End-of-life care in the Dutch medical curricula 39 They could either submit the questionnaire by email or were interviewed (telephone interviews) using the questionnaire, which was done in almost all cases. In addition, the elective courses of each medical faculty were studied using online course catalogues or by contacting coordinators of the elective programs when course catalogues were not available online. The study was carried out in accordance with the Declaration of Helsinki, including, but not limited to, there being no potential harm to participants, that the anonymity of participants was guaranteed, and that informed consent of participants was obtained. The study was approved by the institutional scientific review board. Table 1. The five domains and 22 subdomains of essential ELC education composed of criteria formulated by Barnard et al.7 and Emanuel et al.17 Domain 1: Psychological, sociological, cultural, and spiritual aspects Suffering Loss Mourning Rituals and meaning at the end of life Domain 2: Communication and conversational techniques Listening to the impact of disease on the patient ’s life Explore hope, helplessness, and fear in depth Discuss loss and mourning Discuss spiritual considerations Discuss advance care planning Domain 3: Pathophysiology and treatment of symptoms Pain Dyspnoea Dehydration Depression Delirium Fear Domain 4: Juridical and ethical aspects Not starting/stopping treatment and euthanasia Dilemmas on the treatment of pain Non-abandonment of the patient Domain 5: Self-reflection on personal and professional experiences with death and loss Personal experience with death View on the hereafter Goals of medicine Role of the doctor and other health workers in ELC 2
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