Chapter 2 44 Only one faculty (Radboud University Nijmegen) offered an elective course that paid attention to all the domains. Here, we see opportunities to develop and share educational programs on ELC to improve the elective program. There are numerous possible explanations for the shortage of attention to ELC in the medical curricula. Firstly, there is still a taboo on talking about death and dying.5 Furthermore, since many practising physicians were never formally trained in ELC themselves, this makes it difficult to pass this knowledge on to future generations. Moreover, as mentioned by two respondents who acknowledged the importance of ELC in medical education, other subjects were prioritized over ELC because ELC was not described explicitly in the national blueprint. These and other reasons for incomplete ELC education are described extensively in the report on Appropriate care in the last phase of life, published by the Royal Dutch Association on the Advancement of Medicine.18 This overview of current ELC education has several implications for practice. Firstly, since the national blueprint does not cover all the aspects of ELC education that are considered essential knowledge by international standards, we recommend adding all five domains and their subdomains to the national blueprint. The absence of the multi-dimensional approach of ELC in the national blueprint results in deprioritizing of ELC at the faculty level. Secondly, this study suggests that exchange of information and knowledge on ELC education can improve Dutch medical education on ELC. For example, Radboud University Nijmegen developed an elective course on ELC that included all five domains of our checklist, and this course could therefore serve as a model for other faculties. Thirdly, this study can be used to compare curricula with international medical education standards and to identify room for improvement. Fourthly, this study can be used as a baseline measurement for testing future curricular changes. And lastly, the established questionnaire for the different faculties can be used as a measurement tool for further research on ELC education in the future. Limitations There are four possible limitations of this study. Firstly, the data of the master medicine of the Erasmus University Rotterdam were not available because of time restraints of the responsible persons. Therefore, our overview of ELC in Dutch medical education is not fully complete. However, since otherwise all the data were collected, this study still provides a reliable overview of the medical curricula and indicates many possibilities for improvement of medical education dedicated to ELC. Secondly, since ELC was mainly integrated into other compulsory courses, the education directors reported that it was difficult to give a precise indication of the presence and time spent on the domains on ELC. Therefore, they may have given a more positive or negative view of their curricula,
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