Palliative care clinical placement at School of Medicine, University of Liverpool

I feel that the palliative care placement has been an important part of my undergraduate education. I had the opportunity to learn valuable communication skills and witness difficult conversations, such as breaking bad news, all of which will help me as a foundation doctor.
Medical student

Details of placement

The palliative care placement is part of the fourth-year undergraduate medical school programme at the University of Liverpool. It is based in seven hospices in the Mersey region. Each student has a ten-day hospice placement, which is underpinned by a further three days of communication in clinical practice training.

In palliative care, while needing to understand the general medicine and prescribing, you need to be able to view the patient and their situation from a greater perspective and really approach care from the patient’s perspective.
Medical student

Good practice and innovative elements

  • Students are taught before the placement about common presentations, referral processes, diagnosis, secondary care management, survivorship and palliative care.
  • Each student has a different timetable and is assigned specific ‘beds’ to look after and a team to be part of. The overwhelming positive outcome from this is that the students get to know their patients and their team members, which makes them feel supported and valued. The students take a history of their patients and then present their cases each week. They also provide their thoughts on next steps in terms of care. Small group teaching includes calculation sessions for drug prescribing and learning about common clinical scenarios they will encounter.
  • Students have training on communication in clinical practice, focusing on taking histories from palliative care patients and how to cope with and deal with emotions. They also take part in role plays and give feedback to each other. Students also bring difficult communication scenarios to the role play session and choose the scenarios they want to work on in a supportive environment.
  • Hospices in the catchment area have collaborated to develop the positive teaching and education culture. The placements are well evaluated, and all changes made from student feedback are incorporated across all the sites. The hospices would like to share their experiences with other hospices across the country to develop clinical placements.
Palliative care uses knowledge alongside application of communication, empathy and considering social factors. This is something that I will take forward with me into other specialities and rotations and I think it is important for all students to gain this perspective.
Medical student

Positive outcomes

  • Students who have been on the placement and now moved into F1 posts have demonstrated more confidence in managing and communicating with palliative care patients and their families.
  • There is significant interaction with a wide range of health care professionals and the opportunity for interprofessional learning.
  • Palliative care is involved across all specialties and this placement enables the students to be more open about death and dying, which in turn supports their wellbeing in both a personal and professional capacity.
  • Students help to develop a patient’s advanced care plan, which involves them working with a wider team of health professionals and across many interfaces of care.
  • Skills needed for palliative care cut across many aspects of other specialty curricula, such as caring for patients with complex needs, pain and symptom management, dealing with uncertainty, and shared decision making.
  • This placement has increased student exposure to Palliative Medicine and highlights the broad range of work they do. The placement also helps to combat incorrect perceptions about hospices, and it’s hoped this will support recruitment.