Teaching care of terminally ill patients: a primary care perspective

Currently there is a great interest in educating medical students in the care of patients with terminal illness. When medical students do encounter patients with terminal illness, it is often in the acute care setting. We have designed a workshop for fourth-year medical students who are working in general medical, family, or pediatrics practices as part of their month-long primary-care clerkship. The emphasis of this workshop is on the care of the terminally ill patient as a natural extension of the continuum of care offered by a primary-care physician. The workshop involves an interactive interview of a patient with a terminal illness by a group of four to eight students and the guidance of an experienced physician facilitator. Four themes are identified as central to the primary care of patients with terminal illness, and emphasis is placed on communication skills and the meaning of language to the dying patient.