How effective is undergraduate palliative care teaching for medical students? A systematic literature review

Multiple choice as formative assessment in dental education

INTRODUCTION

The effectiveness of multiple-choice questions (MCQs) in dental education is pivotal to student performance and knowledge advancement. However, their optimal implementation requires exploration to enhance the benefits.

MATERIALS AND METHODS

An educational tool incorporating MCQs was administered from the 5th to the 10th semester in a dental curriculum. The students filled out a questionnaire after the MCQ, which was linked to the learning management system. Four cohorts of four semesters generated 2300 data points analysed by Spearmen correlation and mixed model regression analysis.

RESULTS

Demonstrated a significant correlation between early exam preparation and improved student performance. Independent study hours and lecture attendance emerged as significant predictors, accounting for approximately 10.27% of the variance in student performance on MCQs. While the number of MCQs taken showed an inverse relationship with study hours, the perceived clarity of these questions positively correlated with academic achievement.

CONCLUSION

MCQs have proven effective in enhancing student learning and knowledge within the discipline. Our analysis underscores the important role of independent study and consistent lecture attendance in positively influencing MCQ scores. The study provides valuable insights into using MCQs as a practical tool for dental student learning. Moreover, the clarity of assessment tools, such as MCQs, remains pivotal in influencing student outcomes. This study underscores the multifaceted nature of learning experiences in dental education and the importance of bridging the gap between student expectations and actual performance.

Palliative care training in medical undergraduate education: a survey among the faculty

BACKGROUND

A minority of European countries have compulsory training in palliative care within all medical schools. The aim of the study was to examine palliative care education in Estonia.

METHODS

We used the adapted version of the Palliative Education Assessment Tool (PEAT) to evaluate palliative care education at the University of Tartu, the only medical school in Estonia. The PEAT comprises of different palliative care domains and allows for assessing the curricula for palliative care education.

RESULTS

26 hours (h) of palliative care is taught within the basic medical curriculum, which is divided between 14 courses. Ethical issues (4 h, lecture and seminar) and basics of palliative care (2.5 h, lecture) are well covered however, pain and symptom management (12.5 h, lecture, seminar, workshop), psychosocial, spiritual aspects (5.5 h, seminar), and communication (1.5 h, lecture) teaching do not reach the recommended number of hours. Teamwork and self-reflection are not taught at all.

CONCLUSIONS

Increased time, more diverse teaching strategies and clear learning outcomes are required to enable the development of palliative care education in Estonia. The teaching and learning of palliative care is a process that requires constant development and collaboration.

Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis

ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.

Impact of Palliative and End of Life Care Interprofessional Education for Pre-licensure Healthcare Students: An Integrated Review

An accelerating aging society and rise in serious illnesses has led to an increase in deaths and made the demand for palliative care even greater. An integrated review was conducted to identify the impact of interprofessional education (IPE) on palliative/end of life (EOL) care for unlicensed health care students with a multidisciplinary approach. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and the Cochrane Library's CENTRAL. Fifteen studies were included. Participants' disciplines included medicine, nursing, pharmacy, physical therapy, occupational therapy, social work, chaplain, public health and psychology. Nine were pre-post design and others were post course evaluations. One research study was an interventional trial with a comparative group. The selected studies included a variety of teaching strategies such as simulation or role play, clinical experience, case study, and TOSCE training. The importance of an interprofessional approach to palliative/EOL care has been highlighted, and our review suggests that combined IPE and palliative/EOL interventions can potentially impact palliative/EOL patient outcomes. More studies are needed to clarify the effectiveness of interprofessional palliative/EOL educational interventions including facilitators, learning outcomes, variable methods or teaching strategy, and the level of students.

Primary Palliative Care in the Emergency Department and Acute Care Setting

Amidst a global COVID pandemic, the palliative care community and healthcare systems around the country continue to explore opportunities to improve early patient and family access to end-of-life care resources. They need not look any further than the Emergency Departments (ED) located on their campuses and around their communities for this chance. As advances in medical therapies continue to extend disease specific life expectancies and as the American population continues to age, we will continue to see older adults with chronic medical illnesses visiting the ED in their final stages of life (Smith et al. in Health Aff (Millwood) 31(6):1277-1285, 2012; Albert et al. in NCHS Data Brief 130:1-8, 2013). If the ED is to continue to be the primary portal of hospital entry for patients requiring emergent care for acute and chronic terminal illnesses, then it stands to reason that it should also be equally prepared to provide the earliest access to palliative care and advance care planning resources for patients and families who may want and benefit from these services. This chapter will explore the unique horizon of opportunities that exist for emergency medicine and the palliative care specialty to fulfill this obligation. Discussion will be centered around core principles in screening, assessment, and management of palliative care needs in the ED, importance of goals of care conversations, and the coordination of early palliative care and hospice consults that can facilitate safe transitions of care.

Spiralled Palliative Care Curriculum Aligned with International Guidelines Improves Self-Efficacy but Not Attitudes: Education Intervention Study

PURPOSE

Despite recommendations that palliative care education should be in all health professional programmes, such education is ad-hoc and variable. To reduce variability, the European Association of Palliative Care (EAPC) published a comprehensive guideline for curricula development. This study evaluates a new palliative and end-of-life care course for medical undergraduates aligned with the EAPC guidelines, focusing on knowledge, skills and attitudes.

METHODS

Final-year medical students were surveyed using two validated questionnaires: Self Efficacy in Palliative Care (SEP-C) and Thanatophobia scale (TS). We compared the intervention group, that were exposed to an integrated palliative medicine course throughout the three clinical years, with a control group that were not exposed to the new educational intervention.

RESULTS

For self-efficacy, the intervention group had statistically significantly higher scores than the control arm. The control group had high scores compared with international data. Positive attitudes to dying patients were low and did not differ between the two groups.

CONCLUSION

A well-designed palliative and end-of-life curriculum that is aligned to EAPC guidelines increases the self-efficacy of medical students in managing palliative patients but has little effect on attitudes to dying people. This is likely to be influenced by other factors such as the need for experiential learning.

Palliative medicine education-Bed Race, The End of Life Board Game in undergraduates

BACKGROUND

Educational board games facilitate active learning to conceptualise knowledge, and, promote collaborative learning and team work. Despite increasing interest in them, use in palliative and end of life care has been very limited to date.

METHOD

In 'Bed race, The End of Life Game', participants are divided into four teams who move a model hospital bed around a board to collect items (syringe driver; Do Not Attempt Resuscitation form; oral hydration gel; a 'heart'; Just In Case medicines). To obtain items at themed 'checkpoints', each team needs to answer quiz questions, which require application of clinical knowledge and/or communication skills. Pregame and postgame quiz scores and feedback were collected from 12 game sessions involving 251 year 5 medical students.

RESULTS

169 (67%) of students completed pregame and postgame anonymous quiz questions and free-text feedback. Postgame quiz scores were higher for each topic, and the difference in the paired pregame and postgame questionnaires was statistically significant (p<0.05). Themes from the free-text feedback included 'engaging and fun'; 'relevant learning'; 'peer learning and team work'.

CONCLUSIONS

Educational board games are not a new panacea for education, but the concept can be successfully applied in palliative care.

Assessing Medical Students' Confidence towards Provision of Palliative Care: A Cross-Sectional Study

Under a surging demand for palliative care, medical students generally still show a lack of confidence in the provision in abroad studies. This cross-sectional study aims to investigate the confidence and its association with knowledge, attitude and exposure on providing palliative care among medical undergraduates with a self-administered questionnaire to improve the international phenomenon. Full-time local medical undergraduates were recruited to obtain information regarding the demographics, confidence, knowledge, attitude and exposure on palliative care; the information was collected from July 2020 to October 2020. Questions on confidence (10-items), knowledge (20-items), attitude (10-items) and exposure were referenced from validated indexes and designed from literature review. Confidence level was categorized into “Confident” and “Non-confident” as suggested by studies to facilitate data analysis and comparison. Of the 303 participants, 59.4% were “Non-confident” (95% C.I.: 53.8% to 65.0%) in providing palliative care on average. Among medical students, knowledge (p = 0.010) and attitude (p = 0.003) are significantly positively associated with the confidence to provide palliative care, while exposure to death of family/friends (p = 0.024) is negatively associated. This study begins an investigation on the research area in Hong Kong primarily. The confidence of local medical students should be enhanced to provide palliative care in their future. It thus highlights the importance of the medical curriculum and provides insights to remove barriers responsively to improve the overall confidence and the quality of palliative care.

Palliative care education and its effectiveness: a systematic review

BACKGROUND

Palliative care education (PCE) is an important public health approach to palliative care and is crucial to improving its utilisation. The present study aims to develop a comprehensive understanding of PCE and its effectiveness.

METHOD

A systematic review approach, including narrative synthesis, was used to review qualitative and quantitative studies published in the English language between January 1969 and January 2019, focussing on PCE programs.

RESULTS

Thirty-nine research studies were included in the systematic review. The target audience of the included studies were mostly healthcare professionals, followed by family caregivers. Definitions of death and palliative care, symptom management and communication were leading themes in the reviewed PCE programs. The educational resources used in PCE programs were mainly self-developed teaching materials, with some programs utilising eLearning resources. The included PCE programs were effective in improving knowledge, attitude and confidence in palliative care and the satisfaction of participant learning experience.

CONCLUSION

PCE is a useful tool to improve knowledge of, confidence in and attitudes towards palliative care amongst healthcare professionals and carers. To make palliative care a public health issue, PCE should be expanded to the public and policy-makers.