Squeezing palliative medicine into the crowded curriculum: the Sydney University Graduate Medical Program (GMP)

The University of Sydney Medical School switched to a four-year, graduate entry program (GMP) in 1998. Competition for teaching time is fierce in the crowded GMP timetable, and teaching palliative medicine (PM) to the 240 students enrolled is no exception. Universal coverage of non-core units like palliative care (PC) can only be achieved in the GMP if there excellent integration of the teaching into the core curriculum.

In the old curriculum, PC involved a half-day seminar (lectures, video) and a full day visit to a palliative care unit. In the GMP, approximately 18 hours is devoted to PM, 10 hours of which involves didactic lectures. These include the principles of PC, assessing and managing pain, managing other symptoms, decision making in advanced disease, quality of life, death and dying, hospice care, multidisciplinary care, breaking bad news, patient needs and satisfaction.

Most teaching time for PM is during the 5-week Oncology Block at the end of 2nd year and during the Oncology Integrated Clinical Attachments during in 3rd year, both of which are taught at the three clinical schools. Eight- week options and Honours projects are also available. Teaching resources used include formal lectures, PBL sessions, symposia, tutorials, videos, web-based learning topics and hospice and oncology unit visits. Assessment includes Single Best Answer and Modified Essay Questions on palliative care during the barrier exam in 3rd year.

While PC is covered to a moderate degree in the GMP curriculum, there are a number of challenges to be faced in delivering the teaching. The teaching duties fall on overworked PM clinicians attached to the teaching hospitals. Organising the "hospice visit" for 90 students requires military precision. Consistent with a recent survey, the students want more contact with patients.! Optimally, we believe mandatory clinical attachments (2-4 weeks) later in the program would be appropriate. Identifying opportunities for meeting these challenges and improving the existing teaching is an ongoing task.