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Teach About "Advance Care Planning" Early During Medical Education - Update July 7

Presenting the topics of advance care and end of life planning into a medical student's education early may improve care in the long term.

Photo of Bettina Fliegel
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Who is your idea designed for and how does it reimagine the end-of-life experience?

The idea is to introduce and begin a discussion on "Advance Care Planning" during the 1st year Gross Anatomy Class of the medical school curriculum. During this class months are spent learning from a body willed for the purpose of education. This anatomical gift is based on a decision made by one during their end of life planning. After honoring the donor it seems an opportune moment to begin a conversation on EOL planning with students. Early education can have a positive impact over time.

Parting Gifts - Please watch this great video, linked to the article here.  (Click on the photo in the article to start the video.)  It is about the anatomical gifts program at Boston University Medical School.


When might we begin a meaningful conversation with medical students on advance care and end of life planning?                                                   

Most medical schools in the US teach anatomy via dissection of donated bodies.  The gross anatomy lab is a fundamental course taught during the 1st year of school.  Some students see the cadaver as their "first patient."  As each cadaver has been donated to a medical school as part of a person's end of life plan, might this be an opportunity to present this important topic for discussion?  As students honor those that made this amazing gift to their education might this conversation be presented as a first exposure to the topics of death, dying, advance care planning and end of life planning?   

Might bringing this conversation to students early in their education and building on it during their clinical training be a practical and useful approach, one that graduates physicians who are comfortable, knowledgable and prepared to have these necessary and important discussions with patients under their care?  Might this approach also move the conversation out into the community as students are open and eager to learn, and share what they are learning with others?

[Students are excited to learn and to apply what they are learning. They often apply what they are learning to their own experience.  They ask questions.  They will ask questions to others as they move forward in their clinical education.]


Might some of the great ideas presented on this challenge be useful tools when having conversations with medical students?  

@Death Over Dinner  - They are currently working on an edition for medical personnel.  

My Gift of Grace - Card Game  - mentioned in a comment in this post - @Social Advance Care Planning 


Update:  July 7, 2016

Implementation - Some thoughts on how and when to implement this work.

Two sessions at the end of the gross anatomy class can be held during which EOL planning and concepts related to this can be discussed.  Advanced directive forms, laws and their variation from state to state can be introduced briefly to give students an overview.  Students can be introduced to these concepts using the My Gift of Grace Card Game during class sessions, working in small groups.

Students can actively learn about this work.  How?

  • By interviewing each other, followed by a reflective writing exercise which can then be shared with the group.  They can also do a drawing exercise, such as graphic comics, also to be shared.  (Timing of this to be determined.  Does it belong in the Intro section in a Gross Anatomy Class or later in a course on interviewing skills and history taking?  Both?

(Thanks MK Czerwiec for your great build!)

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

Discuss this idea with physicians to see what their opinions are based on their own experiences with medical education, and comfort level as practitioners with EOL planning conversations with patients.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

It would be great to get feedback from other medical practitioners on this challenge. It would be helpful to connect with anyone involved in medical student education at this time.

Tell us about your work experience:

I work in healthcare as a pediatrician. I have experience as a clinician, teacher and as an administrator/ program director.

This idea emerged from

  • An Individual


Join the conversation:

Photo of MK Czerwiec

This is great, Bettina. Very practical, very do-able. Excellent idea and plan. 

Photo of Bettina Fliegel

Thanks!  Do you think that 2 sessions work, and at the end of the course? Any other thoughts on how to incorporate it?  

Photo of MK Czerwiec

I'm envisioning the students in pairs, interviewing one another about each other's end of life planning, perhaps challenges they might anticipate having the conversation with their own families and patients,  then writing a reflective bit about the experience. Also, along the way, they could be learning about what forms are involved to document wishes, how laws vary between states. Being that I teach Graphic Medicine, I also would love to see the students draw about the process, perhaps a few panels of a comic in which they script an EOL wishes conversation, rather than just using text. 

Photo of Bettina Fliegel

This is great feedback!  Thank you.
I am not sure if this fits at this stage, or maybe later on in a more clinical rotation, but either way the scenario is great for this work.  I was thinking that at this stage intro to the fact that there are forms and laws that vary would be part of the conversation.  Going further into depth might be great during a course on Interview and History taking techniques.  All to be worked out but this is definitely great!  In the past I taught students in an Intro to Primary Care Course.  Many of the modules were on Interviewing and History taking -   How to take a developmental hx in pediatrics, how to take a dietary hx, how to take a sexual history, etc.  This can fit into a course like that for sure.  The process in that course was to meet as a group first, present the topic and do an exercise together.  I matched each student with a volunteer patient in our health center.  After they did their hx taking exercise we had a group meeting where each was able to reflect.  I love the idea of adding writing, and comic drawing!  I also like the idea of pairing students for this work in particular!  It would be great to incorporate this idea fully into the anatomy course.  I think students would love to have the opportunity to do interviewing exercises in classes early and often!  Great stuff!  I will update the post with these ideas!
Thanks again for the great build!

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