All physicians training in primary care in San Diego (internal medicine, family practice) spend time at IPM learning about hospice and palliative care. In addition, physicians training to be psychiatrists, pediatricians, geriatricians, anesthesiologist pain specialists, and oncologists also spend time at IPM. Those physicians who participate come from UCSD, Scripps, Camp Pendleton and Navy Medical Center of San Diego. Some also come from other parts of California and from other States.
The core of the education is learning by doing. Consequently, these physicians participate in the care of patients in the ICC, make home visits, and participate in our three hospital-based consultation services. They all use an on-line teaching curriculum which our faculty helped develop in order to quickly learn the didactic and theoretical aspects of the work. This permits them to maximize the skills they develop when they apply this information at the bedside.
In evaluating the outcomes of the curriculum for physician residents, we have been able to show they improve their attitudes, knowledge and skills to a level that exceeds that of a sample of internal medicine physician faculty from medical centers across the country. Residents say they learn the most about how hospice care works, and how to present it to family members. In San Diego County, 58% of all eligible patients are referred for hospice care. This compares to a California average of 33% and a national average of 25%. We think the training of all primary care physicians has played an important role in yielding this kind of access to appropriate end-of-life care. We are hoping that a similar outcome will be palliative care consultation services in all area hospitals.