Palliative care and Medical Education: Systematic review




Palliative Care; Medical education; Clinical competence; Graduation.


Introduction: Palliative care underlies the daily life of health services, due to the increased burden of chronic diseases and aging. While teaching is fundamental, there are significant gaps in the medical curriculum. There is a consensus about the relevance of teaching in undergraduate courses; however, many schools do not include it in the curriculum. Methods: The search strategy was used, and descriptors were defined as follows: “palliative care” AND “medical education” OR “curriculum and competence clinical”, total of 89 papers were identified. From this sample, 67 papers were not included and 22 papers analyzed. Results: The emerging categories were as follows: impact on learning by the incorporation of palliative care education in the undergraduate medical course, essential competencies in palliative care in the medical undergraduate course and obstacles and paths aimed at its insertion in the undergraduate medical curriculum. Disciplinary modules contribute to changes in the approach to finitude and the acquisition of emotional competencies by professionals. This paper addresses a systematic review of how and why palliative care teaching should be carried out in graduation, considering difficulties and challenges for curricular incorporation. The main obstacles identified were lack of clinical context for education, lack of curricular time in the face of the demand, low support and structure, lack of qualified teachers, fragmented teaching and formal absence in curricula. Conclusion: The studies analyzed demonstrate benefits of teaching in PC in medical training, through longitudinal education, since they enhance the acquisition of essential skills in the exercise of medicine and especially in the treatment of people with life-threatening diseases.


Annear, M. J., Lea, E., Lo, A., Tierney, L., & Robinson, A. (2016). Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences. BMC Geriatr;16-38. 10.1186/s12877-016-0211-8.

Back, A. L., Steinhauser, K. E., Kamal, A. H., & Jackson, V. A. (2016). Building Resilience for Palliative Care Clinicians: An Approach to Burnout. Prevention Based on Individual Skills and Workplace Factors. J Pain Symptom Manage. Aug;52(2):284-91. 10.1016/j.jpainsymman.2016.02.002

Brown, C. E., Back, A. L., Ford, D. W., Kross, E. K., Downey, L., Shannon, S. E., Curtis, J. R., & Engelberg, R. A. (2018). Self-Assessment Scores Improve After Simulation-Based Palliative Care Communication Skill Workshops. Am J Hosp Palliat Care. Jan;35(1):45-51. 10.3928/01484834-20180720-08

Carroll, T., El-Sourady, M., Karlekar, M., & Richeson, A. (2019). Primary Palliative Care Education Programs: Review and Characterization. Am J Hosp Palliat Care. Jun;36(6):546-49. 10.1177/1049909118809947.

Crawford, G. B., & Zambrano, S. C.(2015). Junior doctors' views of how their undergraduate clinical electives in palliative care influenced their current practice of medicine Acad Med; 90(3): 338-44. 10.1097/ACM.0000000000000632

Ellman, M. S., Fortin, A. H., Putnam, A., & Bia, M. (2016). Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students. Teach Learn Med.28(2):229-39. 10.1080/10401334.2016.1146601

Eychmüller, S., Forster, M., Gudat, H., Lütolf, U. M., & Borasio, G. D. (2015) Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives.Med Educ. 2015 Nov 27;15:213. 10.1186/s12909-015-0485-0

Gibbins, J., McCoubrie, R.; Maher, J., & Forbes, K.(2009). Incorporating palliative care into undergraduate curricula: lessons for curriculum development Med Educ; 43(8): 776-83. 10.1111/j.1365-2923.2009.03400.x

Kriesen, U., Altiner, A., & Müller-Hilke, B. (2018). Perception of bedside teaching within the palliative care setting-views from patients, students and staff members. Ann Palliat Med. Oct;7(4):411-19. 10.21037/apm.2018.05.01

Lehto, J. T., Hakkarainen, K., Kellokumpu-Lehtinen, P. L., & Saarto, T. (2017). Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge. BMC Palliat Care. Jan 25;16(1):13. 10.1186/s12904-016-0182-8

MacPherson, A., Lawrie, I., Collin, S., & Forman, L. (2014).Teaching the difficult-to-teach topics BMJ Support Palliat Care;,4(1): 87-91. 10.1136/bmjspcare-2012-000408

Murray, S. A., Firth, A., Schneider, N., Van den Eynde, B., Gomez-Batiste, X., Brogard T., et al. (2015). Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med;29(2):101-11.

Pastrana, T., Wenk, R., & De Lima, L. (2016). Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities. J Palliat MedJan;19(1):76-82. 10.1089/jpm.2015.0202

Parikh, P. P., White, M. T., Buckingham, L., & Tchorz, K. M.(2017) Evaluation of palliative care training and skills retention by medical students.J Surg Res; 211: 172-77. 10.1016/j.jss.2016.11.006

Peh, T. Y.,Yang, G. M., Krishna, L. K., & Yee, A. C. (2017).Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting? J Palliat Med. Feb;20(2):141-46. 10.1089/jpm.2016.0293

Romotzky, V., Galushko, M., Düsterdiek, A., Obliers, R., Albus, C., Ostgathe, C., & Voltz, R. (2015)."It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication.J Cancer Educ; 30(2): 333-39. 10.1007/s13187-014-0712-0.

Samala, R. V., Hoeksema, L. J., & Colbert, C. Y. (2019). A Qualitative Study of Independent Home Visits by Hospice Fellows: Addressing Gaps in ACGME Milestones by Fostering Reflection and Self-Assessment.Am J Hosp Palliat Care. Oct;36(10):885-92.

Saylor, J., Vernoony, S., Selekman, J., & Cowperthwait, A. (2016). Interprofessional Education Using a Palliative Care Simulation. Nurse Educ. May-Jun;41(3):125-29. 10.1097/NNE.0000000000000228.

Schaeffer, K. et al. (2014). Raising the bar for the seriously III patients: Results of a National survey to define essential competencies of medical students and residents. NIH - Public access. Author manuscript. Acad Med. July;89(7): 1024-31. 10.1097/ACM.0000000000000271

Schiessl, C., Walshe, M., Wildfeuer, S., Larkin, P., Voltz, R., & Juenger, J. (2013). Undergraduate curricula in palliative medicine: a systematic analysis based on the palliative education assessment tool. J Palliat Med; 16(1): 20-30. 10.1089/jpm.2012.0281.

Schillerstrom, J. E.,Sanchez-Reilly, S., & O'Donnell, L.(2012).Improving student comfort with death and dying discussions through facilitated family encounters. Acad Psychiatry, 36(3): 188-90. 10.1176/appi.ap.10020032.

Schneidernam, L. J. (2011) Defining Medical Futility and Improving Medical Care. Journal of Bioethical Inquiry,8:123-31. 10.1007/s11673-011-9293-3.

Shaheen, A., Denton, G. D., Stratton, T. D., & Hoellein, A. R.(2014). Chretien KC End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors Acad Med; 2014, 89(8): 1168-73. 10.1097/ACM.0000000000000311.

Smith, A., Carey, C., Sadler, J., Smith, H., Stephens, R., & Frith, C. (2019). Undergraduate education in anaesthesia, intensive care, pain, and perioperative medicine: The development of a national curriculum framework. Med Teach. Mar;41(3):340-46. 10.1080/0142159X.2018.1472373.

Smith, G. M., & Schaefer, K. G. (2014).Missed opportunities to train medical students in generalist palliative care during core clerkships. J Palliat Med; 17(12): 1344-7.

Schulz-Quach, C., Wenzel-Meyburg, U., & Fetz, K. (2018). Can elearning be used to teach palliative care? - medical students' acceptance,knowledge, and self-estimation of competence in palliative care after elearning. BMC Med Educ. Apr 27;18-82. 10.1186/s12909-018-1186-2

Spalding, J., &Yardley, S. (2016). 'The nice thing about doctors is that you can sometimes get a day off school': anaction research study to bring lived experiences from children, parents and hospice staff into medical students' preparation for practice BMJ Support Palliat Care. Dec;6(4):459-64. 10.1136/bmjopen-2016-01389

Taquete, S. R., & Rego, S. et all, (2005) Situações conflituosas vivenciadas por estudantes de medicina. Rev Assoc Med Bras; 51(1): 23-28. ISSN 1806-9282.

Taquete, S. R., & Borges, L. M. (2020). Pesquisa qualitativa para todos: Vozes..

Vergo, M. T., Sachs, S., MacMartin, M. A., Kirkland, K. B., Cullinan, A. M., & Stephens, L. A. (2017). Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills. J Palliat Med. May ;20(5):542-47. 10.1089/jpm.2016.0348

Von Gunten, F., Mullan, P. B., Nelesen, R., Garman, K., McNeal, H., Savoia, M., et all. (2017). Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After aClinical Curriculum With a Hospice. Am J Hosp Palliat Care. Sep;34(8):713-20. 10.1177/1049909116655767

Weber, M.,Schmiedel, S., Nauck, F., & Alt-Epping, B. (2016).Knowledge and attitude of medical students in Germany towards palliative care : Does the final year of medical school make a difference?]. Schmerz. Jun;30(3):279-85. 10.1007/s00482-015-0055-8

World Health Organization.(2002). National cancer control programmes: policies and managerial guidelines, (2nd ed.) Geneva: World Health Organization,

World Health Organization. (2014). Global Atlas of Palliative Care at the end-of-life.



How to Cite

CASTRO, A. A. .; TAQUETTE, S. R. .; PEREIRA, C. A. R. . Palliative care and Medical Education: Systematic review. Research, Society and Development, [S. l.], v. 10, n. 1, p. e50210111976, 2021. DOI: 10.33448/rsd-v10i1.11976. Disponível em: Acesso em: 23 mar. 2023.



Education Sciences