Can you tell me why, in your opinion, is it important to focus on education in palliative care?
Unless you have education, unless you are training health care professionals, you won’t be able to provide palliative care. In the public health model of palliative care, education is one of the pillars, one of the foundation measures for the development of palliative care. Without a trained workforce, you can’t provide good quality palliative care.
It is also important to sensitise the public and policy makers, so education in palliative care is very broad and not just for health and social care professionals, and each aspect has an important part to play.
What educational activities are you currently involved in?
I’m involved in a variety of educational activities, because of the different roles that I have. As part of our project in Serbia, we were asked by the Ministry of Health to develop a strategy for palliative care education in Serbia, so we looked at providing training at different levels. We drew on the EAPC white paper on education, as the government is very keen to follow European guidelines. We need to be providing education at different levels. We need to train those who are already qualified, by providing continuing professional development, we needed to provide multidisciplinary training for doctors, nurses, social workers, psychologists, physiotherapists etc.
We’ve also been looking at undergraduate education. We’ve managed to get palliative care into the undergraduate curriculum in all the medical schools in Serbia. We’re also working on getting palliative care into the higher nursing schools and, in October, our first course in the undergraduate training for social workers will start. In future we’ll be looking at specialist level training for doctors, nurses, social workers etc.
Therefore, when you are looking at palliative care training for health and social care professionals, you are looking at the whole package of education: undergraduate education, continuing professional education, and specialist training.
With the International Children’s Palliative Care Network (ICPCN), we’ve been looking at using e-learning to try to increase access to children’s palliative care training. We undertook a needs assessment for children’s palliative care training needs across the ICPCN membership. From this, we’ve been developing e-learning materials for children’s palliative care so that training can be accessible to more people, for example in Africa, where the need for children’s palliative care is very high, and there are not many trained professionals. So we are working on making training available and accessible in an affordable manner.
We carried out a pilot study across a variety of countries and this went well. However, we found that the software and the materials we were using required quite a high bandwidth. So now we are reviewing the format so that it uses a low bandwidth.
I think that training needs to be available in different formats to increase accessibility. For example, I don’t think that e-learning should be a complete replacement for face- to-face teaching, or clinical placements. I think that a blended approach should be used to make training available to more people, and while some people are self-motivated and can learn through distance learning or e-learning, others need the face-to-face approach.
Then I’m a Professor at Makerere University in Uganda, and am involved in teaching on the BSc in palliative care run through Hospice Africa Uganda (HAU). At the moment HAU are developing a Masters programme in Palliative Care for accreditation through Makerere University. along with Hospice Africa Uganda.
So you are involved in a whole spectrum of palliative care education projects. Are there any common lessons you could draw out of your experience?
The key thing in education is to train people so that they are competent in the role that they are doing.
Another key thing, which might sound obvious, is that the people who are facilitating the courses must have experience in palliative care. In Serbia, only ten percent of courses can be taught by non-university staff, so we have had to train university staff in palliative care. Without clinical experience, it is very hard to be able to really teach with passion and communicate the philosophy of care. Students really prefer it and learn more when you can give examples and teach from experience.
Whilst the principles and philosophy of palliative care are similar wherever you are, you need to apply them within the individual context. So when you are using previously-developed palliative care course materials, it is really important to be aware of the cultural context to which these principles will be applied, as well as the context in which you are teaching.
Also, it is important to understand the context for training in the different environments. We have all our courses accredited but, for instance, in Serbia, there are guidelines for who is able to teach multidisciplinary courses, particularly those that include doctors, and these guidelines need to be followed. Therefore, we may have to adapt the structure of our courses in the future in order that these guidelines are followed –and this may mean some of the courses are no longer multidisciplinary; however you have to work within that context. Whilst we passionately believe in multidisciplinary teaching, we also have to fit into the environment in which we are working.
The other important thing is to have passion. If you have training that is being done by people who really have a passion for palliative care then that passion is transferred to others causing a ripple effect. The students catch that passion.
It is important to ensure that the education and training you are providing is developing competency and that you draw on the experiences that students have for interactive training and learning.
And finally, just to mention the importance of clinical training and clinical placements for palliative care education. It is vital to translate theory into practice.
Prof Julia Downing is an honorary professor at Makerere University in Uganda as well as Team Leader for the EU funded project: ‘Development of Palliative Care in the Republic of Serbia’. She is also the Education and Research Consultant for the ICPCN.