General discussion 193 The study demonstrates that the 2009 Dutch national blueprint on medical education insufficiently mentioned end-of-life care, and none of the formal undergraduate curricula of the Dutch medical schools in the academic year of 2015-2016 offered all essential elements of end-of-life care education. The national blueprint on medical education is authoritative for the curricula for Dutch medical faculties and should therefore at least include the essential domains of end-of-life care, which were found using a literature review. Pieters et al. found that final year medical students indicated that various topics were insufficiently addressed in their curricula and 60% of them felt unconfident in providing palliative care.27 In March 2020, the new blueprint on medical education was published.28 The introduction of the blueprint stated that it aims to prepare medical students for the future, including challenges of ageing populations and multimorbidity. The definition of palliative care is added, and generalist palliative care is now anchored as basic knowledge any freshly graduated physician should have. Chapter 2 provides insight in how individual bachelor and master curricula in the Netherlands can improve their programmes so that young physicians are sufficiently prepared for clinical practice. Many efforts have been made to integrate palliative care into existing Dutch medical curricula. The Palliative care Alliance Sharing Educational tools for Medical student Competencies development (PASEMECO) project, listed six Entrustable Professional Activities (EPAs) for undergraduate medical education regarding palliative care that should be taught to all medical students.29 These EPAs reflect which clinical activities young physicians can encounter in clinical practice. Additionally, the PASEMECO project offers an online toolbox with elements of palliative care education which are published on the Palliaweb website.30 These elements are collected from all Dutch universities and are free to use by teachers. This thesis only addressed undergraduate medical education. The O2PZ programme, which is supported by the Dutch government since 2019, aims at securing palliative care education at all educational levels in the Netherlands. In this programme, palliative care specialists, teachers and educationalists cooperate in developing education frameworks that provide an overview of all continuing education courses, designing and implementing education, and increasing the visibility of what is happening to optimise palliative care education.31 In the O2PZ programme, the EPAs for undergraduate medical education formulated by the PASEMECO project are further developed and complemented.32 Amongst many other activities, the O2PZ programme supports medical faculties in implementing palliative care education, so that their curricula meet the criteria of the blueprint. 8
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