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Harhara T, Buhumaid R, Oyoun Alsoud L, Ibrahim H. Palliative care education: a nationwide qualitative study of emergency medicine residency program directors in the United Arab Emirates. Int J Emerg Med 2024; 17:69. [PMID: 38783214 PMCID: PMC11119274 DOI: 10.1186/s12245-024-00643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Emergency medicine (EM) physicians routinely care for patients with serious life-limiting illnesses. Educating EM residents to have general skills and competencies in palliative medicine is a global priority. The purpose of this study was to describe the current status of palliative and end-of-life education in EM residency programs in the United Arab Emirates (UAE) and to identify barriers and opportunities to inculcating palliative care (PC) instruction into EM training in a non-Western setting. METHODS Using the American College of Emergency Medicine's milestones for Hospice and Palliative Medicine for Emergency Medicine as a question guide, semi-structured interviews were conducted with program directors of all 7 EM residency programs in the UAE from January through July 2023. Qualitative content analysis was conducted to identify recurring themes. RESULTS All program directors agreed that PC knowledge and skills are essential components of training for EM residents but have had variable success in implementing a structured PC curriculum. Six themes emerged, namely the educational curriculum, PC policies and practices, comprehensive PC services, cultural and religious barriers to PC, EM scope of practice, and supporting residents after patient death. CONCLUSION UAE national EM residency curriculum development is evolving with an emphasis on developing a structured PC curriculum. As EM residencies implement policies and programs to improve care for patients and families dealing with serious illness, future studies are needed to assess the impact of these initiatives on patient quality of life and physician well-being.
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Affiliation(s)
- Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Department of Emergency Medicine, Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Leen Oyoun Alsoud
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.
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Reidy JA, Brizzi K, Chan SH, Day H, Epstein SK, Fischer M, Garg PS, Gosline A, Jaramillo C, Livne E, Mitchell S, Morgan S, Olmsted MW, Stebbins P, Stumpf I, Vesel T, Yeh IM, Young ME, Goldman RE. Curricular Reform in Serious Illness Communication and Palliative Care: Using Medical Students' Voices to Guide Change. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:550-557. [PMID: 38277443 DOI: 10.1097/acm.0000000000005647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
PURPOSE To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools. METHOD The study was conducted by the Massachusetts Medical Schools' Collaborative, a working group committed to ensuring all medical students in Massachusetts receive foundational training in serious illness communication (SIC) and palliative care. Eight focus groups (2 per participating medical school) were conducted during January-May 2021 and included a total of 50 students from Boston University Chobanian & Avedisian School of Medicine, Harvard Medical School, Tufts University School of Medicine, and the UMass Chan Medical School. Data collected from focus groups were discussed and coded. Themes were identified using the immersion/crystallization qualitative data analysis approach. RESULTS Six key themes emerged. Students viewed SIC as essential to high-quality medical practice regardless of specialty, and believed training in SIC skills and palliative care should be required in medical school curricula. Students preferred to learn and practice these skills using frameworks, particularly in real-world situations. Students recognized the expertise of palliative care specialists and described them as a scarce, often misunderstood resource in health care. Students reported it was mostly "luck" if they were included in family meetings and observed good role models. Finally, students desired practice in debriefing after difficult and emotional situations. CONCLUSIONS This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change. Collaborative faculty also created recommendations based on the focus group data for immediate and ongoing SIC and palliative care curricular change in Massachusetts, which can apply to medical schools nationwide.
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Sagin A, Balmer D, Rose S, Musheno R, Olenik JM, Dingfield L, Dine CJ, Bennett NL. Evaluation of a Palliative Care Longitudinal Curriculum for Medical Students Using the Context-Input-Process-Product Model. Am J Hosp Palliat Care 2024; 41:158-166. [PMID: 36945136 PMCID: PMC10751966 DOI: 10.1177/10499091231165504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Palliative care (PC) longitudinal curricula are increasingly being recognized as important in Undergraduate Medical Education (UME). They are however, not yet commonplace, and where they do exist may be implemented without a systematic, prospective approach to curriculum evaluation. This paper describes an implementation of a new longitudinal curriculum at the Perelman School of Medicine (PSOM) at the University of Pennsylvania. We used the Context Input Process Product (CIPP) model, a holistic evaluation model, to assess the local environment, design the curriculum, guide the improvement process, and evaluate outcomes. Comprehensive models such as CIPP provide a more robust approach to curriculum evaluation than outcomes-only models and may be of use to other programs who are implementing new curricula or improving upon existing programs.
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Affiliation(s)
- Alana Sagin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dorene Balmer
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Suzanne Rose
- Medicine/Academic Programs, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rosie Musheno
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer M. Olenik
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura Dingfield
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C. Jessica Dine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nadia L. Bennett
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Reidy JA, Chan SH, Boelitz KM, Chavez M, Clark MA, Epstein SK, Gosline A, Healy R, Livne E, Peirce H, Schaefer KG, Streid J, Vesel T, Young ME, Zehm A, Garg PS. A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education. J Palliat Med 2024; 27:39-46. [PMID: 37976143 DOI: 10.1089/jpm.2022.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. The Massachusetts Medical Schools' Collaborative was created to ensure that students receive foundational SIC training in undergraduate medical education. This Collaborative developed a curriculum-mapping tool to assess SIC at four medical schools. Objective: We aimed to understand existing educational activities across four medical schools and identify opportunities to build longitudinal, developmentally based curricular threads in SIC. Design: From July 2019 to April 2021, faculty, staff, and medical students assessed current educational activities related to five core competencies in SIC, adapted for students from national competencies for palliative medicine fellows, using a curriculum mapping tool. Measurements: The group selected 23 keywords and collected metrics to describe the timing, instruction and assessment for each school's educational activities. Results: On average, there were only 40 hours of required curricula in SIC over four years. Over 80% of relevant SIC hours occurred as elective experiences, mostly during the postclerkship phase, with limited capacity in these elective experiences. Only one school had SIC educational activities during the clerkship phase when students are developing clinical competencies. Assessment methods focused on student participation, and no school-assessed clinical performance in the clerkship or postclerkship phase. Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education.
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Affiliation(s)
- Jennifer A Reidy
- UMass Memorial Medical Health Care, Division of Palliative Care, Worcester, Massachusetts, USA
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Kris M Boelitz
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Melissa Chavez
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Melissa A Clark
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
- Brown University School of Public Health, Department of Health Services, Policy and Practice, Providence, Rhode Island, USA
| | - Scott K Epstein
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
| | - Anna Gosline
- Massachusetts Coalition for Serious Illness Care, Boston, Massachusetts, USA
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
| | - Rose Healy
- Boston Medical Center, Departments of Neurology and Otolaryngology, Boston, Massachusetts, USA
| | - Emma Livne
- Hasbro Children's Hospital, Department of Pediatrics, Providence, Rhode Island, USA
| | - Hayden Peirce
- UMass Chan Medical School, Departments of Medicine, Pediatrics and Surgery, Worcester, Massachusetts, USA
| | - Kristen G Schaefer
- Care Dimensions, Inc., Danvers, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Jocelyn Streid
- Brigham and Women's Hospital, Department of Anesthesiology, Boston, Massachusetts, USA
| | - Tamara Vesel
- Tufts University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
- Tufts Medical Center, Division of Palliative Care, Boston, Massachusetts, USA
| | - Megan E Young
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
| | - April Zehm
- Medical College of Wisconsin, Department of Medicine, Milwaukee, Wisconsin, USA
| | - Priya S Garg
- Boston University School of Medicine, Departments of Medicine and Pediatrics, Boston, Massachusetts, USA
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Engel KG, Millham LRI, Yeh IM, Malecha PW, Brizzi K, Schwartz AW, Tolchin DW. Assessing the Impact of a Hospice and Palliative Medicine Mentored Clinical Shadowing Experience for First-Year Medical and Dental Students: A Pilot Study. Am J Hosp Palliat Care 2023:10499091231214787. [PMID: 37950642 DOI: 10.1177/10499091231214787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Background: All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives: To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design: Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements: The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results: 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions: Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care.
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Affiliation(s)
- Kirsten G Engel
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucia R I Millham
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Irene M Yeh
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick W Malecha
- Harvard Medical School, Boston, MA, USA
- Section of Palliative Care, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorothy W Tolchin
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Reidy JA, Clark MA, Berman HA, Chan SH, Gawande AA, Streid J, Vesel T, Young ME, Zehm A, Schaefer KG. Paving the way for universal medical student training in serious illness communication: the Massachusetts Medical Schools' Collaborative. BMC MEDICAL EDUCATION 2022; 22:654. [PMID: 36050708 PMCID: PMC9438111 DOI: 10.1186/s12909-022-03702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with serious illness look to their clinicians for discussion and guidance on high-stakes treatment decisions, which are complex, emotional and value-laden. However, required training in serious illness communication is rare in U.S. medical schools, with efforts at curricular reform stymied by competing institutional demands, lack of resources and accreditation requirements. We describe an approach to building and scaling medical student training in serious illness communication through the creation of a statewide collaborative of medical schools. METHODS The Massachusetts Medical Schools' Collaborative is a first-of-its-kind group that promotes longitudinal, developmentally-based curricula in serious illness communication for all students. Convened externally by the Massachusetts Coalition for Serious Illness Care, the collaborative includes faculty, staff, and students from four medical schools. RESULTS The collaborative started with listening to member's perspectives and collectively developed core competencies in serious illness communication for implementation at each school. We share early lessons on the opportunities, challenges and sustainability of our statewide collective action to influence curricular reform, which can be replicated in other topic areas. CONCLUSIONS Our next steps include curriculum mapping, student focus groups and faculty development to guide successful and enduring implementation of the competencies to impact undergraduate medical education in Massachusetts and beyond.
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Affiliation(s)
- Jennifer A Reidy
- UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA.
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Melissa A Clark
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
- Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
| | - Harris A Berman
- Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, 101 Huntington Ave, Ste 1300, Boston, MA, 02199, USA
- Blue Cross Blue Shield of Massachusetts, 101 Huntington Ave, Ste 1300, Boston, MA, 02199, USA
| | - Atul A Gawande
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Ariadne Labs, 401 Park Dr, 3rd Floor, Boston, MA, 02215, USA
| | - Jocelyn Streid
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Tamara Vesel
- Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
- Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Megan E Young
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - April Zehm
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
- Froedtert Memorial Lutheran Hospital, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kristen G Schaefer
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Care Dimensions, 75 Sylvan Street, Suite B-102, Danvers, MA, 01923, USA
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Clemens EJ, Reed JB, Baker ES, Baker CM. Effect of death and dying elective on student empathy and attitudes toward mortality. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1627-1633. [PMID: 34895672 DOI: 10.1016/j.cptl.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/30/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pharmacy graduates should be equipped for one inevitable aspect of health care, mortality, yet only 10% of United States pharmacy curricula courses cover end-of-life (EoL) with limited evidence of effectiveness. This study's objective was to evaluate the impact of an EoL elective on student pharmacists' empathy and attitudes toward mortality and caring for terminally ill persons. METHODS First- through third-year student pharmacists enrolled in an EoL elective. Students completed pre- and post-course surveys on self-perceptions of empathy and mortality. Surveys included the following: Kiersma-Chen Empathy Scale (KCES), which assesses empathy of pharmacy and nursing students; revised Collett-Lester Fear of Death and Dying Scale (CL-FODS), which measures fear related to death; and Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B), which measures health care professionals' attitudes toward EoL care. Anonymous identifiers were used to link pre- and post-course surveys and were collected with an online survey software. Data were analyzed using two-sided paired t-tests. RESULTS Twenty-seven student pharmacists completed the elective. The change in overall mean scores for KCES, CL-FODS, and FATCOD-B correlated with increased empathy, reduced fear of death, and increased positive attitudes toward caring for terminal patients (KCES pre-course = 86.15 vs. post-course = 90.37; CL-FODS pre-course = 93.70 vs. post-course = 75.15; FATCOD-B pre-course = 115.89 vs. post-course = 124.04). CONCLUSIONS After the EoL elective, student empathy and attitudes toward mortality and caring for terminally ill persons improved. Implementing EoL concepts in pharmacy curricula should be explored to better prepare graduates in patient care.
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Affiliation(s)
- Emily J Clemens
- Clinical Pharmacy Specialist, Franciscan Alliance ACO, 700 E Southport Rd., Indianapolis, IN 46227-8553, United States.
| | - Jason B Reed
- Assistant Professor of Library Science, Purdue University Libraries and School of Information Studies, 340 Centennial Mall Drive, West Lafayette, IN 47907-2124, United States.
| | - Emma S Baker
- Purdue College of Pharmacy Third-Year PharmD Student, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907-2091, United States.
| | - Chelsea M Baker
- Associate Director of Professional Program Laboratories, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907-209, United States.
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Harhara T, Ibrahim H. Undergraduate palliative care education in the United Arab Emirates: a nationwide assessment of medical school deans. BMC MEDICAL EDUCATION 2021; 21:526. [PMID: 34627211 PMCID: PMC8502263 DOI: 10.1186/s12909-021-02966-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/23/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND The provision of comprehensive, high quality palliative care (PC) is a global public health concern. In the United Arab Emirates (UAE), palliative medicine services are limited, and most patients in need of PC are treated in the acute hospital setting, where health professionals of all specialties provide treatment. Improving end-of-life care requires teaching medical students, residents, and other healthcare professionals about PC. The purpose of this study was to assess the current status of PC education in medical schools in the UAE, and to identify barriers to successful implementation of a PC and end-of-life curriculum. METHODS The authors conducted semi-structured interviews with deans from all medical schools in the UAE. Data were analyzed using qualitative content analysis. RESULTS All medical school deans in our study recognized the importance of inculcating palliative and end-of-life care into the undergraduate curriculum, but there was substantial variability in implementation, with opportunities for improvement. Barriers to the successful implementation of an undergraduate PC curriculum include (1) lack of student awareness and interest in PC, (2) inconsistent clinical exposure to PC, (3) lack of specialized PC faculty, (4) limited clinical facilities for PC training, (5) lack of a multidisciplinary approach to PC education, and (6) cultural barriers to PC education. CONCLUSIONS Understanding challenges to teaching PC in the undergraduate medical curriculum can help inform educational interventions to improve PC knowledge and skills for UAE medical students. Curricular and policy reform are necessary to educate a future generation of health professionals, who can provide high quality palliative care services to UAE patients and their families.
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Affiliation(s)
- Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates.
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Rong R, Chen W, Dai Z, Gu J, Chen W, Zhou Y, Kuang M, Xiao H. Improvement of the management of mental well-being and empathy in Chinese medical students: a randomized controlled study. BMC MEDICAL EDUCATION 2021; 21:378. [PMID: 34246265 PMCID: PMC8272356 DOI: 10.1186/s12909-021-02813-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/28/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students. METHODS A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention. RESULTS Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P = .02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P = .16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P = .31) were observed between the two groups. CONCLUSIONS The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016.
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Affiliation(s)
- Rong Rong
- Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Zihao Dai
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Jingli Gu
- Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Weiying Chen
- Department of Diagnostics, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yanbin Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Ming Kuang
- Department of Medical Education, Department of Liver Surgery, College of Basic Surgery, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
| | - Haipeng Xiao
- Department of Medical Education, Department of Endocrinology, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
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10
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Sinclair S, Kondejewski J, Jaggi P, Dennett L, Roze des Ordons AL, Hack TF. What Is the State of Compassion Education? A Systematic Review of Compassion Training in Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1057-1070. [PMID: 33830949 PMCID: PMC8231671 DOI: 10.1097/acm.0000000000004114] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To investigate the current state and quality of compassion education interventions offered to health care providers during training or practice, determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, and identify the most common approaches to compassion education. METHOD The MEDLINE, Embase, CINAHL Plus with Full Text, Sociological Abstracts, Web of Science, ERIC, and Education Research Complete databases were searched from inception to March 2020 in this systematic review. Studies that evaluated a compassion education intervention for health care providers or those in training to enhance compassion toward patients and/or families were included. A narrative synthesis of the included studies was performed. The components of each intervention were mapped onto the domains of compassion described in the Patient Compassion Model. RESULTS One hundred eight peer-reviewed publications describing 103 interventions were included. Modalities ranged from establishing curricula and interventions in clinical settings to programs that used humanities-based reflective practices, clinical simulation, role modeling, and contemplative practices, with many education interventions adopting a multimodal approach. Most interventions mapped to the virtuous response domain of the Patient Compassion Model; very few mapped to the other domains of this model. CONCLUSIONS Most interventions were limited as they focused on a single domain of compassion; did not adequately define compassion; were assessed exclusively by self-report; were devoid of a comparator/control group; and did not evaluate retention, sustainability, and translation to clinical practice over time. The authors suggest that compassion education interventions be grounded in an empirically based definition of compassion; use a competency-based approach; employ multimodal teaching methods that address the requisite attitudes, skills, behaviors, and knowledge within the multiple domains of compassion; evaluate learning over time; and incorporate patient, preceptor, and peer evaluations.
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Affiliation(s)
- Shane Sinclair
- S. Sinclair is associate professor and director, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- J. Kondejewski is research assistant, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Priya Jaggi
- P. Jaggi is research coordinator, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Liz Dennett
- L. Dennett is librarian, Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda L. Roze des Ordons
- A.L. Roze des Ordons is clinical associate professor, Department of Critical Care Medicine and Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas F. Hack
- T.F. Hack is professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, and director, Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
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Sagin A, Ellman MS, Shariff RR, Jones CA, Tindall K, Siropaides CH. A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective. Am J Hosp Palliat Care 2020; 38:1126-1134. [PMID: 33143465 DOI: 10.1177/1049909120971565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The medical student experience of a clinical elective in palliative care (PC) remains understudied. Reflective narrative interventions can help students hone narrative competency skills, make sense of their clinical experiences and shed light on their perception of the rotation. OBJECTIVES To evaluate medical student written reflections after a PC clinical elective. DESIGN Students were asked to write a short reflective essay after PC clinical electives using open-ended writing prompts. SETTING Essays were collected from third and fourth-year medical students after completion of a PC elective at three geographically diverse academic medical centers in the United States. MEASUREMENTS Essays were coded for themes using a conventional content qualitative method of analysis. RESULTS Thirty-four essays were analyzed and four major themes emerged: reflection on the mission of medicine or motivation for being in medicine, reflection on professional skills or lessons learned, reflection on patient's experience and personal responses to PC rotation. Sub-themes were also identified. CONCLUSIONS Themes underscore the utility of the PC clinical elective as a meaningful experience that imparts useful skills, builds empathy, reminds students of their own motivations for being in medicine and serves as a catalyst for reflection on their own lives and relationships with their patients. Awareness of medical students' personal and emotional responses to a PC elective can help inform educators as they support their students and provide opportunities for reflection and education.
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Affiliation(s)
- Alana Sagin
- Palliative Care Program, Department of Medicine, 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew S Ellman
- Department of Internal Medicine, 12228Yale School of Medicine, New Haven, CT, USA
| | - Ruhi R Shariff
- Palliative Care Program, 12245Rush Medical College, Chicago, IL, USA
| | - Christopher A Jones
- Section of Palliative Care, 12277Duke University School of Medicine, Durham, NC, USA
| | - Kate Tindall
- Section of Supportive and Palliative Medicine, Department of Medicine, 25989UT Southwestern Medical School, Dallas, TX, USA
| | - Caitlin H Siropaides
- Section of Supportive and Palliative Medicine, Department of Medicine, 25989UT Southwestern Medical School, Dallas, TX, USA
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12
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Boland JW, Brown MEL, Duenas A, Finn GM, Gibbins J. How effective is undergraduate palliative care teaching for medical students? A systematic literature review. BMJ Open 2020; 10:e036458. [PMID: 32912945 PMCID: PMC7482461 DOI: 10.1136/bmjopen-2019-036458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Palliative care is central to the role of all clinical doctors. There is variability in the amount and type of teaching about palliative care at undergraduate level. Time allocated for such teaching within the undergraduate medical curricula remains scarce. Given this, the effectiveness of palliative care teaching needs to be known. OBJECTIVES To evaluate the effectiveness of palliative care teaching for undergraduate medical students. DESIGN A systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Screening, data extraction and quality assessment (mixed methods and Cochrane risk of bias tool) were performed in duplicate. DATA SOURCES Embase, MEDLINE, PsycINFO, Web of Science, ClinicalTrials.gov, Cochrane and grey literature in August 2019. Studies evaluating palliative care teaching interventions with medical students were included. RESULTS 1446 titles/abstracts and 122 full-text articles were screened. 19 studies were included with 3253 participants. 17 of the varied methods palliative care teaching interventions improved knowledge outcomes. The effect of teaching on clinical practice and patient outcomes was not evaluated in any study. CONCLUSIONS The majority of palliative care teaching interventions reviewed improved knowledge of medical students. The studies did not show one type of teaching method to be better than others, and thus no 'best way' to provide teaching about palliative care was identified. High quality, comparative research is needed to further understand effectiveness of palliative care teaching on patient care/clinical practice/outcomes in the short-term and longer-term. PROSPERO REGISTRATION NUMBER CRD42018115257.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Angelique Duenas
- Health Professions Education Unit, Hull York Medical School, York, UK
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13
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Downar J. Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care. J Palliat Med 2020; 21:S57-S62. [PMID: 29283871 DOI: 10.1089/jpm.2017.0396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the "hidden curriculum" in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.
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Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Family and Community Medicine and Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto , Toronto, Ontario, Canada
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14
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Wang XM, Swinton M, You JJ. Medical students' experiences with goals of care discussions and their impact on professional identity formation. MEDICAL EDUCATION 2019; 53:1230-1242. [PMID: 31750573 DOI: 10.1111/medu.14006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/07/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end-of-life care. In previous research, medical learners have reported insufficient training and emotional distress about end-of-life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. METHODS Using purposive sampling at one Canadian medical school, individual semi-structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. RESULTS Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. CONCLUSIONS GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively.
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Affiliation(s)
- Xuyi Mimi Wang
- Division of Geriatric Medicine Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Healthy Aging, St Peter's Hospital, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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15
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Boland JW, Barclay S, Gibbins J. Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students. MEDICAL TEACHER 2019; 41:1359-1365. [PMID: 30689479 DOI: 10.1080/0142159x.2018.1533243] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Palliative care is the holistic care of patients with advanced, progressive incurable illness. Palliative care is well recognized as an essential component of medical student curricula. However, teaching is variable within medical schools. Using current literature, these tips aim to highlight key points necessary to facilitate the development and delivery of palliative care teaching to medical students. The key practice points include: clinical exposure to patients with palliative care needs and those that are dying, being compulsory (and integrated) across the course, summative and formative assessments to encourage learning, support from within the university for curricular time and development, visits to a hospice/inpatient palliative care facility, emphasis on clinically based learning later in the course, teaching by specialists in palliative care as well as specialists in other areas including Family Doctors/General Practitioners, innovative teaching methods and inter-professional learning to develop teaching.
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Affiliation(s)
- Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane Gibbins
- St Julia's Hospice, Cornwall Hospice Care, Hayle, UK
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16
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Talwalkar JS, Moriarty JP, Ellman MS. Students' Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students' Written Reflections. Am J Hosp Palliat Care 2019; 36:999-1007. [PMID: 31046393 DOI: 10.1177/1049909119847965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students' experiences with death and dying, describe the range of students' emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death. METHODS We provided a writing prompt to newly matriculated medical students asking them to "reflect on experiences you may have had with family or friends near the end of life." Content analysis was performed to identify themes in the responses. RESULTS The 104 students in the entering class submitted 90 individual free-text responses (87%). Most (57%) students specifically mentioned at least 1 personal experience with death, with a range of emotional responses including sadness (29%), surprise (14%), and guilt (12%). Distinct themes emerged on content analysis including personal experiences with death, anticipated response to death in future, changes in body or mind of the dying person, thoughts and observations about others, and cognitive or existential responses. Few students wrote about religion or spirituality (8%) or palliative or hospice care (2%). CONCLUSIONS An understanding of students' premedical school experiences and emotional reactions to death may help educators frame curricula around end-of-life care. Educators could apply enhanced awareness to help students process their own experiences as they begin caring for patients and to focus on areas that were underrepresented in students' comments, such as religion, spirituality, palliative care, and hospice.
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Affiliation(s)
- Jaideep S Talwalkar
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,2 Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - John P Moriarty
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Ellman
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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17
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Kerr A, O'Connor H, Pawlikowska T, Gallagher P, Strawbridge J. A scoping review of health professional curricula: Implications for developing integration in pharmacy. Res Social Adm Pharm 2019; 16:1-16. [PMID: 30898572 DOI: 10.1016/j.sapharm.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Integrated health professions curricula aim to produce graduates who are capable of meeting current and future healthcare needs. This is reflected in pharmacy education where integration is increasingly advocated by pharmacy regulators as the perceived optimal way of preparing students for registration as pharmacists. There is, however, no definition of integration. Integration can be described according to a model of horizontal, vertical or spiral integration. It can also be described by the themes used to integrate, such as a systems-based approach or by integrative teaching and learning approaches. The level of integration can also be described. OBJECTIVE This scoping review aimed to explore health professions education literature to inform the optimal design of integrated pharmacy curricula. This review asks: what is meant by integration in health professions curricula? METHODS The Arksey and O'Malley scoping review framework was utilised. Ovid MEDLINE, EMBASE, Scopus, Web of Science and ERIC were searched. Models of integration, themes for integration, integrative teaching and learning approaches, and level of integration were defined and supported data extraction. RESULTS There were 9696 records screened and of these 137 were included. The majority of studies (n = 88) described horizontal integration. Systems-based teaching (n = 56) was the most common theme reported. Various integrative teaching and learning approaches were described, including experiential (n = 43), case-based (n = 42) and problem-based (n = 38) learning. The majority of the curricula could be classified as levels 5-7 on Harden's ladder (n = 102). Perception outcomes were reported for 81 studies, and only 3 reported outcomes beyond perception. Reported outcomes were generally positive and included knowledge gains and increased motivation. CONCLUSIONS There is a need for integration to be explicitly defined by curriculum developers and researchers. Attention should be given to describing the model, theme, teaching and learning approach and level of integration. There remains a lack of evidence for integration.
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Affiliation(s)
- Aisling Kerr
- RCSI School of Pharmacy, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland.
| | - Hannah O'Connor
- RCSI School of Pharmacy, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland.
| | - Teresa Pawlikowska
- RCSI Health Professions Education Centre, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Paul Gallagher
- Department of Pharmacy, 18 Science Drive 4, National University of Singapore, 117559, Singapore.
| | - Judith Strawbridge
- RCSI School of Pharmacy, 1st Floor Ardilaun House Block B, 111 St Stephen's Green, Dublin 2, Ireland.
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18
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Lele Mookerjee A, Fischer BD, Cavanaugh S, Rajput V. Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years. MEDICAL TEACHER 2019; 41:167-171. [PMID: 29781379 DOI: 10.1080/0142159x.2018.1457214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.
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Affiliation(s)
| | | | - Susan Cavanaugh
- a Cooper Medical School of Rowan University , Camden , NJ , USA
| | - Vijay Rajput
- b Ross University School of Medicine , Miramar , FL , USA
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Denney-Koelsch EM, Horowitz R, Quill T, Baldwin CD. An Integrated, Developmental Four-Year Medical School Curriculum in Palliative Care: A Longitudinal Content Evaluation Based on National Competency Standards. J Palliat Med 2018; 21:1221-1233. [PMID: 29768072 DOI: 10.1089/jpm.2017.0371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While palliative care (PC) competencies for medical school graduates have been defined, the lack of established curriculum models and assessment tools hampers curricular evaluation. OBJECTIVE To describe the scope and content of the University of Rochester's longitudinal, integrated four-year PC curriculum after 17 years of implementation, review student evaluative responses, and compare the curriculum to national competency standards. DESIGN AND SETTING Combining and reorganizing a published PC curriculum assessment tool and a list of medical school PC competencies, we created a novel nine-topic framework to assess the content coverage of our curriculum. We queried our electronic medical school curriculum database and surveyed course and clerkship directors, as well as PC, pain, ethics, and humanities faculty, to locate where and when PC topics are taught and to collate student responses to these experiences. RESULTS We present a comprehensive list of PC curricular activities over a four-year medical school experience. The curriculum covers all nine PC topics longitudinally in multiple formats. Five in-depth activities cover multiple PC topics in a format that integrates biological, psychological, and social dimensions; these activities have survived and evolved over 17 years in our setting. A majority of year 3 University of Rochester students feel "well" or "extremely well" trained in PC. CONCLUSIONS Our four-year PC curriculum provides robust and developmentally appropriate training that addresses all nine evidence-based core topics for PC education. Medical student feedback and their Association of American Medical Colleges (AAMC) survey responses suggest that they find their PC learning experiences rewarding. This curriculum could serve as a model for other schools.
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Affiliation(s)
- Erin M Denney-Koelsch
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Robert Horowitz
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Timothy Quill
- 1 Division of Palliative Care, University of Rochester Medical Center , Rochester, New York
| | - Constance D Baldwin
- 2 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York
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Hirakawa Y, Chiang C, Haregot Hilawe E, Andoh H, Uemura K, Aoyama A. Formative research for the nationwide promotion of a multidisciplinary community-based educational program on end-of-life care. NAGOYA JOURNAL OF MEDICAL SCIENCE 2017. [PMID: 28626258 PMCID: PMC5472548 DOI: 10.18999/nagjms.79.2.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although one of the most important missions of end-of-life education is to ensure proper inter-professional education (IPE), in Japan, end-of-life care IPE has not been given enough attention especially in community settings. This study aims at developing an effective workshop facilitator training program on end-of-life care IPE and acquiring the know-how to set up and efficiently run administrative offices. We first developed a tentative facilitation training program and conducted it in five cities nationwide. The training strategy was as follows: (1) participating in the workshop, (2) attending a lecture on facilitation, (3) conducting a preparatory study, (4) attending one workshop session as a facilitator, and (5) reflecting on one’s attitude as a facilitator based on workshop participants’ questionnaire, peer-feedback, and video recording. A total of 10 trainees completed the training program. We assessed the level of improvement in the trainees’ facilitation skills and the efficacy of the training course using a qualitative approach. This formative study helped us identify several aspects needing improvement, especially in the areas of information technology and social media. Progress in these areas may have a positive impact on the education of community health care professionals whose study hours are limited, helping provide continued facilitation training.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Hideaki Andoh
- Department of Clinical Nursing, Akita University Graduate School of Health Science
| | - Kazumasa Uemura
- Center for Medical Education, Nagoya University School of Medicine
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
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Tse CS, Morrison LJ, Ellman MS. Preclinical Medical Students' Diverse Educational and Emotional Responses to a Required Hospice Experience. Am J Hosp Palliat Care 2016; 34:704-712. [PMID: 27235456 DOI: 10.1177/1049909116652574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care. OBJECTIVE To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). DESIGN Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. SETTING/PATIENTS Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. MEASUREMENTS Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. RESULTS Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions." CONCLUSION In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
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Affiliation(s)
- Chung Sang Tse
- 1 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Laura J Morrison
- 2 Yale Palliative Care Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Ellman
- 3 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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