Requirements for Endof Life Physician Education in the United States

Until recently, few medical schools offered comprehensive training in end-of-life care. The training that existed was largely elective, in lecture format, and with limited patient contact. Although some U.S. medical schools developed dedicated palliative care courses or comprehensive curricula, this was the exception until very recently. The Liaison Committee on Medical Education (LCME), the accrediting authority for United States medical schools, mandated in 2000 that all medical schools provide instruction in end of life care, which may improve the situation.

Graduate physician education requirements for end-of-life training are also highly variable. Since 1997 the oversight educational committees for Geriatrics, Family Medicine, Internal Medicine, Neurology, General Surgery and Hema-tology/Oncology have added requirements for end-of-life training. In the realm of testing, the National Board of Medical Examiners started work in 1999 to review, re-write and expand end-of-life content on test questions administered to all medical students and interns.

Although there is no national requirement for physicians already in practice to attend continuing education courses in end-of-life care, the American Medical Association (AMA) has encouraged all its member physicians to participate in Education for Physicians on End-of-life Care (EPEC), a comprehensive training program. In addition, starting in 2000, the state of California began requiring that all applicants for a medical license successfully complete a medical curriculum that provides instruction in pain management and end-of-life care. As with the LCME requirement for medical schools, the exact criteria to determine what constitutes end of life instruction have not been defined.

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