title: A novel advance directives course provides a transformative learning experience for medical students.
abstract: BACKGROUND
  Inadequate physician training may be a barrier to physician-patient discussions of advance directives (ADs).
  
  
  METHODS
  The purpose of this study was to determine the effects of an ADs course, which includes completing a directive, on medical students' perceived knowledge of and preparedness for discussing ADs with patients. All 4th-year medical students completed a 10-hr bioethics course comprising interactive lecture and small-group discussion formats. Curriculum content included ethical and legal aspects of ADs. An 8-item survey with free-text entry was administered 1 month after course completion. Internal consistency reliability of survey scores was determined. Two authors independently coded the free-text comments and reached consensus on underlying themes.
  
  
  RESULTS
  Of the 89 students who completed the survey (response rate 80%), 87 (98%) felt more knowledgeable and 88 (99%) better equipped to counsel patients about ADs. Forty-two (47%) reported they had counseled others to complete ADs during the month after the course. Internal consistency reliability of survey scores was very good (Cronbach's alpha =.78). Dominant themes of responses to the question, "What was the most eye opening, troubling, or difficult aspect about filling out your advance directive?" included difficulties articulating wishes, legal language, selecting a surrogate, and facing mortality.
  
  
  CONCLUSIONS
  These findings suggest an ADs course that includes completing a directive enhances medical students' empathy for and preparedness to discuss ADs with patients.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. mueller.pauls@mayo.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
authors.forename: Scott C
authors.initials: SC
authors.lastname: Litin
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Hook
authors.forename: Edward T
authors.initials: ET
authors.lastname: Creagan
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
mesh_terms: D000328:Adult; D016223:Advance Directives; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D013337:Students, Medical / Q000706:statistics & numerical data*; D055815:Young Adult