Admitting they do an inadequate job of training future physicians in end-of-life care, New York state's 14 medical schools recently announced they will collaborate on ways to improve.
Their initiative marks one of the potentially more significant measures nationally to correct what many believe is a dearth of education in palliative care. New York accounts for about 10% of all medical students and 15% of the nation's residency slots, says Frank Jones, executive director of the Associated Medical Schools of New York, a consortium of the 14 schools' deans.
The move was prompted by a blue-ribbon panel of medical professionals assembled by New York state Attorney General Dennis Vacco. The panel, called the Commission on Quality Care at the End of Life, is charged with identifying barriers to effective end-of-life care. It will hold a public hearing Sept. 3 and is expected to issue a final report next March.
Last month the commission surveyed medical schools in the state on their curricula. Surveys returned as of last week show that some schools addressed end-of-life issues in multiple courses while others "really didn't offer anything," says Lucia Valente, Vacco's chief special counsel.
"I'm thrilled about their initiative. That's all you need to do is shine a little light on the problem," Valente says.
Focusing on end-of-life care could present medical schools with hefty challenges, such as fitting new material into already-crowded curricula and identifying qualified people to teach it, says Herbert Pardes, M.D., president of the Associated Medical Schools. Pardes is also the dean of Columbia University College of Physicians and Surgeons.
Nevertheless, Pardes says, "If the schools say, `This is important,' I think the medical students will respond."
Schools such as Columbia and Albert Einstein College of Medicine integrated palliative care into their curricula and training years before the hype about physician-assisted suicide. They say more attention now needs to be paid in the field, in clinical training and in residency programs.
Columbia is looking at offering third- and fourth-year students more opportunities to work with terminal patients in hospitals, hospices and homes.
Michael J. Reichgott, M.D., associate dean for students at Albert Einstein, believes medical schools should teach basics like the role of a hospice and the concept of palliative care. But he believes the real business of end-of-life care should be taught in residencies, where students can discuss ethics and personal care on a case-by-case basis.
Those arenas, however, are not as easy to control as the classroom.
Pain control can be taught in a month, but kindness takes much more time, and sometimes it's never learned, says James E. Cimino, M.D., clinical professor of medicine at New York Medical College in Valhalla and director of the palliative-care institute at 200-bed Calvary Hospital in the Bronx.
One overlooked problem, Cimino says, is that residency programs lack sufficient supervision. Another is cutbacks in hospital staffing. If those factors aren't corrected, he says, physicians who do learn sympathetic attitudes in their early training could quickly forget them in practice.