CLEVELANDNearly 450 physicians have been trained to teach the
American Medical Associations curriculum on the appropriate
care of dying patients. The program, known as Education for
Physicians on End-of-Life Care, or EPEC, provides physicians with the
basic skills and knowledge needed to care for the seriously ill and dying.
The program is intended for all generalist physicians, not just
hospice or palliative care physicians, Frank D. Ferris, MD, said at
the 33rd annual meeting of the American Association for Cancer
Education. We know there is a lack of physician competency in
end-of-life care, he said. Dr. Ferris, medical director of San
Diego Hospice, is a member of the EPEC curriculum design team.
The EPEC project is being spread across the country by the physicians
who participated in the training sessions. After receiving
instruction, the physician-trainers are expected to return to their
home institutions and present the EPEC program as continuing
education to their colleagues, Dr. Ferris said.
Six regional sessions were offered last year to prepare physicians to
become EPEC trainers. Almost 450 physicians attended. They then
proceeded to offer more than 180 EPEC programs in their communities.
Nearly 10,000 people have received instruction in the EPEC project as
a result of their efforts, Kathryn A. Meshenberg, administrative
director of the EPEC Project, told ONI. At least another 40 EPEC
programs have been planned for 2000.
The trainers activities will be tracked over a 2-year period to
determine the projects success. Initial evaluations show that
the physician-trainers significantly improve their knowledge of the
material after attendance at a training session, Dr. Ferris said. The
56 trainers who attended the first regional session scored 73% on a
pretest before attending the session and 81% on a post-test at the
In addition to this method of outreach, the AMA is also sending all
of its renewing physician members a CD-ROM version of the EPEC
curriculum to use for self-education or to establish educational
programs within their own practice or institution. Furthermore, the
CD-ROM curriculum is being sent to presidents of state, county, and
national specialty societies.
To encourage the addition of end-of-life skills and core competencies
to medical education, EPEC is sending residency program directors and
medical school department chairmen a complimentary CD-ROM. All
medical school deans will receive a print version of the EPEC
curriculum as well.
The EPEC curriculum consists of four plenary modules and 12 workshop
modules. The plenary topics are: Gaps in End-of-Life Care, Legal
Issues in End-of-Life Care, Elements of End-of-Life Care, and Next
Steps. The workshop modules include Communicating Bad News, Pain
Management, Withholding/Withdrawing Treatment, and Last Hours of
Living. [See ONI January 2000, page 23, for articles describing some
of the program topics.]
The CD-ROM version of the curriculum, a print version of the
Participants Handbook, and the complete Trainers Guide,
which includes videotapes and slides in Power Point, are also
available for purchase through the AMA catalogue.
In the future, EPEC would also like to see the creation of
opportunities for physicians who are highly skilled in end-of-life
care to share their expertise, Dr. Ferris said. For instance, San
Diego Hospice is developing a visiting scholar program, he told ONI.
In addition to Dr. Ferris, the EPEC project has been led by Linda
Emanuel, MD, PhD; Charles F. von Gunten, MD, PhD; and Russell
Portenoy, MD. The project is supported by the AMA and a grant from
The Robert Wood Johnson Foundation. It is housed within the
End-of-Life-Care Section of the Institute for Ethics at the AMA. The
EPEC website is www.ama-assn.org/ethic/epec