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Biomedical subjects

D E Weissman

Publications and source records attributed to D E Weissman.

At least 37 records · Page 2Linked to original sources
PubMed1999

Recommendations for incorporating palliative care education into the acute care hospital setting.

This article presents recommendations for improving the education of physicians about end-of-life care in the acute care hospital setting. The authors, who have a variety of backgrounds and represent several types of institutions, formulated and reached consensus on these recommendations as members of the Acute Care Hospital Working Group, one of eight working groups convened at the National Consensus Conference on Medical Education for Care Near the End of Life in May 1997. A recently published literature review on the status of palliative care education, a summary of recent research on education about end-of-life care, and expert opinion were helpful in developing the recommendations. The authors emphasize that the acute care setting offers many opportunities for education about care at the end of life. Faculty should support learners' appreciation of the importance of end-of-life care, and convey the meaning and privilege of attending to patients and families at this difficult time. Faculty should teach students and residents to provide care that embodies attention to the control of distressing physical, physiologic, and spiritual symptoms, appropriate awareness of patients' differing cultural backgrounds and their impact upon the experience of dying, excellent communication skills, the application of bioethical principles, timely referral and smooth transition to other care settings that meet patient and family goals, and the role of the interdisciplinary team in meeting the diverse needs of dying patients and their families.

Education, Medical, Continuing↗
PubMed1998

A survey of competencies and concerns in end-of-life care for physician trainees.

A survey was developed to explore physician trainee competencies and concerns surrounding end-of-life care. Thirty-one medical students, interns, and residents from the Department of Internal Medicine completed the survey in August 1996. The survey instrument found differing levels of competence/concern among medical students, interns, and residents. Self-reported competence increased with level of training. All trainees indicated the least comfort around discussions of hydration and feeding withdrawal. Both residents and interns indicated concern about potential illegality, breach of ethics or potential malpractice when reviewing eight currently legal and ethical end-of-life scenarios involving pain management or treatment withdrawal. Pain management, ethical issues, and delirium were the top three topics for which residents indicated an interest in future educational sessions. Results from the survey will be used to guide the development of educational initiatives that address trainee concerns. The competence/concern survey adds an important dimension to understanding how best to incorporate end-of-life education into residency training programs.

Clinical Competence↗
PubMed1998

Integration of palliative medicine at the Medical College of Wisconsin 1990-1996.

Palliative medicine is an emerging world-wide discipline. This article describes efforts at the Medical College of Wisconsin (MCW) to develop programs to enhance palliative medicine education and clinical care. New courses, seminars and clinical programs have been developed. Education and clinical care activities since 1990 have included a required course for second-year medical students, clinical electives for third- and fourth-year medical students, a clinical palliative care consultation service, a palliative care seminar series designed for housestaff, and a nurse preceptorship program. Palliative medicine activities have included both the academic medical center and community health agencies. MCW has integrated palliative medicine into its academic environment so that trainees at all education levels now have opportunities for didactic and clinical end-of-life care education.

Education, Medical, Graduate↗
PubMed1998

A faculty development course for end-of-life care.

A faculty development course was offered at the Medical College of Wisconsin to bolster existing medical student and housestaff training opportunities in palliative medicine. An 8- week, 12 contact-hour course was designed to provide up to 15 faculty members training in the practice and teaching of end-of-life care. Fifteen faculty registered, but only 10 attended at least three of eight educational sessions. Educational formats included didactic presentations, case studies, study guides and completion of action plans-explicit plans for utilization of newly learned material in clinical and educational practice. In a retrospective, pre/post self-evaluation, participants indicated poor or fair precourse knowledge and self-confidence in most areas of end-of-life care. Significant improvement in end-of-life knowledge and selfconfidence was noted for eight of 11 content areas and in self-assessed education skills in six of seven content areas. Although attendance was disappointing, the course was strongly endorsed by participating faculty. Faculty who attended at least three sessions reported significant improvement in many aspects of end-of-life clinical care, as well as in self-confidence and education skills, and were able to use the educational material to train a range of learners. Sample educational material is included with this report.

Journal Article↗
PubMed1997

Consultation in palliative medicine.

Palliative medicine is an emerging medical discipline in the United States, modeled after similar efforts in Great Britain, Australia, and Canada. Increasingly, academic medical centers are starting clinical programs in palliative medicine including inpatient consultation services. A description of the essential components of a palliative medicine consultation is presented, based on the author's experience of more than 600 patient encounters at the Medical College of Wisconsin in Milwaukee. A palliative medicine consultation consists of 6 features: assessment and management of physical symptoms; assisting patients to identify personal goals for end-of-life care; assessment and management of psychological and spiritual needs; assessment of the patient's support system; assessment and communication of estimated prognosis; and assessment of discharge planning issues.

Home Care Services↗
PubMed1997

A role model program to promote institutional changes for management of acute and cancer pain.

This report describes an 18-month project to make acute and cancer pain management an institutional priority in Southeastern Wisconsin health-care facilities. Facility-based teams, each of which included a nurse in a leadership position, were recruited to participate in a project based on the Cancer Pain Role Model Program. The project was conducted in three stages: (a) a 1-day conference focusing on basic pain management issues and clinical standards, (b) a preceptorship at the Medical College of Wisconsin, and (c) a follow-up conference focusing on institutional change. Participants completed an Action Plan, outlining activities aimed at changing practice in their facility. Participants from 17 of the 32 participating facilities partially or completely met their Action Plan goals. Lack of ongoing facility commitment, staff turnover and facility closures were cited as reasons for failure to meet goals. Nurses in key positions, provided with strong institutional commitment and given suitable educational training and nurturing, are ideally suited to help facilitate changes in institutional pain practices.

Acute Disease↗
PubMed1996

Teaching cancer pain management: durability of educational effects of a role model program.

BACKGROUND: Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions. METHODS: Fifty health-care providers (13 physicians, 21 nurses, and 16 pharmacists), working as a team, participated in a Role Model Program that presented principles of cancer pain management. A questionnaire that evaluated the fund of knowledge and attitudes regarding cancer pain management was administered prior to the 1-day workshop, at the end of the workshop, and at 4 and 12 months follow-up. The workshop consisted of lectures and discussion groups; in the discussion groups, concepts were clarified, cases presented, and barriers to optimal cancer pain management identified. RESULTS: Significant improvements in attitudes (P < 0.01), knowledge (P < 0.01), and total scores (P < 0.002) were observed when the preworkshop responses were compared with those obtained immediately after instruction. Scores on the questionnaire were the same or slightly better at both 4 and 12 months in follow-up, demonstrating no loss in acquired knowledge or attitude. Comparison of the postworkshop scores with those at 12 months follow-up were significantly better in attitude (P < 0.03), and in total score (P < 0.01); improvements in knowledge also approached significance (p < 0.06). These represented continuing improvements because significant differences in the attitude scores (P < 0.05) and the total score (P < 0.05) were observed when the 4-month and 12-month follow-up responses were evaluated. The effectiveness of the program in the transference of knowledge was also measured; in the first year of the program, more than 4500 health-care professionals were subsequently informed about cancer pain management from the Role Model Participants. CONCLUSIONS: Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.

Analgesia↗
PubMed1996

Palliative medicine nurse preceptorship at the Medical College of Wisconsin.

This article describes a 3-day nurse preceptorship education program in cancer pain and palliative medicine at the Medical College of Wisconsin (MCW). The program includes experiential and didactic information skills development, and assistance with planning for institutional change in the delivery of health care services. The education program is centered around five teaching modules: pain, nonpain symptoms, hospice, nursing professional issues, and palliative care. Evaluation data from a recent cohort of 23 nurses demonstrate that learning and personal objectives were met to a high degree of satisfaction.

Education, Nursing, Continuing↗
PubMed1996

Cancer pain education for physicians in practice: establishing a new paradigm.

Traditional education methods for physicians have failed to impact positively upon cancer pain clinical practice. This article presents a new paradigm for physician cancer pain education based on principles of adult learning and physician behavior theory. Three key issues that weave together education and institutionalization issues are reviewed: (a) how to make physicians aware that their current practice behavior is less than optimal; (b) how to match education objectives with appropriate education formats; and (c) how to change pain management practices without imposing new burdens on physician practice.

Adult↗
PubMed1995

Update on the cancer pain role model education program.

Application of traditional educational methods has done little to improve cancer pain management in the United States. This report details the results of the first year of the expanded Wisconsin Cancer Pain Initiative Role Model Program, a novel approach to cancer pain education. One hundred and ninety-six physicians and nurse educators together with their clinical partners attended one of three role model conferences in 1992-1993 and developed Action Plans detailing their proposed educational goals. Results indicate that participants demonstrated significant improvement in cancer pain knowledge as a result of the 1-day conference. Within 12 months of the conference, 64% of Role Model teams completely or partially met their Action Plan goals. In total, 227 educational or clinical practice projects were completed. The Cancer Pain Role Model Program represents an excellent educational program for disseminating cancer pain information and instituting positive changes in clinical practice.

Education, Medical, Continuing↗