Incorporating palliative care into undergraduate curricula: lessons for curriculum development

Context It is well recognised that teaching about palliative care, death and dying should begin at undergraduate level. The General Medical Council in the UK has issued clear recommendations for core teaching on the relieving of pain and distress, and care for the terminally ill. However, whereas some medical schools have incorporated comprehensive teaching programmes, others provide very little. The reasons underpinning such variability are unknown. Objectives The aim of this study was to explore the factors that help or hinder the incorporation of palliative care teaching at undergraduate level in the UK. Methods Semi-structured interviews were carried out with a purposive sample of coordinators of palliative care teaching in 14 medical schools in the UK. Transcribed interviews were analysed using principles of grounded theory and respondent validation. Results There are several factors promoting or inhibiting palliative care teaching at undergraduate level that are common to the development of teaching about any specialty. However, this study also revealed several factors that are distinctive to palliative care. Emergent themes were 'need for an individual lead or champion', 'the curriculum', 'patient characteristics and exposure', 'local colleagues and set-up of service', 'university support' and 'the influence of students'. Conclusions The incorporation of palliative care into the medical undergraduate curriculum involves a complex process of individual, institutional, clinical, patient and curricular factors. These new findings could help medical schools to incorporate or improve such teaching.