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Medical students training for end-of-life-care 'woeful'

Emma Hatton, Journalist

The palliative care sector is warning a crisis for New Zealand's ageing population is imminent as not enough people are being trained in end-of-life care.

Ministry of Health data shows in the next 20 years the number of people dying will increase by 50 percent - or 45,000 each year and by 2068 that number will hit 55,000.

Palliative Medicine Specialist Rod MacLeod said students and junior doctors received a "woeful" amount of training.

"I think it's fair to say that in New Zealand the students are only getting a few days out of their five or six year programme with direct exposure to palliative medicine specialists, and quite frankly that's woeful."

He said other specialities received a disproportionate amount of attention in the curriculum.

"Medical students have to learn all sorts of fascinating facts about liver or pancreas disease which they may never see in their life, but they don't have enough exposure to death and dying which they certainly will see."

Lis Latta oversees the palliative care module at Dunedin School of Medicine.

She said the palliative care workforce was ageing and while medical students got more training now than they did six years ago, it was still not enough to replace those who would soon retire.

"By 2020, 56 percent of the current palliative medicine specialist workforce is going to be over the age of 65. So that's compounded by an ageing population which increases the demand for palliative care services. So we are facing a shortage."

Palliative medicine consultant Anne O'Callaghan, who also lectures at Auckland University, said in the Auckland region there were six placements available in palliative care per year, and about 800 junior doctors.

She said a shortage of palliative specialists meant there was not a lot of time for them to teach because they were too busy looking after patients.

"We've got a real problem with training because we've got a lack of funded posts for people to come into the speciality.

"It's well recognised by Health Workforce New Zealand as being probably the most vulnerable speciality at the moment and that's been recognised for a while but we don't have a solution to that in terms of the funding, so we do have a problem."

But junior doctor Lucy Sulzberger said she has had lots of support.

She has been working at Hutt Hospital for six months, and has been actively involved in providing palliative care to about 15 patients.

"There isn't a shortage of knowledge or support I feel. I've had no trouble as a junior doctor in seeking support from senior colleagues and expert palliative care providers especially in our larger centres where an expert is only ever a phone call away."

But she said while doctors tended to be with a patient for 10 minutes, nurses were the ones who undertook hours of one-on-one care.

The chair of Palliative Care Nurses, Jacqui Bowden-Tucker, said most nurses were not getting enough support and it was unclear exactly how much palliative training students actually got.

"Coming across people who have life-limiting or terminal illnesses as a newly graduated nurse it's quite a significant experience and it can have quite a strong impact," she said.

"It's difficult to ascertain what's happening at the moment but it appears to be minimal so in terms of meeting the increasing demand it's absolutely vital that palliative care becomes in integral component of undergraduate nursing."

In March last year the government launched an action plan to improve services over the next three to five years, while taking into account the long term expected demand.

But the sector said while the plan was a good start, it was yet to gain any serious traction.

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