Marilène Filbet, Associate Professor at Lyon University, Chair of the Palliative Medicine Department in CHU de Lyon Sud, France, and a former President of the European Association for Palliative Care (2005-2007). Marilène continues our special series celebrating the 25th anniversary of the European Association for Palliative Care.
Anniversaries are always a time for memories, and it seems to me that the first EAPC congress (held in Paris in 1990) was a really important event. A highlight for me was to see the French President and the Duchess of Kent as they walked in together at the opening ceremony. This was a strong, encouraging message for those like me struggling day after day to expand our very new palliative care unit, which had been built despite strong opposition from my colleagues. How many times was it said, “ We don’t need palliative care, we are doing it every day and very well too.” Yet, on the other hand, there were the nurses and other health providers who were very interested and asking for training.
At this time, training staff and building up services was a major task for palliative care teams, growing from the inner circle of the palliative care cancer patients to include patients with AIDS, neurological patients and older people We were also extending training to include not only physicians and nurses but also everyone involved in the care: social workers, psychologists, volunteers and pharmacists. If extended training is consuming a lot of resources for a newly developing service, it is also a way of building a network, to improve the quality of care, and to recruit the future leaders. Training is like sowing a small seed: at first it seems to sleep quietly and although you never know quite when it will happen, sometimes one will grow up. And this is a really good reward.
From the beginning, the EAPC was aware about the importance and value of education in palliative care and Derek Doyle, together with the educational group, published the first recommendation in 1992. The EAPC Steering Group on Medical Education recently updated the recommendations, which have now been published and widely disseminated. (You can download a copy here).
For the future of palliative care it seems to me that it is crucial to focus on education for physicians, as other health care workers are already aware of the need for palliative care and go spontaneously to training sessions. Physicians are often more reluctant; educated in medical school to cure, to ‘do’, with very little attention to care and symptom control, communication, and dying people. They often have prejudices about palliative care and their experience of end of life care has consisted of physicians who hold the hands of dying people with compassion, and nothing else; and it is only when they spend time in a palliative care unit during their training rotation that they change their views. It would be a huge step in the right direction if it became mandatory for all medical students to spend one or two weeks in a palliative care unit as part of their training. The recognition of palliative medicine as a medical speciality is also vital if we are to successfully incorporate palliative medicine into mainstream medicine, and at the academic level.
Recent research shows that early palliative care intervention increases the quality of life of patients and surprisingly the length of survival. But if we are to break down barriers and ensure greater access to palliative care for our patients it is vital that we provide more training for physicians.
To find out more…
The following EAPC task forces are all concerned with medical education in palliative care.
- Update of EAPC Curriculum in Palliative Care for Undergraduate Medical Education.
- EAPC Task Force on International Medical Education in Palliative Care – Research on Undergraduates (Pilot) iMEP-RU.
- Mapping of medical training and physician certification in palliative medicine in Europe.
- EAPC Task Force on Specialisation for Physicians.