Training in palliative and end-of-life care: Guidance for trainees (and their trainers) in non-palliative medicine training posts
Physicians practising in general internal medicine (GIM), acute internal medicine (AIM) and most medical specialties commonly manage illness in patients who may be in the last phase of their lives, both as inpatients and outpatients, and decision making about their preferences for treatment and care should routinely be a joint process with patients and their families.
Ensuring that this is the normal or default approach, coupled with specific attitudes and skills to manage end-of-life care (EoLC) discussions sensitively and manage symptoms optimally are core attributes of good doctors.
The key competences expected are shown in the curriculum extracts in section four. There are approximately 6500 trainees in higher training (ST3 and above), up to 50% of whom undertake dual training with GIM. Most of these will require some palliative care (PC) skills for patients in the last phase of life (LPoL) which may range from hours/days to many months. The UK annual intake of trainees requiring these skills amounts to about 1000 pa. At deanery level, this means that on average there will be 80 trainees eligible for enhanced training per year, but the numbers will vary from 20 - 150 pa depending on the size of the deanery / LETB. Specialties requested guidance for how the required competences can be gained for use at training programme level. This document focusses on the training methods rather than the competencies required.