End-of-life care in the Dutch medical curricula 37 INTRODUCTION More people are living to ever increasing ages which has resulted in a large part of healthcare being devoted to chronic age-related diseases. Additionally, numerous diseases that used to be fatal have been turned into more chronic diseases by improved treatments. Medical and technical possibilities at the end of life have also increased substantially. All these developments have led to an increasing number of people needing complex end-of life care (ELC). To complicate matters, people also increasingly believe in the manipulability of the human life course and wish to be actively involved in decision-making. For the work of medical doctors, good ELC, as part of palliative care1, is more important than ever before. At the moment, however, ELC is not yet optimal. For example, on the ICU, a third of the doctors questioned thought the care for at least one patient at that moment was disproportional, of which most care was considered futile and potentially harmful.2 Moreover, doctors often offer palliative care too late and endof-life discussions are not carried out frequently enough and often too late.3-5 These factors influence the quality of life of terminal patients in a negative way.6,7 To improve the quality of life at the end of life doctors should be properly trained in ELC as a part of palliative care. Research has shown that students should be taught about ELC especially in the preclinical years of medical education, since these years are the most important for the development of basic skills, attitudes, and knowledge for general medical practice. Besides, training in ELC does not conflict with other medical educational agendas since the acquired skills are useful to every healthcare specialization.8-10 Worldwide, many studies have been performed to assess the attention to ELC in medical curricula. After having assessed the status quo of ELC in medical education, medical schools in several countries adapted their curricula to implement themes related to ELC, such as palliative care, hospice care and terminal care. In the United States, the first study that assessed the quality and quantity of ELC education was conducted in students and residents in 2003, concluding that fourth year medical students did not feel well-prepared to provide ELC and suggesting curricular changes and improvements in the medical working and educational sphere for students to learn how to provide good ELC.11 In 2004, the same authors interviewed the deans of 51 medical schools in the US about ELC education in the curricula of their schools and concluded that most deans were willing to improve ELC education.12 In Europe, the status of palliative care medical education in the undergraduate curricula of 43 countries was evaluated in 2015. Although palliative medicine was taught in a vast majority of European countries, there were substantial differences in the level of development of education about palliative medicine.13 Several individual countries such as Switzerland, the United Kingdom and Germany studied their medical curricula and recommended curricular changes such 2
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