2009 marked the 10th anniversary of the Education in Palliative and End-of-life Care (EPEC) program. EPEC’s teaching efforts began in 1997, a time when the field of medicine had generated increased capacity in palliative care and symptom management, but was still struggling to develop a balance between curative approaches to treatment and the need to ameliorate suffering in chronic and incurable diseases.

In order to help achieve this balance, Linda L. Emanuel, MD, PhD, Charles F. von Gunten, MD, PhD, and Frank Ferris, MD, worked with national palliative care leaders to develop the EPEC Curriculum. At that time, many of the medical education interventions had little impact, perhaps because they were limited mostly to a ritualized process of information presentation. EPEC was designed as a train-the-trainer program geared at teaching both the content of the curriculum and educational approaches to improve palliative and end-of-life care. It stresses the use of adult education methods that emphasize interactive learning techniques and builds on the application of social science principles that can lead to changes in social expectations and behavioral norms.

EPEC was located within the American Medical Association during the developmental and implementation stages of the project and from this location the project was able to reach national and international physicians from all disciplines. The success of EPEC during the first decade was due in part to the generous support of the Robert Wood Johnson Foundation, the National Cancer Institute, and others who embarked on a national strategy to improve and sustain palliative care.

EPEC was once funded solely by grants, but it has evolved into an ongoing, self-sustaining educational program that has been molded by the needs of the health care workers who have participated in the conferences. The program has undergone modifications in order to meet the needs and goals identified by the participants. Participants learn palliative care skills and competencies and are introduced to effective teaching methods at core conferences ('Become an EPEC Trainer' Conferences). The conferences, which began in 1999, are held twice a year in various locations and are taught by EPEC master facilitators. Some of the professionals who received training at the core conferences sought to increase their teaching skills and expressed an interest in becoming master facilitators. In response to these needs, EPEC initiated an annual Professional Development Workshop with its own defined curriculum in 2001.

In more recent years, EPEC has actively collaborated with many partners to create adaptations of the original curriculum. The goal of these adaptations is to expand the scope and range of palliative care by introducing it into new settings, broadening the definition to include the entire spectrum of illness, and referring patients for palliative care earlier in the disease process. Our medical specialty partners include EPEC - Oncology, EPEC - Emergency Medicine, EPEC - Geriatrics/Long-term Care, EPEC for Veterans, and EPEC - Pediatrics. We have also sought to extend the EPEC model by working with partners to adapt our curriculum to the needs of specific populations. This effort has led to the development of projects such as APPEAL (A Progressive Palliative Care Education Curriculum for the Care of African Americans at Life’s End); EPEC - Roman Catholic; EPEC - Caregiver (communication and navigation topics for patients and family caregivers); and EPEC - India.

In addition to being taught at live conferences, EPEC is also available via a distance learning platform that includes the core EPEC Curriculum, the EPEC - Oncology Curriculum, and the EPEC for Veterans Curriculum.

The dissemination of the EPEC Curriculum and initial training efforts were evaluated by an external group after one year. Results indicated that 90% of trainers were actively using the EPEC Curriculum to teach others; a sample indicated that 184 of the initial trainers were estimated to have taught 120,000 other professionals. Today there are more than 2,000 EPEC trainers in the United States and 16 other countries. During the next decade, the EPEC team will continue to support the efforts of its trainers, adapt and expand the curriculum to fit the needs of interdisciplinary audiences, and evaluate and measure the impact that the training has had on the experiences of patients and families. “As the Palliative Care Coordinator at a mid-sized teaching hospital, the EPEC train-the-trainer program has given me the confidence and knowledge to teach about end-of-life care. I have also been providing the curriculum to our entire Hospitalist Service, and work as a resource to my colleagues on palliative and end-of-life care. The Professional Development Workshop was a wonderful experience and strengthened my teaching skills. The EPEC Program is very useful in all disciplines and across many settings. I am grateful to be a participant of multiple EPEC Programs! Thank You!” Karen Mulvihill, Danbury Hospital

“Yesterday, I had to speak to the wife and family of a patient who had a serious problem in the Recovery Room - all I could think about was how the role play helped me deal with it, and how well I was received by the family. All turned out well, and now the family thinks I hung the moon! What an immediate benefit. I cannot remember any meeting where the tools I learned were so easily incorporated into my practice and my teaching.”
James A. Ramsey, Vanderbilt School of Medicine

"I took EPEC in Charleston a few years ago. We use it all the time...it is the backbone of our education for physicians and for social workers."
Laurie Lybrand Busby, Roper St. Francis Healthcare

“Just back from India, and writing to say how impressed I am with EPEC - India. Congratulations.”
Robert Twycross, palliativedrugs.com Ltd.

“This has been one of the best conferences I have attended.”

“I think all physicians should be required to attend such a conference. I believe it would make them better practitioners. We would see an increase in family and patient satisfaction.”

“I think it would be hard to attend [the conference] and not be changed by it.”

“The course and material have given me the motivation to get out of my busy office and share with my colleagues from a fund of knowledge I’ve obtained in hospice care for the past 10-12 years.”