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Fortin Magaña M, Diaz S, Salazar-Colocho P, Feng A, López-Saca M. Long-term effects of an undergraduate palliative care course: a prospective cohort study in El Salvador. BMJ Support Palliat Care 2024; 14:200-207. [PMID: 33219104 DOI: 10.1136/bmjspcare-2020-002311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND International organisations recommend the inclusion of palliative care undergraduate education as a way to meet increasing demand; the long-term effects, however, are unknown. Since 2013 the Dr José Matías Delgado University has offered an undergraduate course for palliative care. AIMS To assess whether a palliative care course results in improvement in self-perceived comfort among students and if it lasts up to 4 years later; and to examine students' knowledge of palliative care and assess the relationship between comfort and knowledge. DESIGN This is a prospective cohort study where students attending the course were requested to complete the Scale of Self-Perceived Comfort in palliative care pre and post course. Participants were contacted in 2018 and a group without palliative care education was established as a control group, matched one-to-one according to current academic level. They were asked to complete the Scale of Self-Perceived Comfort questionnaire together with the Palliative Care Knowledge Test. SETTINGS/PARTICIPANTS 83 students who attended the course between the years 2014 and 2017 and 101 controls. RESULTS In the postcourse test, participants had a 1.13-point increase (p≤0.001) in comfort, which persisted 4 years later and was superior to the control group by 0.6 points (p≤0.001). The control group showed no difference in the precourse test despite having more clinical experience (p=0.68). The students outscored the control group in the knowledge test by 4.2 points (p≤0.001). There appears to be no correlation between comfort and knowledge. CONCLUSION A palliative care undergraduate course results in improvement in student comfort and knowledge which persists up to 4 years later.
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Affiliation(s)
- Miguel Fortin Magaña
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Susana Diaz
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | | | - Ancu Feng
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
| | - Mario López-Saca
- Palliative Medicine, Dr Jose Matias Delgado University, San Salvador, El Salvador
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Toussaint V, Paal P, Simader R, Elsner F. The state of undergraduate palliative care education at Austrian medical schools - a mixed methods study. BMC Palliat Care 2023; 22:151. [PMID: 37814283 PMCID: PMC10563205 DOI: 10.1186/s12904-023-01255-9] [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] [Received: 04/17/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND There is an increasing demand for universal, high-quality access to palliative care in Austria. To ensure this, the implementation of palliative care in the medical studies curriculum is essential. This is the first study to investigate the state of undergraduate palliative care education at Austrian medical schools. METHODS For this mixed-methods study with concurrent embedded design, expert interviews and online surveys were conducted between March and August 2022. The interviews were subjected to a thematic analysis according to Braun and Clarke, while the questionnaires were analysed descriptively-statistically. For the final integration, the results of both methods for each topic are presented and discussed complementarily. Both the primary qualitative and supportive quantitative data were collected to combine the advantages of the in-depth nature of the qualitative data and the consistent structure of the quantitative data to provide a more precise representation of the state of teaching. RESULTS Twenty-two persons participated in the study, of whom twenty-one participated in the interview and eight in the questionnaire. The participants were experts in palliative care teaching at Austrian medical schools. Currently, palliative care is taught at seven out of the eight universities. Large differences were found in the number of hours, organisation, teaching formats, and interprofessional education. At present, three universities have a chair for palliative care and at least five universities have access to a palliative care unit. CONCLUSION Undergraduate palliative care education in Austria is very heterogeneous and does not meet the minimum standards suggested by the European Association for Palliative Care (EAPC) curriculum recommendations. However, several universities are planning measures to expand palliative care teaching, such as the introduction of mandatory teaching or the establishment of new teaching formats. Better coordination and networking within and between universities would be beneficial for the expansion and quality of teaching.
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Affiliation(s)
- Véronique Toussaint
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany.
| | - Piret Paal
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Rainer Simader
- Hospiz Österreich / Österreichische Palliativgesellschaft, Vienna, Österreich
| | - Frank Elsner
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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Wells G, Llewellyn C, Hiersche A, Minton O, Barclay D, Wright J. Care of the dying - medical student confidence and preparedness: mixed-methods simulation study. BMJ Support Palliat Care 2022:bmjspcare-2022-003698. [PMID: 35850959 DOI: 10.1136/spcare-2022-003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Of all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care. METHODS A mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis. RESULTS Thirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change. CONCLUSION Using simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.
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Affiliation(s)
- Geoffrey Wells
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Andreas Hiersche
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Ollie Minton
- Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Juliet Wright
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
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Landers A, Wilkinson TJ. Spiralled Palliative Care Curriculum Aligned with International Guidelines Improves Self-Efficacy but Not Attitudes: Education Intervention Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1531-1538. [PMID: 35002352 PMCID: PMC8722720 DOI: 10.2147/amep.s338697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Amanda Landers
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim J Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
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Gerlach C, Mai SS, Schmidtmann I, Weber M. Palliative care in undergraduate medical education - consolidation of the learning contents of palliative care in the final academic year. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc103. [PMID: 34651061 PMCID: PMC8493850 DOI: 10.3205/zma001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Background: Demographic change and the medical imperative to accompany patients at all times and also in the case of illness leading to death require good basic knowledge of palliative care in large parts of the medical profession. Palliative care has been introduced into undergraduate medical education as a compulsory subject: "interdisciplinary subject 13 palliative care" (Q13). While course concepts for Q13 have already been positively evaluated, assessment of the consolidation and practical relevance of the knowledge taught is lacking. Methods: Assessment of the consolidation of the learning content from Q13 after the practical year (the "practical year" is the sixth and final year of undergraduate medical education in Germany) by means of a survey with a proven questionnaire and integrated qualitative free-text analysis of a cohort of medical students (n=176) who had already participated in an evaluation before and after Q13. Results: The response rate was 96% after Q13 and 45% after the practical year (PY). Teaching was predominantly perceived as more helpful than the PY (p<0.001). Compared to the status after Q13, students rated themselves as less competent after the PY in all areas surveyed, including drug-based pain therapy (p=0.0386). The certainty in informing patients about the incurability of the disease also decreased significantly after the PY (p=0.0117), although the preparation in Q13 was positively highlighted. Conclusion: The knowledge acquired in Q13 could not be anchored in the PY. On the contrary, after initial practical experiences, the students found it challenging to conduct conversations in cases of serious illness and to deal with their own uncertainty in the care of seriously ill patients. Structural factors regarding palliative care in the PY, as well as intrinsic motives of students, such as prior knowledge or motivation to learn, should be analyzed to identify ways to close the gap between theoretical and practical training in general palliative care. To generate samples that are sufficiently representative, future studies on teaching should be easily accessible to students and consider attractive forms of evaluation including electronic methods and social media.
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Affiliation(s)
- Christina Gerlach
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
- Heidelberg University Hospital, Department of Palliative Care, Heidelberg, Germany
| | - Sandra Stephanie Mai
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
| | - Irene Schmidtmann
- Johannes Gutenberg University Mainz, University Medical Center, Institute for Medical Biometry, Epidemiology and Informatics, Mainz, Germany
| | - Martin Weber
- Johannes Gutenberg University Mainz, University Medical Center, III. Med. Clinic & Polyclinic, Hematology, Oncology und Pneumology, Interdisciplinary Department of Palliative Care, Mainz, Germany
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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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Wells G, Youssef E, Winter R, Wright J, Llewellyn C. Medical student confidence in care of the dying and their family: a systematic review. BMJ Support Palliat Care 2020; 11:233-241. [PMID: 31919103 DOI: 10.1136/bmjspcare-2019-001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying. AIM This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients. DESIGN A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored. DATA SOURCES MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms 'medical student', 'confidence' and 'dying', alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence. CONCLUSION This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning. PROSPERO REGISTRATION NUMBER CRD42019119057.
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Affiliation(s)
- Geoffrey Wells
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Elaney Youssef
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Juliet Wright
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School Division of Primary Care and Public Health Medicine, Brighton, UK
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Melgaard SK, Neergaard MA. Medical students do not feel confident in managing palliative care as future doctors. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1696007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. K. Melgaard
- Oncology Department, Aarhus University Hospital, Aarhus, Denmark
| | - M. A. Neergaard
- Oncology Department, Aarhus University Hospital, Aarhus, Denmark
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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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Lippe M, Johnson B, Mohr SB, Kraemer KR. Palliative Care Educational Interventions for Prelicensure Health-Care Students: An Integrative Review. Am J Hosp Palliat Care 2018; 35:1235-1244. [DOI: 10.1177/1049909118754494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To provide adequate care, students from all health-care professions require education regarding palliative and end-of-life (EOL) care prior to entering professional practice. In particular, students need proper training to be equal members of interprofessional teams providing palliative and EOL care. However, limited information is currently available about the effectiveness of educational interventions relating to palliative and EOL care. Thus, an assessment of educational interventions to utilize in providing this education is warranted. The purpose of this integrative review was to critically evaluate the impact of palliative or EOL care interventional studies on learning outcomes for prelicensure health-care students. Articles published from 2001 to present that utilizied palliative or EOL care educational interventions for prelicensure students from any health-care profession and also evaluated preidentified learning outcomes were included in the review. The final sample comprised 34 articles. Four studies utilized interprofessional interventions, whereas the remaining taught students from a single profession. Trends in sample sizes, teaching interventions, learning outcomes, and outcome measures are discussed. Teaching interventions reviewed were primarily focused on student learning outcomes specific to knowledge and attitudes. Future studies should implement interprofessional educational interventions, utilize reliable and valid outcome measures, and evaluate their impact on different learning outcomes, such as self-efficacy, comfort, and communication.
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Affiliation(s)
- Megan Lippe
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Bailey Johnson
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Stephanie Barger Mohr
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
- University of North Alabama, Anderson College of Nursing, Florence, AL, USA
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Kolben T, Haberland B, Degenhardt T, Burgmann M, Koenig A, Kolben TM, Ulbach K, Mahner S, Bausewein C, Harbeck N, Wuerstlein R. Evaluation of an interdisciplinary palliative care inhouse training for professionals in gynecological oncology. Arch Gynecol Obstet 2018; 297:767-773. [PMID: 29362923 DOI: 10.1007/s00404-018-4681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of a pilot interdisciplinary inhouse training in palliative care (PC) for gynecological oncologists. METHODS Competencies of participants from a gynecological university department were evaluated taking part in an interdisciplinary PC course in a pre and post design. The multiprofessional course covered basic principles of PC, symptom management and communication taught by PC specialists. Competencies were evaluated using self-designed questionnaires before (ISPG-1), right after (ISPG-2), and 6 months after the training (ISPG-3) (inhouse seminar palliative care in gynecology: ISPG). RESULTS 31 persons from the department of gynecology took part in the course, of which 27 answered the first questionnaire (seven nurses (26%), 19 doctors (71%), one profession not indicated (3%), median working experience in gynecological oncology: 5 years). Return rates were: ISPG-1 27/31 (87.1%), ISPG-2 20/31 (64.5%) and IPSG-3 14/31 (45.2%). A more positive attitude towards PC could be observed in the majority of participants after the course (ISPG-2 62%, ISPG-3 71%). They felt more competent in the care of palliative patients (46%). PC would be initiated earlier and the interaction with other disciplines was improved (ISPG-2 85%, ISPG-3 100%). The participants assessed a significant improvement of their skills in all palliative fields which were analyzed. CONCLUSION PC inhouse training improves the understanding of PC and the interdisciplinary approach in the management of patients with advanced disease. It is a feasible and useful instrument to improve the competencies in generalist PC of specialists in gynecological oncology.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Birgit Haberland
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximiliane Burgmann
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Koenig
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Theresa Maria Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristina Ulbach
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department for Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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Krautheim V, Schmitz A, Benze G, Standl T, Schiessl C, Waldeyer W, Hapfelmeier A, Kochs EF, Schneider G, Wagner KJ, Schulz CM. Self-confidence and knowledge of German ICU physicians in palliative care - a multicentre prospective study. BMC Palliat Care 2017; 16:57. [PMID: 29166887 PMCID: PMC5700543 DOI: 10.1186/s12904-017-0244-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Little is known about ICU physicians’ self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine. Methods In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge. Beyond descriptive statistics and non-parametric tests for group comparisons, linear regression analysis was used to assess the impact of independent variable on self-confidence and knowledge. Spearman‘s rank test was calculated. Results 55% of answers in the knowledge test were correct and more than half of the participants rated themselves as “rather confident” or “confident”. Linear regression analysis revealed that an additional certificate in either pain or palliative medicine significantly increased both knowledge and self-confidence, but only 15 out of 137 participants had at least one of those certificates. Relation between self-confidence and the results of the knowledge test was weak (r = 0.270 in female) and very weak (r = −0.007 in male). Conclusions Although the questionnaire needs improvement according to the item analysis, it appears that, with respect to palliative care, ICU Physicians’ self-confidence is not related to their knowledge. An additional certificate in either pain or palliative medicine was positively correlated to both self-confidence and knowledge. However, only a minority of the participants were qualified through such a certificate. Electronic supplementary material The online version of this article (10.1186/s12904-017-0244-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Veronika Krautheim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andrea Schmitz
- Interdisziplinäres Zentrum für Palliativmedizin, Medizinische Fakultät Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Gesine Benze
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Thomas Standl
- Klinik für Anaesthesiologie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen, Solingen, Germany
| | | | - Wolfgang Waldeyer
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Eberhard F Kochs
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Gerhard Schneider
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,Klinik für Anaesthesiologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Klaus J Wagner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christian M Schulz
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
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Lehto JT, Hakkarainen K, Kellokumpu-Lehtinen PL, Saarto T. Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge. BMC Palliat Care 2017; 16:13. [PMID: 28122553 PMCID: PMC5264301 DOI: 10.1186/s12904-016-0182-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. METHODS We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years. RESULTS We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p < 0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p < 0.001). CONCLUSIONS The curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.
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Affiliation(s)
- Juho T Lehto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Oncology, Tampere University Hospital, Tampere, Finland. .,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, Rbuilding, 33520, Tampere, Finland.
| | - Kati Hakkarainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Saarto
- Comprehensive Cancer Center and Faculty of Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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The contribution of undergraduate palliative care education: does it influence the clinical patient's care? Curr Opin Support Palliat Care 2016; 9:375-91. [PMID: 26418527 DOI: 10.1097/spc.0000000000000169] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this 2-year systematic review is to understand how learner assessment and curriculum evaluation of education in palliative care is being undertaken and to examine whether current undergraduate education influences the clinical patient's care. RECENT FINDINGS Almost half of the 30 studies reviewed used a qualitative approach to evaluate learning experiences. Only three of them were controlled studies and a further one was a cohort study.When students openly express themselves, they agree that there is 'something' deep as regards the core or the essence of medical practice or nursing. They feel that they become better professionals and better prepared for the patients, not only in terms of end of life care, but also as regards care, irrespective of the phase of the disease.The inclusion of palliative care in undergraduate education is a way of providing knowledge, skill, and competences about palliative care (especially communication) and also improving attitudes toward caring in advanced disease and at the end of life. Different methods of experiential learning, even brief experiences, which bring students into close contact with palliative care clinical cases or patients, are providing better results. SUMMARY From research studies, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. In the future, long-term cohort or controlled studies might answer that question.
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Fitzpatrick D, Heah R, Patten S, Ward H. Palliative Care in Undergraduate Medical Education—How Far Have We Come? Am J Hosp Palliat Care 2016; 34:762-773. [DOI: 10.1177/1049909116659737] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: There is an increasing demand for quality palliative care teaching within undergraduate medical education. Studies suggest that many junior doctors feel underprepared to perform end-of-life care. Previous systematic reviews on palliative care teaching within medical schools have identified significant variability and lack of consistency in teaching. This review aims to update the literature on the current status of palliative care teaching to undergraduates within medical schools. Method: A systematic review was undertaken on articles published from December 2001 to November 2015 on palliative care teaching for undergraduate medical students. In all, 650 abstract citations were obtained, of which 126 were relevant to the research questions. Thematic analysis was performed on remaining articles according to whether they discussed content and/or methodology of palliative care education, and data collated. Results: There is greater consistency in the content being delivered as part of end-of-life care education within medical schools. The most frequently taught topics include attitudes to death and dying, communication skills, and pain management. Pediatric care and religious/cultural issues are less frequently addressed. Teaching institutions are also utilising a broader range of teaching modalities. Conclusion: There is significant progress in palliative care education within medical schools. Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care.
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Affiliation(s)
- Danielle Fitzpatrick
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Rebecca Heah
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Simon Patten
- Adelaide Health Simulation and Skills Centre, The University of Adelaide, Adelaide, Australia
| | - Helena Ward
- Medicine Learning and Teaching Unit, The University of Adelaide, Adelaide, Australia
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Dickinson GE. A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015. Am J Hosp Palliat Care 2016; 34:559-565. [DOI: 10.1177/1049909116638071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.
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Affiliation(s)
- George E. Dickinson
- Department of Sociology and Anthropology, College of Charleston, Charleston, SC, USA
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