Palliative care education in Thailand is mainly located in the country’s medical and nursing schools. In June 2006, Temsak Phungrassami conducted a survey of the country’s medical and nurse training establishments and elicited responses from six medical and two nursing schools. At that time, palliative care was integrated into the medical curriculum of four of the respondents’ undergraduate programmes, whereas two offered palliative care as a project on request (Table 3).

While the principles of palliative care are included in the medical curriculum, the specific term is not always used. Supranee Niruthisard, anaesthesiologist and chairperson of the Committee for the Development of End of Life Care at King Chulalongkorn Memorial Hospital in Bangkok, explains:

‘We don’t use the words palliative care. But we are changing the student programme and now fifth year medical students will focus on not just medicine but also ‘humanity’. In the first year they have a course called ‘Doctor and Society’ which consists of lectures, workshops, group discussion and site visits. The students visit places such as the School of Aromatherapy, the School of Traditional Thai Medicine, the acupuncture clinic and the HIV self-help group. And when they come back they present their knowledge, or speak about their activities to their friends in the class. In the second year there is a focus on ‘birth ‘til death’. We call the subject the ‘Cycle of Life’. And now in the fifth year we have an element called ‘Critical, Chronic and Terminal Care’, which is very close to the palliative care programme.’³¹

All six medical schools include palliative care in their postgraduate programmes (Table 4). Although these respondents represent just half of the medical schools in Thailand, Sakon Singha, a lecturer at the Prince of Songkla University Medical School and chairperson of Songklanagarind Hospital’s Palliative Care Development Committee is encouraged by the developments. Importantly, he envisages a leading role for the universities, especially in changing the attitudes of medical practitioners and their approach to the care of the dying:

Table 3 Palliative care education in Thailand’s undergraduate medical curriculum

Source: Survey undertaken by Temsak Phungrassami, 2006

‘We see clearly that we have to teach palliative care in the medical curriculum. It’s a must, because for almost a hundred years medical schools in Thailand have been focused very deeply on the biology aspect of medical science - Including myself. It was thought that the best way to give palliative care to the dying patient when I was a medical student was to not ease off the morphine that makes them sleep. And I graduated with that idea.’³²

The Faculty of Medicine at Prince of Songkla University, located in the southern town of Hat Yai has set a lead in palliative care education since the foundation of the Palliative Care Development Committee in 1999. In addition to incorporating palliative care education into undergraduate and postgraduate medical curricula, a wide range of initiatives have included:

1. An annual national palliative care conference since 2004.
2. APHN workshop for hospital staff (2006).
3. Training courses in management of cancer pain and palliative care for nurses working in general hospitals throughout southern Thailand.
4. Volunteer training courses for medical, nursing and high school students, and members of the public.
5. Dharma and healing workshops.
6. ‘Peaceful death’ workshops.

Table 4 Palliative care education in Thailand’s postgraduate medical programmes

Source: Survey undertaken by Temsak Phungrassami, 2006

Just two responses to Temsak’s survey were received from nursing schools (Table 5). In both institutions, accredited courses in palliative nursing appear well established. And with 12 lecturers and a programme chair appointed at Ramathibodi Hospital, developments in nurse education appear generally more advanced than those in medical schools.

In June 2006, APHN launched a course leading to a graduate certificate/ diploma in palliative care in association with Flinders University, Adelaide. Forty seven doctors and nurses applied for 16 available places and two of the successful applicants were from Thailand: Laksamee Chanvej - an anaesthesiologist who is director of palliative medicine at Wattanosoth Hospital (Bangkok); and Chanawat Tesavibul - a radiation oncologist who also works in Bangkok. Temsak Phungrassami, from Songklanagarind Hospital, Hat Yai, was enrolled on the second course. Using a distance learning model, intermittent classroom intensives taught by the Flinders University faculty and a one-month clinical attachment leads to the graduate certificate; a three-month attachment is necessary for the diploma.³³

Laksamee Chanvej:

I decided to take the APHN/ Flinders course because, basically, I’m an anaesthesiologist and was doing pain management consultations in my previous hospital [Songklanagarind]. Most of my patients were cancer patients and we knew that palliative care was crucial from the beginning.

Table 5 Palliative care education in Thailand’s nursing programmes

Source: Survey undertaken by Temsak Phungrassami, 2006

What I found on the course was that evidence-based learning is an important tool. In addition, the intensive period of time in Singapore with a group of fellow students and our tutors is a great experience for life as a palliative care physician.³⁴

Chanawat Tesavibul:

I have worked as a radiation oncologist for 17 years and during the last three to four years I have had the chance to see patients at the end of life more than before. I’ve realized that I’m happy to work with, and help, these patients. At the same time, to gain better results, I thought I should learn more about palliative medicine. But in Thailand now-a-days there is no palliative medicine specialty, and for me it is not easy to go abroad; so I decided to take the APHN Flinders diploma course.

After taking the course, I think I know about palliative care; and I have gained from working with other health personnel and seeing more than a doctor’s point of view. Now at least, I’ve got a network and friends with the same idea of helping people, and the course has forced me to search and read more about the end of life.⁹¹

Alongside these training initiatives, the Camillian Social Centre, Rayon, has provided a range of HIV/ AIDS related and palliative care training. Up to 2003, the charity was said to have given prevention training to over 150 organisations and 3,500 trainees. The Centre supported eight factories, nine schools and three local communities in the development of action plans for HIV/ AIDS prevention. It held planning meetings with the leaders of six local communities and continues to raise awareness and publicise events through a newsletter of 500 copies per issue.³⁵

Palliative care related research

Sakon Singha and Jarurin Pitanupong conducted research into the appropriateness of palliative care as a teaching model for medical professionalism; their findings were presented at the APHN conference in 2006.

A group of 25 surgeons, psychiatrists, anaesthetists, nurses and physiotherapists formed an inter-disciplinary group to deliver holistic care to a target group of 80 patients in need of palliative care. Added to this group were Y4 and Y5 medical students and psychiatry externs on rotation. Four domains of patient demand were identified and discussed during service grand rounds, academic palliative care seminars and communication skills workshops. The investigators concluded that palliative care is an inclusive model for medical students to learn and practise almost all aspects of medical professionalism.³⁶