The different levels of learning about dying and death: an evaluation of a personal, professional and interprofessional learning journey

The Perinatal Loss Care Educational Programme and its Evaluation

Introduction

Working with bereaved parents is an immense challenge for professionals in the field of perinatal care and requires a high level of knowledge and skill. This article aims to evaluate the effectiveness of the Perinatal Loss Care blended educational programme.

Methods

An evaluative assessment was carried out using a scored questionnaire to gather pre- and post-programme data. Participants were medical and healthcare professionals (n=200) who participated in the programme voluntarily (the Medical Professional/Motivated group and the Others group) or were selected by their employer and for whom attendance was mandatory (the Medical Professional/Non/Motivated group).

Results

Participants’ perception of their own knowledge and understanding of perinatal bereavement care was significantly higher on completion of the educational programme, proving its effectivity. There was a statistically significant effect on overall score in individual groups of respondents, as well as the whole set (p<0.001), with post-intervention scores higher than pre-intervention scores. No statistically significant differences in overall score were detected before participation in the educational programme in individual groups (p=0.204). Participants from the Medical Professional/Non/Motivated group achieved lower post-intervention scores to a significantly greater extent (p<0.05) and more often perceived the educational programme as being “very difficult” (χ²=20.66, df=6, P<0.01) compared to other groups.

Conclusions

The educational programme was assessed as effective. Care of bereaved parents has its specifics and healthcare professionals should possess a basic knowledge of how to provide sensitive care during this time.

Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy

Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.

Does the unexpected death of the manikin in a simulation maintain the participants' perceived self-efficacy? An observational prospective study with medical students

BACKGROUND

The death of a simulated patient is controversial. Some educators feel that having a manikin die is prejudicial to learning; others feel it is a way of better preparing students for these situations. Perceived self-efficacy (PSE) reflects a person's perception of their ability to carry out a task. A high PSE is necessary to manage a task efficiently. In this study, we measured the impact of the death of a simulated patient on medical students' perceived self-efficacy concerning their ability to cope with a situation of cardiac arrest.

METHODS

We carried out a single-centre, observational, prospective study. In group 1 (n = 27), pre-graduate medical students were warned of the possible death of the manikin; group 2 students were not warned (n = 29). The students' PSE was measured at the end of the simulated situation and after the debriefing.

RESULTS

The PSE of the two groups was similar before the debriefing (p = 0.41). It had significantly progressed at the end of the debriefing (p < 0,001). No significant difference was noted between the 2 groups (p = 0.382).

CONCLUSIONS

The simulated death of the manikin did not have a negative impact on the students' PSE, whether or not they had been warned of the possible occurrence of such an event. Our study helps defend the position which supports the inclusion of unexpected death of the manikin in a simulation setting.

Transforming Students' Attitudes and Anxieties Toward Death and Loss: The Role of Prior Death Experiences

This study examines the impact of a death and dying course on 39 undergraduate students' attitudes and anxieties about death. Authors outline key aspects of the curriculum used in the course and discuss how the approach lends itself to a transformative learning experience related to death and loss, preparing students who will face clients with a variety of needs in these areas across practice settings. The majority of students ( n = 34) experienced a decrease in death avoidance, fear of death, and overall death anxiety. Students with a history of multiple violent, traumatic, or unexpected deaths ( n = 5) did not experience any significant changes but demonstrated increased scores of death anxiety suggesting that they may be in need of greater support while engaging in death education.

Prelicensure Simulation-Enhanced Interprofessional Education: A Critical Review of the Research Literature

STATEMENT

This review explores the state of prelicensure interprofessional education (IPE) using simulation-based education (SBE) by examining studies that use SBE for prelicensure IPE through a critical review of the research literature. We focus particularly on studies that included experiential SBE with reported measures and formal IPE with prelicensure participants from at least 2 health care professions. Fifty-four studies met criteria. We explore these studies, providing a compilation of information (e.g., educational, simulation, and research methods used; outcome measures reported; and demographics of learner groups), identifying themes that may affect learning, as well as surfacing challenges and gaps in the field. The quality and rigor of the existing literature is inadequate to confidently determine factors that affect learning through simulation-enhanced IPE. We suggest that more rigorous research criteria be included in future studies and a list of reporting items be provided, where future publications can enhance knowledge to guide best practice in simulation-enhanced IPE.

Effect of simulated patient death on emergency worker's anxiety: a cluster randomized trial

Objective

Simulation-based teaching offers promising and diverse teaching possibilities. We aim to assess whether the death of the manikin increased anxiety amongst learner compared to similar simulation-based course where the manikin stays alive.

Methods

We conducted a cluster randomized study amongst multidisciplinary teams of emergency workers. Teams of physicians, nurses, and healthcare assistants were randomly assigned to participate in a simulation-based course where the simulated patient died (death group) or not (life group). We assessed anxiety at 1 month after the teaching using Spielberger STAI-state anxiety questionnaire. We compared reduction of anxiety when facing a life-threatening situation in both groups.

Results

We included 25 teams for a total of 129 participants. We analysed 63 participants in the death group and 57 in the life group. Baseline characteristics were similar in both groups, including baseline anxiety (STAI-state score 39.6 (7.8) in the death group vs 38.6 (7.1) in the life group). We report a significant reduction in both groups 1 month after the training: 6.6 (7.8) vs 6 (8.0), mean difference 0.5 (−2.4; 3.4). At 3 months, we report a significant greater reduction of anxiety in the death group (mean difference 4 [0.1; 7.9]).

Conclusion

We observed in our sample that unexpected simulated patient death did not increase anxiety amongst multidisciplinary emergency workers.

To die or not to die? A review of simulated death

SUMMARY STATEMENT

Simulation as an educational technique is increasingly used in health care to teach about managing critical events and life-threatening situations and, infrequently, to teach about death. There is considerable controversy over whether to allow the simulator to die during a session when death is not a predefined learning objective. Some educators never allow the simulator to die unless death is the objective of the scenario, and others allow the simulator to die unexpectedly during any scenario. We do not know whether such a fatal event may affect a student's learning process and emotions, and no randomized trials have been conducted to determine the impact of simulated death. In this narrative review, we survey the literature on simulated death during health care training, present arguments for and against the broad incorporation of such training in curricula for health care providers, and outline recommendations for using death scenarios in health care simulation.

Second-year Italian medical students' attitudes toward care of the dying patient: an exploratory study

To our knowledge, no other study has investigated Italian medical students' attitudes toward care of the dying patient. The purpose of this study is to investigate those attitudes among second-year Italian medical students. Two-hundred students completed the Italian version of the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD Form B). Students obtained a mean total score on FATCOD Form B of 112.8 (the possible total score ranges from 30 to 150). On some items, statistically significant differences (p < 0.05) emerged for gender and personal previous experiences with terminally ill people. This study shows poor attitudes toward care of the dying patient among second-year Italian medical students, as measured by FATCOD Form B. The need to establish tailored methods in End-of-Life Care education to make students aware of their relationship patterns and to improve students' attitudes toward dying patients is discussed.

Multidisciplinary simulation in pediatric critical care: the death of a child

Health care providers are trained to care for the living. They may complete their education and enter the workforce without ever experiencing the death of a patient. Inexperience with the different roles of the multidisciplinary health care team is common. Moreover, the death of a child has a profound effect on parents and staff. In such situations, the expertise of the multidisciplinary team can make a difference. A multidisciplinary education project that uses high-fidelity simulation based on pediatric death and dying was developed to provide an experience during which health care practitioners could practice communicating with families about the death of their child and dealing with different grief reactions.

Evaluation of an interprofessional practice placement in a UK in-patient palliative care unit

This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.

Teaching post-mortem external examination in undergraduate medical education--the formal and the informal curriculum

In undergraduate medical education, the training of post-mortem external examination on dead bodies might evoke strong emotional reactions in medical students that could counteract the intended learning goals. We evaluated student perception of a forensic medicine course, their perceived learning outcome (via self-assessment) and possible tutor-dependent influences on the overall evaluation of the course by a questionnaire-based survey among 150 medical students in Hamburg, Germany. The majority of students identified post-mortem external examination as an important learning objective in undergraduate medical education and did not feel that the dignity of the deceased was offended by the course procedures. After the course, more than 70% of the students felt able to perform an external examination and to fill in a death certificate. Respectful behavior of course tutors towards the deceased entailed better overall course ratings by students (p<0.001). Our findings highlight the importance of factors such as clearly defined learning goals and course standardization (formal curriculum) as well as tutor behavior (informal curriculum) in undergraduate education in forensic medicine. Furthermore, we suggest embedding teaching in forensic medicine in longitudinal curricula on death and dying and on the health consequences of interpersonal violence.

Teaching dying patient care in three universities in Argentina, Spain, and Italy

We performed a multicenter comparative survey on undergraduate medical education regarding the care of dying patients at medical schools in three countries. We enrolled 380 first- and sixth-year medical students from Universidad Austral (Argentina), Universidad de Navarra (Spain), and Università Campus Biomedico di Roma (Italy). Answers to the questions were similar among the three universities. Students acknowledged interacting directly with dying patients in all cases. Attitudes toward dying patients were highly positive. Students spontaneously requested more training in end-of-life care. Some attitudes and wishes varied significantly from course to course. Students perceived that this issue received more attention in humanistic rather than in clinical subjects. Ninety-eight percent of students considered that death and helping patients to have a good death should be included in their training. Students' attitudes revealed high interest and poor training in end-of-life issues. Medical curricula should be improved to adequately address these issues.