PCC4U. Uptake of the PCC4U Resources. Funded by the Australian Government through the National Palliative Care Program

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1 Issue No. 19 July 2010 The Australian Government has committed to improving the quality of care provided to Australians at end of life, by supporting the inclusion of palliative care education as an integral part of all medical, nursing and allied health undergraduate training, and ongoing professional development. Commencing in 2003, the first phase of the Australian Government s Palliative Care Curriculum for Undergraduates Project (PCC4U) resulted in the development of a series of learning resources and supporting materials. The second phase of the PCC4U project ( ) involved the successful implementation and evaluation of the learning resources into three medical, four nursing, and three allied health courses in metropolitan and rural universities in Australia. The third phase of the project (January 2007 June 2010) has involved introducing the learning resources to all undergraduate and entry to practice health courses in Australia (n=209). In this newsletter, we report on the achievements of this third phase of the PCC4U project. The newsletter includes a summary of project activities and outcomes, including the extent of uptake across undergraduate courses across the country. We also include some recommendations to guide future efforts at developing a health care workforce that is capable of providing quality end of life care. The success of the project is a credit to the dedication of many individuals working in clinical and academic settings across the country. The systematic, nationwide efforts to achieve an agreed set of graduate capabilities in palliative The third phase of PCC4U commenced in The objectives of this third phase of the PCC4U project were to: Promote the inclusion in all health care training of the role of palliative care and its principles and practice in the care of dying people, and Support the inclusion of palliative care education as an integral part of all medical, nursing, and allied health undergraduate training. Uptake of the PCC4U Resources Status as at May 2010: Summary of uptake across all courses Universities Courses Contacted Currently implementing Currently reviewing No or limited response % 37% 24% 25% 14% Status as at May 2010: Summary of uptake by discipline Nursing MBBS Occupational therapy Physiotherapy Pharmacy Speech Pathology Psychology Chinese medicine Chiropractic care have seen Australia emerge as a leader in this field. We look forward to continuing this work to further improve the ability of all health care professionals in Australia to provide palliative care. Professor Patsy Yates Project Director Nutrition & dietetics Social work Paramedic Counselling Health Science/Aging Will not use Disability Studies Natural Medicine Total Courses Implementing or reviewing

2 September 2005 Prepared by the Palliative Care Curriculum for Undergraduates Project Team Palliative care quality of life for people with a life-limiting illness, their families and carers PCC4U Key achievements Maintenance and further development of existing communication portals (newsletter and website) and networks Project activities Capacity-building workshops Invitation extended to all undergraduate and entry to practice health courses (207 courses as at May 2010) at 39 universities in Australia to participate in the PCC4U project Support provided to 76 health courses (37 per cent of all undergraduate health courses) to implement the project resources in their curriculum and a further 50 courses (24 per cent) to review the resources, with a view to future implementation Support for innovation in the delivery of palliative care education in undergraduate curricula, through funding of 10 course improvement initiatives, impacting over 1000 students directly, with outcomes that support sustained inclusion of palliative care Academic and clinician networks and partnerships extended through activities including teaching and learning workshops (112 participants), delivery of the Third National Palliative Care Education Conference (125 participants), and 14 conference presentations or promotion activities. An important component of ensuring the sustainability of the project achievements was to actively build the capacity of academics to include palliative care in undergraduate health curricula. Specifically, the workshop aims were to: identify strategies to facilitate the implementation of palliative care review case study exemplars to illustrate how to integrate palliative care in undergraduate curricula explore future directions in teaching and learning in palliative care Participants feedback on the workshop was consistently positive and some exemplars are listed below: Principles for including palliative care in undergraduate curricula Sydney 25 July 2008 Melbourne workshop 28 July 2008 Newcastle 5 February 2009 Sydney 30 November 2009 Perth workshop 2 February 2010 To get to know approaches to palliative care and to adopt them to my needs Discussing opportunities to integrate curriculum with clinical experience providing students with rich and valuable experience (hopefully) Opportunity to brainstorm some ideas and set up opportunity for future collaboration and give feedback on our experiences Case studies educative and relevant Motivated me to start a project plan for undergraduates in paediatrics Sharing/networking with clinical and uni Excellent to network Ideas to provide a framework for palliative care education for undergraduates Opportunity to play with the tools in the group and discuss with group Amazing networking opportunity to catch up with and meet other educators in palliative care

3 Project activities (continued) The Third National Palliative Care Education Conference A conference organising committee, established in June 2009 and drawn from the project team, planned and delivered the Third National Palliative Care Education Conference. This was held in Brisbane at Queensland University of Technology (QUT) on Thursday 11 February and Friday 12 February The Third National Palliative Care Education Conference focused on palliative care workforce education and provided an opportunity to examine specific achievements made as part of the PCC4U project. It also provided an opportunity for those with an interest in developing the palliative care workforce to review the status of palliative care education in Australia and to identify future directions for ensuring a workforce capable of meeting the needs of our communities. Course improvement initiatives PCC4U provided funding to 10 implementation sites that expressed a need to engage in small course improvement projects to achieve sustained improvements in the inclusion of palliative care in undergraduate courses. These sites were supported to undertake a diverse range of activities including curriculum design and evaluation, identification of core skills, and adaption of resources associated with promoting the inclusion of palliative care in their course. Delegates identified positive aspects of the conference including: Networking with other disciplines and across the spectrum Excellent content, interesting speakers, very well organised Communication, development and considerations of innovative approaches to palliative care I liked that it had a larger focus than palliative care, I believe it is very important to look at the broader workforce issues associated with nursing at every opportunity Abstracts were fantastic For all conference presentations and a summary of the conference workshops visit Four examples of these initiatives are: Occupational Therapy Mapping of curriculum to achieve improved integration of palliative care and the use of PCC4U resources Medicine Mapping of MBBS curriculum to achieve improved integration of palliative care and use of PCC4U resources Physiotherapy Mapping of curriculum to achieve improved integration of palliative care and the development of web resources that complement PCC4U resources Nursing Mapping of Bachelor of Nursing curriculum to achieve improved integration of palliative care and use of PCC4U resources Reports on these course improvement projects can be found at under Teaching and Learning support

4 Project evaluation Systematic evaluation of a broad range of processes and outcomes across various levels has been undertaken throughout the third phase of the PCC4U project. The aim of all evaluation activities has been to ensure evaluation data are collected from a range of sources to substantiate project achievements and to enable valid recommendations to be made regarding future developments in undergraduate palliative care education. The evaluation framework used was based on the framework developed by the University of Wollongong s Centre for Health Service Development (Eager et al, 2003). This framework provides for the evaluation of impact and outcomes at three levels: Level 1 Consumers (students and teaching staff) Level 2 Providers (academic units and universities) Level 3 Organisations and systems (networks and relationships developed between academics, courses, universities, disciplines; endorsement by regulating and other professional bodies). The aim of the audit was to identify the extent to which existing undergraduate curricula incorporate palliative care, and the extent to which the PCC4U resources were used within these programs to facilitate the development of palliative care capabilities. The data were summarised and collated using the web-survey analysis tool. Results from each of the three annual audits were then compared after the third and final audit in March Graph 1 Overall, to what degree is palliative care covered in your course/program? (All disciplines) 60% 50% 40% 30% 20% 10% 0% 70% 60% 50% 40% 30% 20% 10% 0% 60% 50% 40% 30% 20% Not at all Graph 2 How is palliative care content structured within the curriculum? (All disciplines) Core 2007/2008 (n=44) To a moderate degree 2007/2008 (n=33) 2008/2009 (n=55) To a minor degree Integrated 2008/2009 (n=39) To a large degree Elective 2009/2010 (n=47) 2009/2010 (n=43) Graph 3 To what degree is palliative care assessed as a specific area within this curriculum? (All disciplines) What learning and teaching strategies do you employ to assist students to develop their knowledge and skills in palliative care? A range of strategies were consistently identified as being implemented to assist students to develop their knowledge and skills in palliative care. Common strategies identified by each discipline group (those that were stated at least twice for each discipline): Lectures Workshops Case studies - as case presentations, video based case discussion and review, problem based learning cases, clinical case reflection, case based tutorials Small group work and discussion Assignments, exams and patient presentations as part of course assessment activities Use of multimedia and resources online resources, PCC4U resources, websites, DVDs, CDs, use of workbook, course readings, journals Clinical placements Visits to clinical settings, including hospice and domiciliary visits Presentations by clinicians or experts. The following graphs show some of the key findings of the comparative analysis. 10% 0% 2007/2008 (n=43) Not at all To a moderate degree 2008/2009 (n=55) To a minor degree To a large degree 2009/2010 (n=47)

5 Recommendations There are four key recommendations applicable to sustaining the outcomes from this project, and further developing the inclusion of palliative care in entry to practice nursing, medical and allied health courses. Recent proposals for health workforce reform and their associated implications for education and training in the health professions provide further opportunities for aligning PCC4U activities to such developments. Recommendation 1: That the implementation strategy developed for supporting the inclusion of palliative care in undergraduate training for all health professionals resulting in approximately 37 per cent uptake of the PCC4U resources across undergraduate health courses be continued. Recommendation 2: That an expanded range of learner-centred, evidence-based resources in areas identified as core components of graduate capability in palliative care be developed. This includes that: Existing PCC4U resources be modified and expanded in response to student, teacher and professional feedback obtained in this evaluation. Specifically, to complement existing PCC4U resources, priority should be given to developing resources in the following areas: discipline specific applications and learning scenarios culture-centred palliative care palliative care for Aboriginal and Torres Strait Islander populations. Mechanisms for routinely collecting data about student and teacher experiences of PCC4U, and for using these data in course improvements at local and national level be implemented A more comprehensive user s guide with strategies and exemplars to support the inclusion of palliative care in undergraduate curricula be developed. Recommendation 3: That the alignment between PCC4U project activities and the broader health workforce reform and development priorities be strengthened. To strengthen such alignment, it is recommended that: Efforts to embed PCC4U resources in the entry to practice courses at masters level courses Further support be provided to promote interprofessional educational activities as part of the PCC4U project Learning activities which examine innovative practice models and role redesign in palliative care be developed A review of the scope of clinical training opportunities in palliative care be undertaken, to identify areas for increasing the number of placements and improving the quality of clinical training in this field. Recommendation 4: To promote sustainability of outcomes from this project, it is recommended that capacity-building initiatives continue to be implemented. These initiatives should include: expanded opportunities for palliative care teaching and learning support, resources and tailored curriculum initiatives further development of networks and partnerships between clinicians and academics through activities including support for collaborative course improvement initiatives, information dissemination and sharing activities, and shared online and face-to-face discussion forums.

6 Learning resources The evaluation of PCC4U achievements to date demonstrates that the PCC4U project has produced high-quality learning resources which have achieved a high level of awareness and acceptance among clinical and academic staff, and which have resulted in improvements to learning experiences and outcomes for students and teachers. A review and refresh of the learning resources is near completion. This review aims to ensure that all resources, links and evidence on the CD are current. The CD resource will be updated to Joomla format to allow the project team to make minor changes to the resource links in a timely manner in future. This will assist with maintaining a quality, relevant and evidence-based resource. Provision of resources As part of promoting and implementing the project the following quantities of hard copies of the project resources have been distributed since 2007: CD learning resources 2700 The Palliative Care Curriculum for Undergraduates (PCC4U) Learning Resources are a set of teaching and learning tools designed to develop the ability of undergraduate students in the health professions to provide palliative care. The learning resources play an important role in improving the quality of health care provided to people with life-limiting illnesses. The Learning Resources include: A publication titled Principles for Including Palliative Care in Undergraduate Curricula A publication titled Principles for Including a Palliative Approach to Aged Care in Undergraduate Nursing Curricula An interactive CD learning resource A DVD learning resource A resource compendium A project fact sheet Principles for including palliative care in undergraduate curricula Prepared by the Palliative Care Curriculum for Undergraduates Project Team September 2005 Factsheets 5400 Principles document 1400 DVD 170 The PCC4U resources are also available online on for clients to view and review. Further Information Palliative care quality of life for people with a life-limiting illness, their families and carers If you are interested in obtaining further information about the project, please visit our web site at or contact one of the project coordinators: Alison Farrington at alison.farrington@qut.edu.au Catriona Bisset at catriona.bisset@qut.edu.au 2010 QUT Produced by QUT Publications INTERNATIONAL INSTITUTE OF PALLIATIVE AND SUPPORTIVE STUDIES FLINDERS UNIVERSITY, ADELAIDE The PCC4U Project is led by Queensland University of Technology in collaboration with the Queensland Government, Flinders University, Charles Darwin University and Curtin University of Technology..