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"Life, death, and medicine": A new terminal care online educational module
Upper Lobby
"Life, death, and medicine": A new terminal care online educational module
Medical Student, Yale
BackgroundMany medical professionals feel uncomfortable or inadequately trained in end-of-life patient care. To address this shortcoming, a novel internet-based educational module entitled “Life, Death,... Read more

Description

Background

Many medical professionals feel uncomfortable or inadequately trained in end-of-life patient care. To address this shortcoming, a novel internet-based educational module entitled “Life, Death, & Medicine” was designed to introduce to medical students 1) the dying process, 2) terminal care, and 3) hospice care. The online module was piloted with second-year medical students and evaluated by a survey and a focus group session.

Technology

“Life, Death, & Medicine” is a 30-45 minute interactive online module designed using the Qualtrics© software augmented with HTML coding. A series of items with display logic (i.e., conditional information presentation depending on the user’s response to a question), embedded URL, and plain text were used to create the educational module’s interface consisting of patient case studies, audio and video clips, multiple choice questions with real-time feedback, and hyperlinks to supplementary material. The online module is literature-based and is accessible by URL: https://yalesurvey.qualtrics.com/SE/?SID=SV_79ALPwy56hb0SLX

Implementation

“Life, Death, & Medicine” was piloted with 2nd year medical students at the Yale School of Medicine in 2012. Access to the online module was offered via email one week prior to a required half-day palliative care shadowing session (an existing curricular component not part of this study). Following completion of the shadowing session, students received an invitation to complete an online survey assessing knowledge and attitudes. The responses of the students who completed the module prior to shadowing were compared to those who did not. A focus group session was held to gather qualitative feedback.

Outcomes

60 students (60% response rate) completed the survey with 27 students in the control group (completed the survey without exposure to the online module). Students who completed the online module scored higher on the knowledge domain (p<0.04). Students in both groups feltsomewhat uncomfortable interacting with terminal patients even though they perceived it asimportant for physicians to provide care for dying patients. Moreover, students felt that learning about end-of-life care in medical school was at least as important as other subjects.

The reliability of the survey was tested using binomial logistic regression analysis. The survey was found to be quite reliable (86.0% concordance, Somer’s D = 0.73) and sub-categorical internal consistency was good for “terminal symptoms” (72.9% concordance, Somer’s D = 0.54)and fair for “hospice care” (63.7% concordance, Somer’s D = 0.51).

A focus group consisting of five students revealed that students appreciated the module’s interactive interface and minor suggestions were made for clearer content display.

Conclusions

A newly developed interactive online module was found to increase the end-of-life care knowledge in preclinical second-year medical students. The preliminary results support the utility of web-based tools for medical education in terminal care. A larger randomized study is planned for fall 2015 with the ultimate goal of full integration into the curriculum of the 2nd year Pre-Clinical Clerkship course by 2016. We hope to provide a model for other institutions who wish to implement a similar program to encourage competency for terminal care at the earliest stage of training.

Chung-Sang Tse graduated from the University of Toronto with an Honors B.S. in Physiology and entered the M.D. program at Yale University in 2011. She was a fellow at the AMSA-VITAS End-of-Life Education Fellowship Program in Fort Lauderdale, Florida. Chung-Sang developed an online module for pre-clinical students as part of Yale’s End-of-Life/Palliative Care Curriculum. She hopes to help train future physicians as compassionate and competent healthcare providers - especially towards patients in the final stages of life. She served as president of the Internal Medicine Interest Group and was a founding member of the Medical Education Interest Group.

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