Dr. Jennifer Reidy believes that anyone who graduates from medical school should be able to lead effective, compassionate conversations with people with serious illnesses.
As the chair of the Massachusetts Medical School Collaborative and an associate professor at UMass Chan Medical School, she is leading an effort to integrate palliative care into the core medical school curricula in her home state.
The collaborative launched in 2017 as a combined effort of faculty, staff and students at UMass Chan Medical School, Tufts University School of Medicine, Harvard Medical School and Boston University School of Medicine. It’s part of a growing movement across the United States to train more doctors in palliative care.
A 2018 study in the Journal of Pain and Symptom Management found that the annual number of new hospice and palliative care specialists would need to nearly double by the year 2030 to keep up with growing demand. To help fulfill that need, many medical schools have been integrating palliative care into their standard curricula so that even non-specialists will learn those skills.
The collaborative recently developed five core competencies, or skills, they want students to acquire before graduation. Those skills include responding to strong emotions effectively and sharing difficult news using a patient-centered framework. The goal is for all students to graduate from their programs equipped to have these conversations during residencies.
Palliative Care News spoke with Reidy about the lack of palliative care training in medical schools, and how the collaborative is working to close that gap.
Why is it important to you that all medical students learn serious illness communication?
No matter what specialty of medicine a physician practices, they need to be able to listen deeply and get to know their patients as whole human beings, along with their families and caregivers, in order to effectively partner with them.
We know that there are long-standing inequities, disparities and a lack of trust in health care. The first step in trying to earn the trust of the people that we serve is by listening, hearing their stories, meeting them where they’re at, and developing relationships.
In addition to knowing the pathophysiology of disease, treatment options, and pharmacology of the medications, we also want to assess quality of life by asking: How are people holding up with their illness? How can we better manage their symptoms? What kind of stress is the illness put on them and their loved ones? How might we help people navigate a broken health care system? Those skills are relevant in any discipline of medicine.
Lastly, palliative care requires that doctors are aware of our own thoughts, emotions, and reactions to what we bear witness to so that we can take care of ourselves. There’s an epidemic of burnout in health care. Imagine if we can strengthen the next generation of doctors to be insightful about themselves, and aware of their own emotions and reactions to make them more effective doctors, but also to help combat burnout so that they can keep showing up and doing this work for their whole career.
What has the collaborative achieved so far?
We developed five competencies, which we want students to learn before they graduate.
We then did curriculum mapping: we looked at the curricula at each school to see how well they aligned with the competencies, whether they’re required or elective, and how many student hours are devoted to each. And then we did student focus groups in which students told us about their experience of the training, where they perceive gaps, and what’s working. We are about to publish papers on the curriculum mapping and focus groups.
And we’re already using what we’ve learned at our own schools. We’re working with the other medical schools in Massachusetts to provide positive peer pressure to each other and innovate in our programs to find ways to introduce students to the material outside of electives.
For example, at UMass we redesigned a third-year half-day so that students now practice having goals-of-care conversations in a simulated scenario using paid actors.
Our results have been encouraging so far. In the focus groups, many students had said, “We feel lucky if we get a chance to participate in a family meeting, or to work with palliative care.” And now that we’ve begun to implement new palliative care lessons, student evaluations have been very positive.
This project and its core competencies are centered around communication. Do you consider communication to be a proof of concept that you’ll use to eventually implement education around other palliative care skills?
There are a lot of different aspects of palliative care, but we ultimately landed on serious illness communication skills as a starting point because that is a major goal of the Massachusetts Coalition for Serious Illness Care, which is our executive sponsor.
It’s a good place to start because it’s a rich and complicated topic. In palliative care, we’re known as being experts in communication, particularly around serious illness. So it was in our wheelhouse to begin with.
We could eventually expand to another topic area. But I think communication skills are a fundamental part of professionalism — and of being an effective doctor. And it’s already a core competency of medical education in general.
With this project, do you hope to inspire other medical schools across the nation to implement palliative care into their general curricula?
Yes, absolutely — but with all humility. Every school has a lot on its plate, and we’re all doing the best we can with the resources we have. And we don’t claim to know what’s right for every school. We really just want to share our journey and the methods we’ve tried.
This is why we’re disseminating our work. We have manuscripts in the pipeline for publication.
We just presented at the Annual Assembly of Hospice and Palliative Care in Montreal, in March. We’re all about sharing our story, and we also want to be inspired by other medical schools.
Medical schools might struggle if they try to do this in isolation. The idea with the collaborative is to try to accelerate the process by supporting each other and sharing ideas and data.
What are you planning to do next?
We’re going to focus on faculty development. Palliative care doctors are seen as natural leaders in this space, but there are not a lot of us. So we need to develop a larger bench of faculty to teach on this topic — particularly folks who are not in palliative care.
It’s very powerful for students to see a primary care doctor, hospitalist, ICU doctor, or cardiologist having these conversations with patients. It models that effective serious illness communication is part of being a good doctor.
We will choose ten faculty from each school who are not necessarily in palliative care, but who are passionate about the topic, and good communicators, and we will invest in common training.
And then we will have created this great community of at least forty educators between our four schools who will have been trained with these goals. Ideally, they will keep in touch with one another after they reenter the health system as doctors and teachers. That will become a pipeline of ideas and innovations that can help grow curricula at each of our schools.