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Langmann GA, Childers J, Merlin JS. Caring for Patients With Opioid Misuse or Substance Use Disorders in Hospice: A National Survey. J Palliat Med 2024; 27:209-215. [PMID: 37824806 PMCID: PMC11074426 DOI: 10.1089/jpm.2023.0082] [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] [Accepted: 08/07/2023] [Indexed: 10/14/2023] Open
Abstract
Background: Opioid misuse and substance use disorders (SUDs) including opioid use disorder (OUD) are common and negatively impact quality of life. Hospice clinicians' experiences with these conditions have not been well described. Objectives: We sought to explore hospice clinicians' knowledge, practices, and comfort caring for patients with opioid misuse (e.g., a pattern of unsanctioned opioid use escalation, or concurrent illicit substance use) and SUDs. Design: We recruited hospice clinicians in the United States via national hospice and palliative care organizations to complete an online survey designed by the study authors and pilot tested with an interdisciplinary group of current/former hospice clinicians. Results: One hundred seventy-five clinicians (40% nurses, 40% physicians, 16% nurse practitioners) responded to the survey; most had cared for two or more hospice patients with opioid misuse or SUD in the past month. The majority felt confident identifying opioid misuse (94%) and taking SUD histories (79%). Most (62%) felt it is their role to treat hospice patients for SUD, though 56% lacked comfort in using buprenorphine for OUD treatment. While the majority felt it is their role to treat pain in hospice patients with SUDs (94%) and that hospice can help patients with SUDs (94%), many were not comfortable managing pain in patients taking buprenorphine (45%) or naltrexone (49%) for SUDs. Most felt comfortable managing pain in patients taking methadone for SUD (73%). Conclusions: Opioid misuse and SUD are common in hospice. Though clinicians are comfortable taking relevant histories, they feel less comfortable managing patients' opioid misuse or SUD, or these patients' pain.
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Affiliation(s)
- Gabrielle A. Langmann
- Supportive and Palliative Care Program, Division of General Internal Medicine, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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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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3
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Hökkä M, Rajala M, Kaakinen P, Lehto JT, Pesonen HM. The effect of teaching methods in palliative care education for undergraduate nursing and medical students: a systematic review. Int J Palliat Nurs 2022; 28:245-253. [PMID: 35727833 DOI: 10.12968/ijpn.2022.28.6.245] [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: 11/11/2022]
Abstract
Background: Palliative care should be seen as a human right and integrated into the healthcare system. Adequate palliative care education is seen as a facilitator to develop the integration of palliative care. Aims: To synthesise evidence of the effect of different teaching methods used in palliative care education to students' competences, knowledge, attitude or skills. Methods: Systematic review. A total of four databases (CINAHL, Eric, PubMed and Scopus) were searched, after which, 16 articles were identified. Findings: Simulations, lectures, films and a humanistic approach all had a positive effect on students' attitudes to care for a dying person. Problem-based learning, simulations and elective courses increased students' knowledge of palliative care. Game interventions in education decreased students' fear of death, while communication with dying patients and relatives became easier. Conclusions: Education interventions had positive effects on students' attitudes and knowledge. However, there is a need for future research into effective palliative care interventions using randomised designs and research about the effects of blended learning.
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Affiliation(s)
- Minna Hökkä
- Head of School, Kajaani University of Applied Sciences, Finland
| | - Mira Rajala
- University Teacher, Research unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Pirjo Kaakinen
- Associate Professor, Research unit of Nursing Science and Health Management, University of Oulu; Finnish Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Finland
| | - Juho T Lehto
- Professor, Faculty of Medicine and Health Technology, University of Tampere; Palliative Care Centre, Tampere University Hospital, Finland
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Schultz K, Howard S, Siegel T, Zonies D, Brasel K, Cook M, Moreno K. Supporting surgical residents learning clinical palliative care: Insights from multi-disciplinary focus groups. Am J Surg 2022; 224:676-680. [DOI: 10.1016/j.amjsurg.2022.02.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/26/2022] [Accepted: 02/25/2022] [Indexed: 12/18/2022]
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5
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Lin Q, Qiu Y, Liang J, Zheng Y, Liao Y, Huang H, Hou L, Lang S, Zhao B, Yiming Z, Yan Q, Ou H, Zhang Y. The Smart Class Teaching Module for Rehabilitation Medicine English Education in China. Med Sci Monit 2021; 27:e929834. [PMID: 33454720 PMCID: PMC7818671 DOI: 10.12659/msm.929834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Learning medical English is particularly challenging for non-native English-speaking medical students. The Smart Class teaching module is a new online teaching module for rehabilitation-related medical English, the efficacy of which has yet to be established in the literature. Gender differences should also not be ignored in our study, taking into account the proven performance differences between males and females in language learning. Material/Methods First-year physiotherapy students in Grade 2018 and Grade 2019 at Guangzhou Medical University were recruited to participate in this study. Grade 2019, as the experimental group, completed the Smart Class teaching module, while Grade 2018, as the control group, completed the Traditional Class teaching module. The efficacy of both modules was assessed objectively using the students’ medical English exam scores and subjectively using the students’ responses to a questionnaire. Results In total, 242 questionnaires were distributed, and 210 valid questionnaires were returned, of which 119 were from the Smart Class teaching module group and 91 were from the Traditional Class teaching module group. There was no statistically significant difference between the medical English exam scores of the 2 groups (P=0.324). However, the subjective assessment revealed that the students experienced a significantly greater burden from the workload in the Smart Class teaching module group (P<0.001). Conclusions We found both the Smart Class teaching module and the Traditional Class teaching module achieved similar teaching outcomes. Therefore, the former represents a viable alternative teaching option for situations where traditional class teaching is not possible.
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Affiliation(s)
- Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yaxian Qiu
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Junjie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yuxin Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yujun Liao
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Huina Huang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Lingying Hou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Shijuan Lang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Biyi Zhao
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Zulipiya Yiming
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Qinghua Yan
- Department of Education, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Haining Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Yanni Zhang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).,Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
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6
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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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Williams BR, Bailey FA, Goode PS, Kvale EA, Slay LA, Bakitas MA, Burgio KL. "Online Training Is Great but Human Interaction Is Better": Training Preferences of VA Interdisciplinary Palliative Care Consult Teams. Am J Hosp Palliat Care 2020; 37:800-808. [PMID: 32122166 DOI: 10.1177/1049909120907599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating in either a multisite webinar or a small group, in-person workshop. We interviewed participants by telephone seven to eight month post-training. In all, 75.9% preferred in-person education and training, including 78.9% of workshop participants and 73.1% of webinar participants. Respondents described in-person training as fostering learning through the following processes: (1) active engagement and focus, (2) interaction and networking, (3) meaning-making and relevance, and (4) reciprocity and commitment. Although it is not possible for Web-based palliative care education programs to replicate all aspects of the in-person learning experience, building experiential, interactive, meaningful, and reciprocal components into Web-based education may help shift preferences and make interdisciplinary team-based palliative care education accessible to a larger audience.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - F Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA
| | - Patricia S Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Laurie A Slay
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie A Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn L Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL and Atlanta, GA, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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8
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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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9
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Donne J, Odrowaz T, Pike S, Youl B, Lo K. Teaching Palliative Care to Health Professional Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Hosp Palliat Care 2019; 36:1026-1041. [DOI: 10.1177/1049909119859521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background:End-of-life care is challenging on health professionals’ mental and emotional state. Palliative care education can support health professional students’ transition, helping them to cope with the challenges of working in this complex setting. Students feel that they need more preparation in this area.Purpose:To collate the relevant information regarding how to teach health professional students about palliative care.Method:The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC, and EMBASE via Elsevier were searched until April 7, 2019. Inclusion criteria were randomized controlled trials of group interventions that aimed to increase health professional students’ knowledge, skills, or attitudes in palliative care. Studies were appraised using the PEDro scale. Data were synthesized using meta-analysis.Results:The results favored the intervention and were statistically significant for knowledge and attitudes but not for skills. A 2-hour seminar accompanied by readings seems sufficient to improve both knowledge and attitudes. Quality assessment scores ranged from 1/10 to 7/10 (mean 5, standard deviation 1.73). When studies at high risk of bias were excluded, then only knowledge improved significantly. Key areas where rigor was lacking were in concealing the randomization, omitting intention-to-treat analysis and not blinding of participants, therapists, or assessors.Conclusions:Palliative care education is effective in improving health professional students’ knowledge and attitudes toward palliative care. More research is required into skill development. This review highlights the need for more high-quality trials in both the short and long-term to determine the most effective mode of palliative care education.
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Affiliation(s)
- Jack Donne
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Thomas Odrowaz
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Sarah Pike
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Bonnie Youl
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Kristin Lo
- Department of Physiotherapy, Monash University, Melbourne, Australia
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10
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Pruskowski J, Patel R, Brazeau G. The Need for Palliative Care in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7410. [PMID: 31333268 PMCID: PMC6630864 DOI: 10.5688/ajpe7410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 06/10/2023]
Abstract
There is a growing need for palliative care pharmacists in the United States. There is also a gap in the education of palliative care for pharmacy students. To address both, pharmacy schools must develop and disseminate palliative care-focused experiences, including traditional didactic lectures, problem-based learning, interactive skills, laboratory- and web-based experiences. This commentary presents the need for palliative care-focused experiences in the Doctor of Pharmacy (PharmD) degree program, and how schools can take smaller steps to tackle this issue.
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Affiliation(s)
| | - Ravi Patel
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Gayle Brazeau
- Marshall University, Huntington, West Virginia
- Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
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11
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Palmer BA, Lee JH, Somers KJ, Swintak CC, Rullo J, Bright RP, Michael Bostwick J, Frye MA, Sperry JA. Effect of In-Class vs Online Education on Sexual Health Communication Skills in First-Year Medical Students: a Pilot Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:175-179. [PMID: 29949052 DOI: 10.1007/s40596-018-0949-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Online education is effective for knowledge acquisition, but its effect on clinical skill development is not well characterized. We aimed to compare communication skills of 50 first-year medical students who learned to assess and treat patients through an online learning module vs an in-class lecture. METHODS Twenty-six students were randomized to learn about antidepressant-induced sexual dysfunction in class and 24 learned the same content through an online module. Students were individually observed conducting an interview with a standardized patient with antidepressant-induced sexual dysfunction. Students were assessed by faculty raters blinded to the student's learning mode. Standardized patients were asked about their willingness to have the student as their physician. RESULTS More students who learned in class vs online demonstrated appropriate verbal empathy (18 [69%] vs 8 [33%]; P = 0.01), defined as completing each task in the "verbal empathy" assessment domain, as measured by a faculty rater. Other assessed variables were not significantly different. Standardized patients' willingness (vs unwillingness; P = 0.01) to have the student as their physician was associated with the demonstration (by faculty appraisal) of a number of basic skills: using open-ended questions, asking one question at a time, using gender-neutral terminology when asking about the patient's relationship, and using appropriate sexual-health terminology. CONCLUSIONS This study, although limited by a single-site design and the small number of participants, offers preliminary evidence that, if confirmed, may suggest that in-class learning from a psychiatrist (vs from an online module) is associated with greater verbal empathy in the assessment of SSRI-related sexual dysfunction.
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Affiliation(s)
| | - James H Lee
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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12
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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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13
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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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Prunuske AJ, Henn L, Brearley AM, Prunuske J. A Randomized Crossover Design to Assess Learning Impact and Student Preference for Active and Passive Online Learning Modules. MEDICAL SCIENCE EDUCATOR 2015; 26:135-141. [PMID: 27076992 PMCID: PMC4819804 DOI: 10.1007/s40670-015-0224-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Medical education increasingly involves online learning experiences to facilitate the standardization of curriculum across time and space. In class, delivering material by lecture is less effective at promoting student learning than engaging students in active learning experience and it is unclear whether this difference also exists online. We sought to evaluate medical student preferences for online lecture or online active learning formats and the impact of format on short- and long-term learning gains. Students participated online in either lecture or constructivist learning activities in a first year neurologic sciences course at a US medical school. In 2012, students selected which format to complete and in 2013, students were randomly assigned in a crossover fashion to the modules. In the first iteration, students strongly preferred the lecture modules and valued being told "what they need to know" rather than figuring it out independently. In the crossover iteration, learning gains and knowledge retention were found to be equivalent regardless of format, and students uniformly demonstrated a strong preference for the lecture format, which also on average took less time to complete. When given a choice for online modules, students prefer passive lecture rather than completing constructivist activities, and in the time-limited environment of medical school, this choice results in similar performance on multiple-choice examinations with less time invested. Instructors need to look more carefully at whether assessments and learning strategies are helping students to obtain self-directed learning skills and to consider strategies to help students learn to value active learning in an online environment.
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Affiliation(s)
- Amy J. Prunuske
- />Department of Biomedical Sciences, University of Minnesota Medical School Duluth, 1035 University Dr, #SMED 321, Duluth, MN 55812-3031 USA
| | - Lisa Henn
- />Division of Biostatistics, University of Minnesota, Minneapolis, MN USA
| | - Ann M. Brearley
- />Biostatistical Design and Analysis Center and an Instructor in the Division of Biostatistics, University of Minnesota, Minneapolis, MN USA
| | - Jacob Prunuske
- />Department of Family Medicine and Community Health, University of Minnesota Medical School Duluth, Duluth, MN USA
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Sklar DP. When we don't want to stop. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:261-263. [PMID: 25710211 DOI: 10.1097/acm.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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