With the over-65 population in the U.S. projected to nearly double by 2050, end-of-life care is more important than ever. Recognizing this need, Medicare recently announced plans to start reimbursing physicians for talking about advance care planning with patients early next year.
Here’s how two osteopathic medical schools are training future physicians in end-of-life care.
Focus: Quality of life
Students at the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey, study end-of-life care during all four years of medical school. After taking part in a weeklong seminar on pain management, death and dying, and addiction during their second year, third- and fourth-year students complete rotations in geriatrics, pain and palliative care at the New Jersey Institute for Successful Aging, which is based at RowanSOM.
Students also learn osteopathic manipulative techniques to relieve pain and provide comfort. “We’re training our future physicians to be well-equipped in caring for the whole person, relieving suffering, and enhancing quality of life, even at the end of life,” explains Thomas A. Cavalieri, DO, RowanSOM’s dean.
Learning strategies for sharing news of the traumatic death of a loved one was an especially valuable part of the death and dying seminar, says Shruti Goel, OMS II. “We learned to present the information sensitively and clearly, as well as how to deal with our own psychological state,” she notes.
Nursing home immersion
Each summer, several students from the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine, are admitted to a nursing home with a faux diagnosis. They spend about two weeks living as residents, eating pureed foods and journaling about their experiences.
The research project, dubbed Learning by Living, was created by UNECOM professor Marilyn R. Gugliucci, PhD. It’s now in its ninth year and includes 14 nursing homes in four states; 35 medical students have participated in total. “Students feel they don’t come out the same person,” Dr. Gugliucci says. “They connect heart-to-heart with the residents and often don’t want to leave their nursing home friends at the end of the project.”
Ianna Hondros-McCarthy, OMS II, lived at the Edgewood Centre in Portsmouth, New Hampshire, this summer as part of the project. She struggled at first to adjust to the lack of control and independence, but soon came to enjoy the community spirit and positive outlook of many fellow residents. Observing the care provided by the center’s medical director, Sarah MacDuffie, DO, reinforced her understanding of the osteopathic philosophy of treating patients as unique individuals, she says. “Patients are going to have different needs, expectations and desires for themselves, and it’s really important to ask them about them,” she notes.
Hospice home lessons
Dr. Gugliucci runs a second immersion program in which pairs of med students spend 48 continuous hours in a hospice home observing the care involved in guiding patients through the final stages of the dying process. Eighteen students have completed the hospice program since it launched last year. One of the students’ biggest takeaways, Gugliucci says, is that touch can be a powerful healing tool. They also learn that listening can be a potent way of communicating. “We’re trying to create learning environments where students truly get it,” Dr. Gugliucci explains. “I’m not convinced we can do that in a classroom to a degree that it rocks their soul.”