If death is part of life and dying is seen in all practices of medicine, why isn’t palliative medicine and palliative care more prominent in the medical school curriculum?

Many medical students graduate from universities across Australia with no or limited exposure to palliative care. In response to this, Townsville Palliative Care Service recently introduced an opportunity for medical students to increase their exposure to palliative medicine. This opportunity involves a formal rotation for all sixth year James Cook University medical students to complete a placement at the palliative care unit. The service provided placements for groups of four to six students every two weeks over the academic year.

Michael Doris, sixth year James Cook University medical student, said the experience was invaluable and an important learning outcome for his professional development.

“It is an extremely valuable experience, with skills that are useful across almost all aspects of medicine. At the very least, it highlights the importance of continuing professional development in areas of communication and empathy, areas that continue to be challenging for many clinicians.

“I have learnt more from a two and a half week experience in palliative care than many six week rotations during my medical training, both in terms of the medical management involved with end-of-life-care, as well as standards of professionalism and communication with patients.

“It has made me consider my own impressions of death and the role of palliative care specialists- knowledge which will put me in good stead for future rotations and referrals to the team.” Mr Doris said.

Similarly, associate Maria Shilova, emphasised the key aspects of her learnings from the placement and reflected on the knowledge she gained.

“The overall rotation was useful in preparation for internship, as palliative care skills are important for any specialist to be well-versed in.

“The most useful lessons were how to talk to patients about death, dying and similar topics, and learning how to approach a patient’s management from a Palliative Care perspective,” Shilova said.

Director of the Townsville Palliative Care Service, Dr Richard Corkill expressed the importance and benefit for students completing a rotation at a palliative care service.

“James Cook University students will be better prepared for palliative care issues they are likely to experience in their early years as a doctor. By covering verification of death and talking about the communication that is needed around this, future students will be better equipped for these difficult situations.

"Given that death affects everyone in our society, we believe that palliative care and end of life care clinical placements should be included as part of mandatory requirement at all medical schools,” Dr Corkill said.

Dr Corkill also highlighted the impact the placement would have not only on the student’s development, but also on the quality of life for future palliative care patients.

“This palliative care experience will likely improve quality of care and improve the quality of life through better symptom management for all patients in the future. This could decrease the risk of expensive treatment by enabling better communication and understanding of patient’s wishes and what is important to them in the future with more advance care planning,´ Dr Corkill said.

Medical students were exposed to clinical palliative care and palliative medicine processes a formal clinical setting. The students gained experience across all facets of end-of-life care including: anticipatory prescribing, safe and legal criteria for opioid prescribing, advance care planning, verification of death and death certification. The students completed their placements across various sections of the unit which included inpatient ward rounds, clinics, consult liaison, and home visits to support occupational therapists, physiotherapists and the community senior medical officer.

The students were also encouraged to engage with educational opportunities that were available at the unit which encompassed grand rounds, clinical decision meetings, mortality and morbidity reviews, escalated mortality meetings or renal/palliative care clinics.

This palliative care placement was a rewarding and important learning opportunity for all students involved from both a personal and professional perspective. The program is likely to continue to develop in future and aim to educate more students on the importance of palliative care and palliative medicine.