Training for palliative medicine. II: How should palliative physicians be trained? An observational study of the clinical skills needed by senior palliative physicians

Palliative medicine is a new specialty in the UK. Formal training schemes are slowly evolving but some debate exists as to what precise experience such schemes provide. Five senior palliative physicians were observed in their clinical work in order to obtain information about the nature of the clinical problems that they were routinely managing and hence about where emphases in training should lie.

The doctors were observed dealing with 262 problems in 112 patients. The results demonstrate the wide range of problems in symptom control that palliative physicians manage, highlight the significant incidence of nonmalignant problems which require a broad knowledge of medicine, and show the large number of psychosocial problems for which communication skills, knowledge of psychiatry and awareness of community services are needed. The authors suggest seven areas which higher training must cover. They note that no other higher specialist training will provide the skills needed, and that no one background or qualification emerges as the 'best' prior to higher specialist training.