Palliative care is explicitly recognized under the human right to health. It should be provided through person-centered and integrated health services that pay special attention to the specific needs and preferences of individuals(1).
The development of palliative care is difficult in many areas of the world, including in Romania. The need for training to gain skills in palliative care by medical students is obvious and has been highlighted in studies. The existence of a postgraduate specialization is controversial, palliative care requiring a team of specialists in various fields. That is why every country has its palliative care education system. In my opinion, palliative care should be studied both during and after graduation for those doctors who want to work in palliative care. The so-called “trainers” had a role especially in underdeveloped countries, and currently, palliative care must be learned at the university level, taught by academic staff.
University education for students in palliative care is different from country to country.
“Undergraduate palliative care education (UPCE) for medical students shows wide variation throughout Europe and internationally. In 2015, palliative care was compulsory in only 14% of countries; only 30% of European medical schools taught palliative care. Medical curricula did not include palliative care in 14 countries (33%)”(2).
In the UK, the General Medical Council requires that newly qualified doctors “contribute to the care of patients and their families at the end of life, including management of symptoms, practical issues of law and certification, and effective communication and team work”(2).
“Palliative medicine is the medical branch of the inter-professional approach known as palliative care. Because the doctor-patient relationship itself is the key to good palliative medicine, family physicians are ideally suited to providing palliative care. Physicians do not need to be palliative medicine specialists to provide excellent palliative care. This truth, however, does not eliminate the need for physicians who focus exclusively on this domain and possess specialized knowledge and skills in the care of patients with complex palliative needs. An argument in favour of palliative medicine being a specialty is not an argument against the ability of, or need for, family physicians to remain the primary providers of palliative care in Canada. Palliative medicine should, in fact, be considered a subspecialty in Canada. In European and US studies, we found that the process of university curriculum renewal provided a critical opportunity to integrate palliative care content, but needed a local palliative care champion already in place as an energetic and tireless advocate. The development and integration of a substantive bilingual (English and French) palliative and end-of-life care curriculum over the four-year medical undergraduate program at our university has occurred over the course of 14 years, and required multiple steps and initiatives. Subsequent to the development of the curriculum, there has been a 13-fold increase in students selecting our palliative care clinical rotations. Critical lessons learned speak to the importance of having a team vision, interprofessional collaboration with a focus on vision, plans and implementation, and flexibility to actively respond and further integrate new educational opportunities within the curriculum. Future directions for our palliative care curriculum include shifting to a competency-based training and evaluation paradigm. Our findings and lessons learned may help others who are working to develop a comprehensive undergraduate medical education curriculum for family physicians to remain the primary providers of palliative care in Canada”(3).
The Royal College of Physicians and Surgeons of Canada (RCPSC) identifies five criteria for the recognition of a subspecialty of palliative care:
- “A subspecialty has an in-depth body of knowledge beyond the scope of the foundational specialty.
- A subspecialty has identifiable competencies that build on foundational specialty training.
- There must be evidence of a need for subspecialists.
- The change in scope of practice must not adversely affect any field of medicine.
- There must be adequate infrastructure to sustain the subspecialty, including a professional organization and recognition in other jurisdictions”(3).
“The generalist-plus-specialist palliative care model is endorsed worldwide. In the Netherlands, the competencies and profile of the generalist provider of palliative care has been described on all professional levels in nursing and medicine. However, there is no clear description of what specialized expertise in palliative care entails, whereas this is important in order for generalists to know who they can consult in complex palliative care situations and for timely referral of patients to palliative care specialists.
This scoping review provides an overview of roles and competencies that define and describe the palliative care specialist. For both nursing and medical professionals in palliative care, five roles were identified: care provider, care consultant, educator, researcher, and advocate. Leadership qualities were found to be pivotal in all roles identified for the palliative care specialist. This overview creates a broader and more lucid understanding of the added value of the palliative care specialist, and helps to position specialists in different healthcare settings. Finally, clarity about the required roles and competencies of palliative care specialists is pivotal to strengthen the curricula of palliative care training and education”(4).
The existence of small palliative care departments in large university hospitals, as provided by the ESMO initiative, is a way that has been embraced by over 250 medical centers in the world. In these centers, academics teach palliative care to students and doctors at the beginning of their careers. In Romania, after 20 years of attempts, one or two centers have appeared trying to put the ESMO criteria into practice. However, it is a misunderstanding at the administrative level of the issue of palliative care. There is also a lack of education of the population in this regard, especially when it comes to the transition from curative medicine to palliative care. I think that the good organization of education in palliative care will lead to a real change for the better in this medical specialty, which is essential for a performing medical system.