End-of-life care in the Dutch medical curricula 43 DISCUSSION The five domains of ELC that are considered essential are currently not taught to medical students of all faculties. This is an important observation when taking into account the growing attention to the patients’ quality of life at the end of life which demands proper training in ELC for all medical doctors. The national blueprint We found that the national blueprint contained only four of the five domains of ELC education that are considered essential skills, knowledge, and attitudes for young medical doctors. Furthermore, the domains are described in a very general way and can be easily overlooked in the national blueprint. Lack of national guidelines for ELC and palliative care has led to legal implementation of palliative medicine education in Germany and Switzerland and the national curricula on palliative care in Australia (the Palliative Care Curriculum for Undergraduates Initiative) and Canada.22,23 The new CanMeds Model of 2015, which serves as an international guideline for medical education around the world, holds several improvements in the light of ELC education. Most importantly, it now explicitly describes the key competence to discuss cultural matters, which includes beliefs about the end-of-life. However, the new CanMeds model still lacks several domains of the international checklist, and we therefore recommend addition of all ELC domains. The medical curricula The most prominent finding of the curricular assessment was that none of the eight faculties offered complete ELC education. This indicates that ELC education is not yet well-developed in the compulsory medical curricula in the Netherlands. These results are consistent with existing literature from other countries. One study, investigating the extent to which palliative medicine was taught in the Swiss medical curricula, showed that not all domains were covered in all curricula of the different medical faculties.14 Furthermore, a series of studies measured the status of palliative care education in the UK, indicating that at first, in 1983, only 4 of the 24 medical schools taught (informal) education dedicated to palliative care.24 These findings led to opportunities to alter and test the medical curricula regarding ELC education, which is done regularly in the UK and Germany.16,25,26 Currently, the attention of the ELC domains in the curricula varied. This is in line with a study on palliative care in medical education at a European level: in 27% of the countries, the faculties could determine whether and how they teach palliative care and consequentially the quality of palliative care education differed within these countries.13 2
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