Palliative medicine education at the University of Cape Town

Categories: Education.

As a family physician, I had cared for a number of patients who had died from cancer and for their families when I was approached by Helderberg Hospice to volunteer in providing medical care of patients referred to the newly established in-patient unit. I attended the volunteer training course and started as on call doctor two nights a week. It was immediately clear that my medical training and 12 years’ experience in general practice had not prepared me in the least to provide palliative care to the patients at the hospice. I was fortunate in that I was working with an experienced palliative care team of professionals – nurses and social worker and I learned all my early palliative care from these colleagues and from the Oxford Textbook of Palliative Medicine (first edition in those days – little thinking I would one day be a contributing author to this palliative care ‘bible’). We also had a very useful and practical textbook written by Claud Regnard which gave us good guidance in patient care. We also decided that it was impractical to have different general practitioners on call each night and that it made sense for one practice to do morning ward rounds and to cover the after-hours needs, so I became the official hospice doctor together with my practice partner, Iain Barton.

Pat Pigeon, the Heldeberg Hospice matron, supported a fund-raising effort to send their doctor and 2 professional nurses to the Asia Pacific Cancer conference in Penang, Malaysia in 1995. The keynote speaker, also active in many presentations and workshops was Professor Ilora Finlay. She was very encouraging of me as a fledgling palliative care doctor and I applied to study the distance-learning post-graduate diploma in palliative medicine at the University of Cardiff with the help of a bank loan. It was a challenging year of study, working full-time as a single mum with 2 primary schoolchildren, reading and assignments every week! When I finished the year, I promised myself and the children – ‘no more studies!!’ But a year later, Cardiff University invited palliative medicine diplomates to undertake an MSc in Palliative Medicine and I had forgotten the pain of the previous year and knew it was important to take the next step in academic palliative care.  

By this stage, I was a member of the Hospice Palliative Care Association (South Africa) Patient Care and Education Committee and HPCA agreed to sponsor the MSc studies. My dissertation was entitled: ‘The need for Palliative medicine education as perceived by South African hospice doctors’. In fact, events overtook the study. My degree was awarded in 2003 but concurrently I had discussed with Baroness Finlay and with Dr Fiona Rawlinson a plan for Cardiff University to support post-graduate palliative care training at the University of Cape Town (UCT). I had also written a motivation for a new course and presented this to the Dean of the Health Sciences Faculty. I had support from both UCT and Cardiff University as well as seed funding for the first 2 years of the course from the Diana Princess of Wales Memorial Fund. The first post-graduate students were enrolled in 2001, there were 23 doctors who at the time were working in SA hospices on this first course.

UCT offers 2 post-graduate training courses in palliative medicine, both through mixed methods teaching – a PG Diploma in Palliative Medicine (Palliative Care) and an MPhil Palliative Medicine. Students attend a five day residential training period at the start of each semester. They then continue their studies through the UCT Vula web-based learning platform. Weekly readings are uploaded and there are structured discussion topics on the discussion forum site. The residential teaching sessions are interactive workshops conducted by faculty with expertise in palliative care and focus on some practical aspects of palliative care which include the development of communication skills, bio-ethical principles, sensitivity to cultural diversity in delivering palliative care, practical pain and other symptom management; and research methodology for the research degree. The participants’ expertise is also a rich source of learning material and each postgraduate student contributes to the teaching and learning experience.

During the course, each postgraduate student identifies patients and families in their own care and writes a personal learning portfolio based on one or two patient histories from their current medical practice to illustrate their understanding of palliative care. This portfolio is presented towards the end of the course to assess development of knowledge, skills and attitudes essential to the effective and compassionate delivery of palliative care. It is a privilege to walk the journey of care with the student and his or her patients and to see the personal growth students experience on the course.

UCT palliative medicine alumni are employed in each of South Africa’s medical schools and have integrated palliative care training at undergraduate level in these medical schools in their areas. Postgraduate training in palliative medicine is integrated into Family medicine training at all medical schools and is a required competency for Family Physicians in the new specialist degree. It was fortuitous that at the time the postgraduate programmes in palliative medicine were being initiated, UCT Faculty of Health Sciences was undergoing a major curriculum review of the undergraduate MB ChB qualification and palliative medicine was integrated into the teaching of Family Medicine and Public Health so that from 2nd year – communication skills- to 6th year, UCT medical students have 47 hours of dedicated palliative care training. 

Each graduate of the PG palliative medicine programmes at UCT has the capacity and commitment to develop palliative care in their geographic region, with support from UCT and strategic partners such as the Hospice Palliative Care Association, African Palliative Care Association, Worldwide Palliative Care Alliance and the International Association of Hospice and Palliative Care.

Graduates are involved in establishing new palliative care services in many parts of Africa, in influencing policy development and in establishing or strengthening hospice palliative care associations in other African countries such as Nigeria, Tanzania, Kenya, Botswana and Namibia.

The key outcome of the UCT palliative medicine training is improved accessibility to professional palliative care for patients and families in Africa who are facing the diagnosis of life-threatening illness.

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