPCC created the Education and Practice workgroup to drive curriculum development and learning activities for clinicians, payers, patients, and their families. With palliative care discussions often initiated by clinicians, standardized palliative care education is a critical need for the medical community to provide interdisciplinary team-based care. Yet, the medical education mandate for U.S. medical schools is specific to end-of-life care, which focuses mainly on hospice care in medicine curricula.
Some medical schools have expanded their palliative care education across the four years to involve rotation time with the palliative care clinical service. Educational topics for students include defining palliative care, communication on delivering bad news, end-of-life discussions across care settings, symptom management, ethics, and law. Recognizing the need for palliative care education, the Accreditation Council for Graduate Medical Education (ACGME) now requires internal medicine residents to receive palliative care clinical training. 3 Extension of this ACGME requirement to other medical specialties, for example, surgery and pediatrics, remain unknown. Moreover, ACGME has not defined the rotation duration or the Milestones 2.0 competencies specific to palliative care. For educational programs integrating palliative care clinical experiences, Table 1 proposes a list of goals and objectives in palliative care that align with the Milestones 2.0 competencies.
Internal Medicine Residents Palliative Care Rotation List of Goals and Objectives
Palliative care is a relatively new medical specialty and more advocacy is needed on the national stage to ensure an adequate and skilled workforce. Palliative care clinicians provide comprehensive symptom management, intensive communication, and a high level of care coordination for episodic and long-term serious illness. The public and medical community must come together and sign up to support HR 1339/S 641, the Palliative Care and Hospice Education and Training Act (PCHETA) sponsored by the American Academy of Hospice and Palliative Medicine. The goal of PCHETA is to create educational centers, expand physician training, provide workforce development, and fund academic career awards and career incentive awards in palliative care. 4 Advocacy for education and professional development on a national level is imperative to systematically address access and shortages in palliative medicine.