In the new curriculum Internal Medicine capabilities in practice (CiPs) are shared across all physician curricula to promote generalist training to support flexibility for trainees to move between the specialties. Managing end of life and applying palliative care skills (CiP 8) is a core element of all specialties particularly in group 1 and even more so for those training in Geriatric Medicine.
It was written before the development of the new curriculum but its contents remain relevant today. Fundamental to it is the fact that experience is very important in gaining competency. Working directly with a consultant-led palliative care team in one block of time or in an equivalent staggered fashion is recognised as an important part of training in palliative care. The document recommends a minimum indicative time requirement to gain the curriculum competencies of 40 hours (equivalent to five working days). However, palliative care is a very important part of what we do as Geriatricians and it would be desirable to do more that this wherever possible, aiming for the recommendation from the previous Geriatric medicine curriculum of 200 hours.
It is also important to experience palliative care in all settings not just on hospital wards. Such settings include hospice, specialist palliative care units, day hospice, general hospital outpatients and the community. Trainees should be encouraged to attend and where appropriate lead specialist palliative care MDT meetings and spend dedicated time in these areas.
By the end of training, trainees have to be able to independently Identify the dying patient and develop individualised care plans that include pharmacological and non-pharmacological measures to manage complex symptoms. Trainees need to also demonstrate excellent consultation and communication skills as well as compassionate professional behaviour and clinical judgement. The document identifies these minimum competency levels required and it highlights the descriptors of training in the domains of knowledge, skills, behaviour and experience. In the new curriculum these are described as Generic Professional Capabilities. Guidance is provided how to achieve and document progress as well as suggestions on which supervised learning events (SLEs) can be used to demonstrate this. These SLEs and assessment methods remain the same in the new curriculum.
This document remains as valid today to the training requirements of the new curriculum as when it was written in 2014. It should be used by Trainers and Trainees as a benchmark to ensure equitable, high quality training in palliative care in all regions.