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Monday, September 10, 2018

The Future of Hospice and Palliative Medicine Starts with Medical Students

by Kayla Sheehan (@kksheehan)

My first day of medical school, I asked the Dean how to start a Hospice and Palliative Medicine Student Interest Group (SIG). Before I became a medical student, I began volunteering for hospice. It changed my life. I learned invaluable lessons about life, death, and healing throughout my nearly five years as a hospice volunteer and I realized these lessons would not be taught in a classroom. Three years into medical school, we are one of the most active groups on campus, and we continue to grow.

Assembling the group was not as difficult as one might think. The biggest hurdle is many students simply don’t realize this is something they should know about, and because HPM is a blind spot for faculty as well, it gets left out of an impacted curriculum. How and when are students supposed to learn about these things if there is no time or place for them? In our case, it came down to a spark of initiative, which caught on with persistence. As a medical student with hospice experience, I understood the anxieties my peers might have when it came to caring for people who are very sick or terminally ill. Clearly, the majority of my classmates were not aiming for careers in hospice or palliative medicine, but there are many specialties which can be enhanced with early exposure to HPM.

At least once a month, our group meets to discuss topics such as grief and loss, advance care planning, and death with dignity. We’ve teamed up with other interest groups to broaden our audience, and have held “cross-talks” with our emergency medicine, internal medicine, and oncology interest groups. Our next meeting is a triple cross-talk with surgery and oncology. When we meet, it not only introduces the topic of palliative medicine to a group of students who have likely never heard of it, but also allows them to discover for themselves why this is something they should know about, and something they will likely use in some capacity in their specialty of choice.

Though these talks are invaluable, I know from firsthand experience that some of HPMs most powerful lessons are learned at the bedside. I have been working with local hospices to find a way to get students trained as hospice volunteers. Though it is difficult to motivate the majority of medical students to do anything other than study, many of us crave interaction with the human side of medicine, and jump at the chance. When I was a volunteer, we had to commit to four hours a week minimum. Because this is not possible for medical students, flexibility from the hospice is key.

The HPM SIG also serves as a springboard for research, which is another opportunity for students to directly engage with the field, and maybe meet a mentor along the way. Our University does not have an affiliated hospital, but we have been involved with research projects done by our neighbor UC Davis’ fellows, and a few from other local physicians as well.

Importantly, this group costs nothing, only time, effort, and lots of e-mails. It is a passion project that would not exist without nurses, social workers, and physicians volunteering their time to come speak to us. Despite the minimal cost of running such a group, very few exist in medical schools. It is no secret that there is a scarcity of hospice and palliative physicians, and that dearth will only become more apparent as our population ages. Student interest groups have the potential to not only recruit future hospice and palliative physicians, but also to educate their colleagues in training on what hospice and palliative medicine is, and when to use it.

At the end of our M2 year, a lecturer said something along the lines of “palliative medicine is only for the terminally ill,” after which dozens of my classmates’ heads snapped back in my direction, recognizing the error. I could have burst with pride. When we graduate, I may be the only one headed for HPM, but 90 physicians will be going into the world with at least some knowledge of what hospice is, what palliative medicine is, how they overlap and differ. It may not singlehandedly solve the HPM physician shortage, but it is a step in the right direction. Does your local medical school have an HPM SIG? If yes, add it to the comments, and share what you have been doing with it. If no, what are you waiting for?

Kayla Sheehan is a third-year medical student at California Northstate University. She enjoys singing, sharp cheddar, and long walks with her Australian Shepherd, Posey.

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