Educating Future Physicians in Palliative and End-of-Life Care
Updated June 2018
A competency-based model of medical education is being integrated across the trajectory of medical education in Canada — from undergraduate, to postgraduate, to continuing professional development — as a way to ensure that Canadian physicians have the skills and abilities required to provide safe and effective medical care, and to guide lifelong learning, where physicians’ skills and abilities evolve along with changes in healthcare and in response to patients’ and societal needs.
Original EFFPEC Project (2004-2008)
In 2004-2008, national undergraduate competencies for palliative and end-of-life care were developed through a project called Educating Future Physicians in Palliative and End-of-life Care (EFPPEC). The project was funded by Health Canada and was led by the Canadian Hospice Palliative Care Association (CHPCA) in partnership with the Association of Faculties of Medicine of Canada (AFMC), the Canadian Society of Palliative Care Physicians (CSPCP), and the faculties of medicine at Canada’s 17 medical schools. The goal was to graduate every medical student with the knowledge, skills and attitudes appropriate to meet patients’ primary palliative care needs.
EFPPEC Update Project (2017-2018)
In 2017, the project partners undertook a “refresh” process to reflect the changes in the practice environment, and to align to the 2015 CanMEDS framework. The CSPCP led content development and the validation process, with support from project partners AFMC and CHPCA. In alignment with transitions in undergraduate medical education towards a competency-based model, the revised EFPPEC document also provides the foundation for developing Entrustable Professional Activities (EPAs) in palliative care specific to medical students; the AFMC recently published EPAs for the transition from medical school to residency will guide the next steps in this important work.
Summary of key changes
- Shift from “palliative care,” which historically was provided at end of life primarily to individuals with cancer, to a “palliative approach to care,” which starts earlier in the course of a life-threatening malignant or non-malignant illness.
- Addition of competencies, or focused objectives, that address changes in the practice environment, including safe and appropriate use of opioid prescribing; recent changes in Canadian laws around Medical Assistance in Dying (MAiD); and the growing use of cannabinoids for symptom management.
- Considerations for pediatric palliative care.
Key steps in the refresh process
The updated competencies were developed through a multi-stage validation process that invited the following stakeholders to comment: members of the CSPCP Undergraduate Education Committee (which includes representatives from all 17 medical schools in Canada); Program Directors for palliative medicine, geriatrics, and family medicine at all of the medical schools in Canada; the Medical Council of Canada (MCC); the Royal College of Physicians and Surgeons of Canada (RCPSC); the College of Family Physicians of Canada (CFPC); the Collège des Médecins du Québec (CMQ); palliative medicine practitioners (including pediatric palliative care practitioners), palliative medicine residents and medical students. The competencies were validated by 60 individuals and organizations from across Canada. (See Appendix A.)
The EFPPEC Refresh Project Team
Dr. Anne Boyle – Chair, CSPCP Undergraduate Education Committee, McMaster University
Dr. Shirley Bush – University of Ottawa
Dr. Srini Chary – Board of Directors, Pallium Canada
Dr. Amanda Roze des Ordons – University of Calgary
Ms. Kim Taylor – Executive Director, CSPCP
Ms. Sharon Baxter – Executive Director, CHPCA
Dr. Sarita Verma – Vice-President Education, AFMC