When internal medicine-pediatrics resident Sam Lazaroff, MD, was discharging a patient who had a recurrence of cancer, he quickly realized her loved ones did not understand the severity of her diagnosis and what would be required for her best care after she left the hospital.
Lazaroff had been attending lectures and using the online resources of the new Vanderbilt Palliative Care Education Curriculum (PCEC) developed by Vanderbilt University Medical Center’s Palliative Care Program, and he quickly fell back on this specialized training to speak frankly with the patient and her family about what they could expect and what resources would be beneficial for her moving forward.
“I’m really proud of the way I was able to advocate for that patient and educate her family; it would not have been possible without this program,” Lazaroff said. “I received practically zero formal training in palliative care as a medical student and even in the early years of my residency. And yet, I’ve found that palliative care is an enormous part of what I do while working in the hospital. The job of discharge planning on internal medicine services falls to the senior resident, and I’m more confident in my ability to help coordinate hospice or simply talk through difficult situations with patients and families as a result of the PCEC curriculum.”
Palliative care is the care of individuals with a serious illness at any point in the course of their medical journeys, and it focuses on decision-making, symptom management and making use of supportive resources including hospice services. While all clinicians need basic palliative care skills to take the best care of patients, exposure to education in this field — for medical students, residents and even long-standing medical faculty — has been limited.
Maie El-Sourady, MD, assistant professor of Internal Medicine, Pediatrics and Palliative Care and director of Palliative Care Education, is keenly aware of this gap. She also knows it’s impossible for members of VUMC’s palliative care team to always be physically present when patients and families, in both inpatient and outpatient settings, face difficult decisions.
Because of this, El-Sourady developed the PCEC program to work with residency and fellowship programs throughout the Medical Center to identify and address the specific palliative care education needs of their trainees. Three residency programs — urology, internal medicine and internal medicine-pediatrics (Med-Peds) — were a part of the initial rollout of the curriculum earlier this year. The program includes both lecture-based and workshop learning as well as online resources.
“There is specialty-level palliative care, provided by those who have been trained in this field through fellowships or other training,” said El-Sourady. “They tend to work as consultants or as hospice medical directors. But everyone takes care of seriously ill patients, so there’s a certain amount of palliative care that every clinician does. This is really a way to build a community around individuals who aren’t necessarily interested in becoming a palliative care specialist, but who are interested in becoming the person who knows the most about palliative care within their specialty.”
Kristen Scarpato, MD, program director for the urology residency program, also did not receive much formal training on palliative care during medical school but said her collaborations over the past several years with the VUMC palliative care team have made her a better physician.
“My communication skills have improved,” Scarpato said. “Just like perfecting a surgical skill, improving communication takes deliberate practice and proper preparation for each encounter. Palliative care can improve quality of life for many of our urologic patients, and urologists should have some baseline understanding of this skill set.”
Scarpato, in collaboration with her palliative care colleagues, is educating urology trainees through monthly journal review, shared conferences and a rotation with Palliative Care in the third year of residency. With the skills and knowledge she’s gained, Scarpato has also led conferences both inside and outside VUMC on palliative care topics in urology.
“As a specialty, urology has recently made palliative care education a priority on the national level, which has been great to see,” she said.
Plans for rolling out the palliative care curriculum were already underway when the COVID-19 pandemic hit, El-Sourady said, causing in-person lectures and workshops to be converted to virtual events. And the importance of offering such training was underscored.
“People are talking about death and dying more, and if you hadn’t already had experiences with critically ill people as a trainee, you certainly had it during the pandemic,” she said.
The curriculum is designed to run in six-month cycles, with real-time feedback driving to any needed refinement along the way, El-Sourady said. Her goal is that medical specialties throughout the Medical Center will have primary experts in palliative care, buoyed by the PCEC training, and those individuals will form a community to share their experiences and successes, always supported by the specialists in the Palliative Care Program.
Programs interested in bringing PCEC to their specialty should email El-Sourady at maie.el-sourady@vumc.org.
