DorAnne Donesky, PhD, ANP-BC, ACHPN, of University of California, San Francisco School of Nursing, shares what it takes to develop an interprofessional center for palliative care education.
Palliative care improves management of pain and other symptoms to help patients and families cope with serious illness, and ensures that treatment plans align with patient and family goals. The core professions contributing to palliative care are medicine, nursing, social work and spiritual care. Health care educators only recently have included a focus on palliative care in pre-licensure education; consequently, most practicing clinicians have received inadequate education in palliative care. A needs assessment we conducted with local health care employers here in the San Francisco Bay Area revealed that they desire clinical palliative care applicants to have practical training in working with other health professions and advanced communication skills.
Currently, most university and continuing education courses are brief and designed by and for a single profession, although these courses may have enrollment open to all professions. In contrast, at UCSF, the Longitudinal Interprofessional Learning Experience in Palliative Care for Practicing Clinicians (Practice-PC) program I lead is a foundational course designed to serve as the first step toward developing a consortium of regional centers for team-based palliative care education. This emerging program is building teamwork across the four core professions, developing a local community of practice, and advancing clinically-oriented education. It is our hope that other schools and institutions working to improve their palliative care education programs can learn from our efforts.
Building Your Program: The Secret Sauce
All phases of curriculum development for Practice-PC (https://nursing.ucsf.edu/palliative-care/continuing-education) are designed through a team-based process with faculty from all of the core professions of palliative care and pharmacy at the table. Beginning with topic selection and continuing through curriculum design and learner selection, the interprofessional Practice-PC faculty work together to make all major decisions and set the direction for the program. We quickly found that the direction of the course was distinctly different and much improved when we took the time to reach consensus on major decisions together.
This sounds so simple and obvious as a way to design interprofessional education, but it actually requires commitment far beyond what it takes for a single profession to build a course. Although we all work together on a day-to-day basis, we often work side-by-side in “parallel play” rather than truly engaging each other and seeking each other’s expertise. We discovered in building Practice-PC that we had a lot to learn from each other and we had to move from being reticent about another profession to being curious about it. Turns out that pharmacists have a lot to say about psychosocial assessment and interventions for patients with serious illness; and social workers and chaplains are very interested in providing a new perspective on assessing physical symptoms. Both social workers and chaplains are focused on team resilience and professional wellbeing to optimize patient care; physicians are interested in the complexities of physiology in health and illness; social workers have a unique perspective on the effect of the environment on health; and nurses are interested in ensuring that the health care system enhances the patients’ and families’ quality of life over time. It takes time to explore and understand these sometimes seemingly conflicting points of view.
The Student Experience
UCSF student surveys consistently support a preference for in-person education. For example, we heard from one student, “I would have attended elsewhere if I wanted an online education.” Knowing this, we are building the Practice-PC program so that participants meet together once a month where they can reflect on their own profession while learning about others, and then with the support of their peers, mentors, and volunteer faculty from the strong palliative care community that exists in the greater San Francisco Bay area, they are able to implement the Practice-PC palliative care principles in their own work settings in an iterative supported process during the 10 months of the program. For example, a nurse practitioner who had just been hired to start a palliative care program in a community hospital attended Practice-PC during the first pilot year of the program. Her program development process mirrored the content she was learning at Practice-PC, and she was able to bring questions and concerns to Practice-PC for discussion and expert consultation. When she completed Practice-PC, she was equipped with resources and personal connections for ongoing support of her project. Practice-PC graduates like this nurse practitioner become mentors and facilitators for others joining the UCSF interprofessional palliative care community of practice. We see this sense of community and teamwork happening across the professions, whether it’s an advanced practice nurse minoring in palliative care, or our practicing clinicians seeking continuing education credits, the interprofessional network builds trust, community and partnerships.
Plans for the Future
UCSF is home to an innovative palliative care clinical team that includes leading palliative care research scientists. However, interprofessional palliative care education was a missing piece of the UCSF palliative care portfolio. Practice-PC remedies this gap.
Within the next five to ten years, the faculty of Practice-PC expect to staff a thriving regional Center of Interprofessional Palliative Care Education that will serve as the flagship for a consortium of regional centers across the country. The centers will share a vision of excellence for team-based palliative care education and work together to generate educational scholarship focused on curriculum development and evaluation. In addition to Practice-PC, interprofessional clinical fellowships will be offered alongside the already existing medical fellowship in palliative care education. My colleagues and I are dedicated to the highest standards of excellence in building the palliative care workforce that is so desperately needed, and developing reproducible models of palliative care education to help get us there. In the end, it is all about providing care for patients with serious illness and their families. Programs such as Practice-PC ground clinicians from multiple professions in palliative care principles so they are ready to care for those patients and families with the highest levels of quality when serious illness occurs.