Preparing the ground: Contributions of the preclinical years to medical education for care near the end of life

The preclinical years of medical education have rich potential for preparin g medical students to provide optimal end-of-life care. Most of the opportu nities and settings for this education already exist in the curricula of mo st medical schools, although they are underutilized for this purpose. In th is report The Working Group on the Pre-clinical Years of the National Conse nsus Conference on Medical Education for Care Near the End of Life identifi es the most promising settings and suggests how they might be used for maxi mum benefit in end of-life education. Basic end-of-life care competencies a re in five do mains: (1) psychological, sociologic, cultural, and spiritual issues; (2) interviewing and communication skills; (3) management of commo n symptoms; (4) ethical issues; and (5) self-knowledge and self-reflection. A centralized group should oversee educational activities related to end-o f-life care at each medical school. This group would identify and facilitat e teaching opportunities in the preclinical curriculum: basic science cours es; problem-based learning seminars; courses in interviewing, the doctor-pa tient relationship, and introduction to clinical medicine; courses in ethic s, humanities, and the social-behavioral sciences; clinical preceptorships; and longitudinal experiences with patients. The group would also assess th e potential impact of the "hidden curriculum."