Reflections on an end-of-life care course for preclinical medical students.
OBJECTIVE
Undergraduate medical education lacks standardized curricula for teaching end-of-life care and only sporadic curricula evaluations have been reported. The objectives of this study were to evaluate the effect of a multimodal teaching program on preclinical medical students' knowledge of palliative care, and their beliefs relating to ethical decision-making.


METHODS
This study had a quasi-experimental design. The teaching formats included didactic lectures, bedside patient care, and interactive discussions. A structured questionnaire evaluated the effects of educational intervention---in terms of knowledge of palliative care and beliefs about common ethical dilemmas relating to end-of-life care in Taiwan.


RESULTS
All 118 students who participated in the study completed the questionnaire. Students showed significant improvement (score of 9.97 pre-test vs. 12.73 post-test; p < 0.001) in the 18-item palliative care knowledge questionnaire after educational intervention. Among the four common ethical dilemmas, students' beliefs of truth-telling (4.22 vs. 4.54; range 1-5; t = -4.66; p < 0.001) and place of care (4.37 vs. 4.52; range 1-5; t = -2.43; p < 0.05) were significantly improved. Logistic regression showed that the improvement in beliefs about ethical decision-making was not significantly influenced by improved knowledge of palliative care.


CONCLUSIONS
A 1-week multimodal curriculum for preclinical medical students can improve the knowledge and beliefs about ethical decision-making in managing terminally ill patients. Clinical skills of symptom management, especially pain control, and ethical decision-making regarding artificial nutrition and hydration should be emphasized in medical education, to promote students' competence in end-of-life care.
Chang
Hao-Hsiang
HH
Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Bei-Hu Branch, Taipei, Taiwan.
Hu
Wen-Yu
WY
Tsai
Stanley S L
SS
Yao
Chien-An
CA
Chen
Chin-Yu
CY
Chiu
Tai-Yuan
TY
D000293:Adolescent; D000328:Adult; D003479:Curriculum; D003657:Decision Making / Q000941:ethics; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D019359:Knowledge; D008297:Male; D013337:Students, Medical; D013727:Terminal Care