Cicely Saunders Institute Spotlight on education and training
Cicely Saunders Institute Spotlight on Education and Training
Welcome Dr Jonathan Koffman Lead for Education & Training Professor Irene Higginson Director, Cicely Saunders Institute
The Cicely Saunders Institute pioneers the very best in palliative care and rehabilitation through the integration of cutting-edge research, skilled multi-professional care, and innovation in engagement and education. In this booklet we spotlight our provision of local, national and international education and training. This includes: • Programmes aimed at developing future leaders (including undergraduate and postgraduate education); • Professional training and skills acquisition; and, • Our wider educational outreach initiatives. We also highlight the important work of the Macmillan Information and Support Centre which is located on the ground floor of the building, and provide examples of service innovations that have an education and training focus. The Institute attracts teams from across the globe who wish to learn about the latest advances in palliative care and rehabilitation. We actively engage with patients, families, professionals, policy makers, the public and the media. These outreach activities support recruitment, evidence uptake, and enhance the value of our education in policy and commissioning arenas. All our activities are deliberately linked to research and evidence in order to maximise patient and family care. To find out more about what we do, or to get involved, please visit our website: www.kcl.ac.uk/palliative Thank you for your interest in our work, and to our funders and collaborators for their support which has made this work possible.
Spotlight on education and training
The undergraduate curriculum explores communication skills, symptom control, sociological theories of loss and grief, and medical ethics towards the end of life.
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Developing tomorrow’s clinicians
Undergraduate education
The Faculty of Life Sciences and Medicine at King’s College London is the largest provider of undergraduate healthcare training in Europe, with over 450 medical students in each year. The undergraduate palliative care curriculum is spread throughout the five-year MBBS degree programme. It includes seminars, symposia, student selected components, bedside clinical teaching and hospice visits provided by our clinical and academic teams. The curriculum explores communication skills, symptom control, sociological theories of loss and grief and medical ethics towards the end of life. Palliative care is also integrated into clinical rotations for core specialties and the palliative care team offers a range of student-selected components in year four with optional tutorials and an extended essay. Elective Placements
Elective placements are regularly undertaken at Guy’s and St Thomas’, and King’s College Hospital by overseas medical, nursing and allied healthcare students. Programmes of study are individually tailored with time shared across the clinical and academic departments as well as Trinity Hospice and St Christopher’s Hospice. King’s College London Palliative Care Society
The world’s first undergraduate palliative care society was set up by two medical students at King’s College London in 2012. The aim of the society is to promote understanding of palliative care amongst undergraduates and to create an opportunity to strengthen the input and contributions those students can make to palliative care research and impact.
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Developing leaders in Palliative Care
Multiprofessional MSc, Postgraduate Diploma & Postgraduate Certificate
Our Master of Science (MSc) is one of the most highly acclaimed palliative care programmes in the world. MSc students develop a deeper knowledge and understanding of the many clinical, social, psychological, spiritual and ethical issues in palliative and end of life care, and the assessment and effective management of these. In addition to being able to critically appraise evidence of new and existing treatments, our students are taught how to formulate important and feasible research questions relevant to the specialty, and then to design and conduct their own rigorous research studies to address these issues. The MSc can be completed over one or two years (full or part-time respectively), and we offer a Certificate (three modules) and Diploma in Palliative Care (six modules) for students wishing to study with greater flexibility. Our international reputation attracts high calibre and very motivated students from all over the world. Students have unique opportunities to share experiences on how palliative care has developed across the world and to reflect on different social and cultural approaches to death, dying, caring and bereavement. The MSc has also been designed to closely complement the training requirements of UK specialist medical training. Around 50% of those taking the course are medically qualified, often training in palliative medicine, and many students are attracted to modules that directly fulfil their professional training needs. So far from the course we have had 263 graduates, who between them have published 741 papers in scientific journals as a result of their work.
Spotlight on education and training
Our MSc Students have unique opportunities to share experiences on how palliative care has developed across the world.
Spotlight on education and training
Our PhD students come from a broad range of backgrounds including medicine, nursing, psychology, health services research, physiotherapy and occupational therapy.
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PhDs and MDs in Palliative Care
The Cicely Saunders Institute has a vibrant and enthusiastic group of PhD students, from backgrounds in medicine, nursing, psychology, health services research, physiotherapy, occupational therapy and others. Many of our students transition from our MSc to PhD. We have a comprehensive internal training programme, which includes monthly journal clubs, researchers meetings, skills development workshops, evidence update sessions, and an Open Seminar series with national and international speakers. There is also a departmental PhD peer-support group to provide mutual support, exchange experiences, and foster rapid learning. Our PhD and MD students also benefit from the extensive range of training and support provided throughout King’s College London, which they access and use according to their individual training and development needs. Doctoral students who choose the Cicely Saunders Institute to undertake PhD research studies are given the opportunity to be at the heart of latest developments in the field. At any one time, there are around eight to ten professionals studying for their PhD with us. Each student develops a bespoke programme in agreement with his or her supervisors.
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The European Palliative Care Academy
The European Palliative Care Academy (EUPCA) is a joint project of the Robert Bosch Stiftung, Germany and the four academic centres: Cicely Saunders Institute, King’s College London, UK; the University Hospital of Cologne, Germany; the Nicolaus Copernicus University Toruń, Collegium Medicum in Bydgoszcz, Poland; and the Hospice Casa Sperantei, Brasov, Romania. Together with these institutions we have developed the curriculum to grow emerging palliative care leaders of all professional backgrounds across Europe. Our aim is to support future leaders to develop the necessary skills, abilities and expertise to advance palliative care across Europe and to address future challenges in the field. The programme comprises six modules – Project Management, Personal Development, Research as Applied to Palliative Care, Team Work, and Advocacy – and includes a personal project and an observation week at a European Institution of the participant’s choice. The European Palliative Care Academy (EUPCA) celebrated the achievements of the first 20 graduating students from their Leadership Programme at a ceremony in Brasov, Romania on 2 May 2015. The students originated from 14 European countries and a wide variety of professional backgrounds.
Spotlight on education and training
We support future leaders to advance palliative care across Europe and to address future challenges in the field.
Spotlight on education and training
We support the development of palliative and end of life care across all clinical areas for all grades of staff.
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Improving clinical practice now
We provide high quality evidence-based learning for doctors, nurses, other clinical professionals and social care professionals, irrespective of their work setting. For professionals working in and around South London, the Cicely Saunders Institute provides many training opportunities including: Postgraduate medical education and specialty training in palliative medicine
Postgraduate medical education in South London is led by our staff within Guy’s and St Thomas’ (GSTT) and King’s College Hospitals (KCH). We collaborate across King’s Health Partners (KHP) to provide palliative medicine training for doctors training to become palliative care consultants or general practitioners. Nursing and allied healthcare professionals
We contribute to the King’s Nurse Induction programme and provide teaching in palliative care to surgical and disease specific wards. Our practice development nurse supports the development of palliative and end of life care across all clinical areas for all grades of staff. There is a teaching programme for developing end of life care champions, and another for ward-based teaching, with sessions tailored to suit the needs of different clinical areas. Principles of Care for the Dying Patient
We support ward teams deliver individualised care through an electronic notification system. This initiative provides wardbased training as the need arises around the care of patients and their families. Our Clinical Nurse Specialists and Practice Development Nurse sign-post front line staff to our formal skills-based training programmes to strengthen their knowledge and confidence.
Sage and Thyme® workshops
The Sage and Thyme® model helps train all grades of staff to listen and respond to patients/clients or carers who are distressed or concerned. It places published research evidence about effective communication skills within a memorable structure for clinical practice. Half-day Sage and Thyme® workshops take place monthly. The training is included in the Florence Nightingale School of Nursing and Midwifery undergraduate training and the workshop is mandatory for all newly qualified nurses on the preceptor programme. Clinical education
Our clinical teams at KCH and GSTT deliver a highly interactive suite of educational activities for staff in the acute and community setting. Events for General Practitioners (GPs) include: quarterly practice meetings; an annual South East London Doctors forum; on-call teaching sessions; evening tutorials; Vocational Training Scheme training events; Southwark Protected Learning Time events; and, a national “Hot topics for GPs” course. We also reach other groups with specialist lectures and events, for example Speech and Language Therapists, the Southwark and Lambeth Integrated Care team, and community dentists. Education multidisciplinary meeting
Over the past three years, the clinical team has run monthly education multidisciplinary meetings to provide a forum to discuss and debate clinical and social issues relevant to palliative and end of life care. These meetings also provide an important opportunity for the team to critically examine its professional development needs and to process requests for clinical visits and teaching. Key themes arising from these meeting have included procedural issues e.g. late referrals, symptom control and complex discharge planning issues.
Spotlight on education and training
Multidisciplinary meetings provide a forum to discuss and debate clinical and social issues relevant to palliative and end of life care.
Spotlight on education and training
Local, national and international networking within palliative care and rehabilitation improves the integration of research and clinical endeavors.
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Reaching out
Our growing programme of knowledge transfer extends well beyond palliative care experts to include those in bioethics, elderly care, psychiatry, respiratory medicine, intensive care, primary care, and renal medicine to name a few. The Knowledge Exchange Seminar (KES) offers an invaluable
opportunity for local clinicians and researchers in the sector to consider current research and evidence and how this has potential to influence clinical practice and inform developing future research. This free-to-attend forum takes place every six months and aims to: • consider recent local research and emerging evidence, and evaluate how this might influence clinical practice • inform clinicians of research initiatives • discuss the validity of methods used to implement research ideas relating to palliative care Evidence update meetings supplement the KES meetings and offer local clinical staff and researchers an opportunity to share recent research relevant to clinical care and policy. The Cicely Saunders Institute Open Seminar and Lecture Series facilitates opportunities for local, national and international networking within palliative care and rehabilitation in order to improve practice, education and policy and the integration of research and clinical endeavours. All our seminars are heavily publicised via our website, Youtube, and Twitter to raise the profile of these opportunities for knowledge exchange.
BuildCARE Study Days encourage national and international networking between researchers and clinicians and usually include an element of training or skills development. Each year, we host over 400 delegates at our BuildCARE study days from across the UK and internationally. Study days have included topics such as: Improving Outcome Measurement; Homecare; and, Access, Equity and Innovation in Palliative Care. The Cicely Saunders Annual Lecture presents an international leader
in the field of palliative care and is a highlight in our education programme. This open access event is hosted at the Cicely Saunders Institute with live video-links to a number of external audiences (in Cardiff University, the University of Oxford and the University of San Francisco for example). In 2013 Professor Diane Meier from the Icahn School of Medicine at Mount Sinai, USA presented a lecture entitled ‘Can (or should) palliative care meet the challenge of care for persons with long-term chronic illness versus remaining in our end-of-life corner?’. The 2015 lecture was given by Dr Eduardo Bruera, Professor and FT McGraw Chair in the Treatment of Cancer, The University of Texas MD Anderson Cancer Centre. Dr Bruera delivered an inspiring presentation on Clinical interventions to enhance the expectation of healing: continuing on the pathway of Dame Cicely. The lecture was particularly poignant as it was part of an event series by Cicely Saunders International, held to commemorate the ten-year anniversary of the death of Dame Cicely and to celebrate the continuation of her life’s work.
Spotlight on education and training
The Cicely Saunders Annual Lecture presents an international leader and is a highlight in our education programme.
Spotlight on education and training
Our new e-learning project aims to improve learning outcomes by using a wide, accessible and interactive format.
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MORECare and E-learning
Despite being a core business of medicine, end of life care is neglected. It is hampered by research that is difficult to conduct with no common standards. Our MORECare project aimed to develop guidance to improve end of life care research. The study resulted in a statement (the MORECare Statement), which sets clear standards on good research practice in evaluating services and treatments in end of life care. The Statement is relevant to those designing, funding and reviewing studies and provides a first step in setting common standards for evaluative research in end of life care. Our innovative new e-learning project aims to disseminate the MORECare findings locally, nationally and internationally, using an e-learning format. The intention is to influence practice through using a wide, accessible and interactive format to improve learning outcomes. Our vision for the e-learning course is to form a platform to disseminate future research findings and complement the Institute’s MSc in Palliative Care by widening the teaching resources available to students and staff. Registration is now open for the short e-learning course on Developing and evaluating complex interventions in palliative and end of life care (MORECare statement).
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The media
We promote our research through YouTube, Twitter, blogs, podcasts, and conventional media. Members of the department have featured in numerous radio and television programmes, and in print media. In 2012, we launched the CSI YouTube channel (CSIKCL), which features our research, promotional videos for our postgraduate programmes, and our growing number of educational seminars. Our video resources are free to access allowing people locally and across the world to learn about our work and benefit from our international speakers. Our Twitter account (@CSI_KCL) attracts a growing number of followers and allows us to communicate our key findings to patients, members of the public, students, health professionals, and researchers from all over the world. The account has been named in the International Journal of Palliative Nursing as one of the ‘must follow’ accounts for palliative care.
Spotlight on education and training
Our video resources are free to access allowing people across the world to learn about our work and benefit from our international speakers.
Spotlight on education and training
Having the right kind of information and support at the right time is essential, whether a person is newly diagnosed or has been living with a condition for some time.
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The Macmillan Information and Support Centre
The Macmillan Information and Support Centre is housed on the ground floor of the Cicely Saunders Institute. It represents a highly accessible, welcoming and relaxing environment for patients, carers or family and friends of people with cancer or other long term conditions to learn about their conditions and how services can best help them. People attend the centre with queries, to access support activities, or simply to make use of the quiet space. Evidence suggests that having the right kind of information and support at the right time is essential, whether a person is newly diagnosed or has been living with a condition for some time. A fulltime Centre Manager, and a team of trained volunteers run the centre. It is open Monday to Friday, 10.00am to 4.00pm, and was designed to be an integral part of the Cicely Saunders Institute. In 2012 the centre obtained a ‘Macmillan Quality Environment Mark award’. This prestigious award acknowledges that the environment is welcoming and accessible to all, respectful of people’s privacy and dignity, supportive to users’ comfort and well-being, gives choice and control to people using the service, and listens to the voice of the user: “We users will arrive with a welter of needs – physical, mental, emotional and spiritual … Some will be amazingly buoyant and optimistic, others stunned that suddenly life is short. Yet others will be looking for relief and support while going through a bad patch, yearning to emerge and put life together again. The impressions I have in my mind are about ebb and flow, not being sucked in or blown out, but being held long enough to make good decisions for oneself and others we love …” Feedback from a user
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Innovation in service and education
Case example The Advanced Renal Care (ARC) Project
The ARC (Advanced Renal Care) project, funded by NHS Kidney Care, addressed the need to improve assessment, coordination, planning and communication for patients with kidney disease who were approaching the last year of life. The project responded to recommendations that had been set out in a NHS 2009 report titled ‘End of Life Care in Kidney Disease: A Framework for Implementation’. At King’s College Hospital and Guy’s and St Thomas’ NHS Foundation Trust the ARC project introduced: screening of symptoms and quality of life; multi-disciplinary meetings to discuss those patients with the most need; a cause for concern register (to coordinate care for those patients becoming less well); and, improved IT systems. The ARC project also: • Developed and delivered an advanced communication training programme for nurses and doctors, to improve their confidence and ability to commence discussions about end of life care and preferences with renal patients. • Developed and distributed an ARC Toolkit which contained: facts and figures on prognosis and survival; symptoms and quality of life screening tools; symptom treatment guidelines, patient information leaflets on renal failure, symptoms and conservative care; advanced care planning documents; information on discharge planning; and information on local hospice and bereavement services. The toolkit was made available (in physical and electronic format) to all renal wards and haemodialysis units.
Case example ACCESSCare Project Advanced Cancer Care Equality Strategy for Sexual minorities
The ACCESSCare project, funded by Marie Curie Cancer Care, aims to improve supply and demand for palliative care for lesbian, gay, bisexual and/or trans* (LGB and/or T) people who are in the later stages of a life-limiting illness. Research has shown that people who identify as LGB and/ or T, and their significant others, may not receive the care they need when facing a life-limiting illness, despite an increased risk of certain cancers. The ACCESSCare project has been designed to address this inequity. The project includes in depth interviews with people who identify as LGB and/or T and are in the later stages of a lifelimiting illness, as well as with bereaved caregivers of trans* people who died from a progressive illness or condition. Using the feedback from these interviews: • Mass media resources will be developed and shared with the LGB and/or T communities to increase the demand for endof-life care; and, • Education and training resources will be supplied to assist health care professionals to deliver appropriate care.
Case example Transforming End of Life Care local training for generalist palliative care staff (funded by Health Education South London)
End of life care is frequently provided by general medical staff working in acute and community settings. Therefore specialist palliative care services have a fundamental role to play in educating their non-specialist colleagues and a free 2-day course has been running at Guy’s and St Thomas’ NHS Foundation Trust since 2012. The Transforming End of Life Care course helps general medical staff improve their skills, knowledge and understanding of end of life care. In 2014 we won a grant from Health Education South London (HESL) to develop the 2-day training course and to assess effectiveness of training for the future. The project includes: • A review of published research literature; • An evaluation of the current Transforming End of Life Care course; • Focus groups with GPs and volunteers to ask about their training needs; • Interviews with staff, patients and family carers to determine how best to assess the effects of a training course in a future trial; and, • A trial of a new training and support package. This research will be used to inform a communication skills training course for non-specialist palliative care providers.
Spotlight on education and training
Specialist palliative care services have a fundamental role to play in educating their non-specialist colleagues.
Spotlight on education and training
We are passionate about ensuring people live better with life-limiting disease, with dignity and choice, and minimal suffering, including to the end of their lives.
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About us
The Cicely Saunders Institute opened in 2010 and is the world’s
only purpose-built Institute dedicated to palliative care research. It brings together a community of academics, healthcare professionals, community organisations, patients and carers that share knowledge and skills across care settings, countries and disease groups. Palliative care aims to identify and manage the physical, psychosocial and spiritual problems of patients and families facing progressive, incurable illness. At the Cicely Saunders Institute, we are passionate about ensuring people live better with life-limiting disease, with dignity and choice, and minimal suffering, including to the end of their lives. The Cicely Saunders Institute is committed to pioneering research into palliative care and rehabilitation that feeds quickly into improving care for patients and their families locally, nationally and internationally. Dame Cicely Saunders trained as a nurse, a medical social worker and finally as a physician. From 1948 she was involved with the care of patients with terminal illness, lectured widely on the subject, wrote many articles and contributed to a great number of books. She founded St. Christopher’s Hospice in 1967 and was also involved with the creation of hospice teams around the world. She is universally recognised as the founder of the modern hospice movement. In 2002 she became the founder trustee of Cicely Saunders International and worked actively for the creation of a centre of excellence housing research, education, information provision and clinical care. Dame Cicely died on 14 July 2005. At the Cicely Saunders Institute, we celebrate the continuation of her life’s work.
Thank you We thank all those who have supported research, teaching and development in the Cicely Saunders Institute including: Academy of Medical Sciences Calouste Gulbenkian Foundation Cancer Research UK Marie Curie Cancer Programme Cicely Saunders International Diana Fund & HPCA Diana Princess of Wales Memorial Fund Dimbleby Cancer Care Department of Health Dunhill Medical Trust (Not associated with the Tobacco Industry
and fully comply with the Join Protocol of Cancer Research and Universities UK on Tobacco Industry Funding to Universities, 2004)
European Union European Union FP7 - Marie Curie Actions - Networks for Initial Training Family and Friends of Rob Buckman Futures Group International LLC Guy’s & St Thomas’ Charity Guy’s & St Thomas’ NHS Trust King’s College Hospital NHS Foundation Trust King’s College Hospital Charity Macmillan Cancer Support Marie Curie Medical Research Council
Medical Research Foundation MRF Alexander Fleming Motor Neurone Disease Association (Health Care Grants) MS Society Myeloma UK National Cancer Research Institute NHS Kidney Care National Institute for Health Research Open Society Institute Palliative Care Funding Review PF Charitable Trust Robert Bosch Stiftung Roy Castle Lung Cancer Foundation Samuel Sebba Trust Sir Halley Stewart Trust St Christopher’s Hospice South London NIHR CLAHRC Sussex Community NHS Trust The Atlantic Philanthropies The Dinwoodie (1968) Settlement The Garfield Weston Foundation The Kirby Laing Foundation The Rayne Foundation The Wolfson Foundation Wellcome Trust
Cicely Saunders Institute King’s College London Bessemer Road London SE5 9PJ T +44 (0)20 7848 5516 E palliativecare@kcl.ac.uk W www.kcl.ac.uk/palliative @CSI_KCL