title: Death is not always a failure: outcomes from implementing an online virtual patient clinical case in palliative care for family medicine clerkship.
abstract: BACKGROUND
  The dying patient is a reality of medicine. Medical students, however, feel unprepared to effectively manage the complex end-of-life (EOL) management issues of the dying patient and want increased experiential learning in Palliative Care.
  
  
  OBJECTIVE
  To address the need for more formal curriculum in EOL care, we developed and implemented an online virtual patient (VP) clinical case in Palliative Care into the 2010-2011 Year Three Family Medicine Clerkship rotation curriculum.
  
  
  METHODS
  A mixed-method design was used to measure the change in knowledge and perceived preparedness level in EOL care before and after completing the online VP case. A survey collected qualitative descriptions of the students' educational experience of using this case.
  
  
  RESULTS
  Ninety five percent (130/137) of the students voluntarily consented to have their results analyzed. The group knowledge score (n=127) increased significantly from a pre-course average of 7.69/16±2.27, to a post-course average of 10.02/16±2.39 (p<0.001). The students' self-assessed comfort level increased significantly with all aspects of EOL management from pre-course to post-course (p<0.001). Nearly, 91.1% of the students rated the VP realism as 'Good to Excellent', 86% rated the case as educationally beneficial. Nearly 59.3% of students felt emotionally engaged with the VP. Qualitative feedback found that the case content was very useful and realistic, but that the interface was sometimes awkward to navigate.
  
  
  CONCLUSIONS
  The online VP case in Palliative Care is a useful teaching tool that may help to address the need for increased formal Palliative Care experience in medical school training programs.
authors.affiliation: Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; amy.tan@ualberta.ca.
authors.forename: Amy
authors.initials: A
authors.lastname: Tan
authors.forename: Shelley Paige
authors.initials: SP
authors.lastname: Ross
authors.forename: Kimberley
authors.initials: K
authors.lastname: Duerksen
mesh_terms: D001293:Attitude to Death; D002170:Canada; D002982:Clinical Clerkship; D003198:Computer Simulation; D003479:Curriculum; D003657:Decision Making; D020375:Education, Distance; D005194:Family Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010166:Palliative Care; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013727:Terminal Care; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: end-of-life care; end-of-life decision-making; online learning; palliative care; undergraduate medical education; virtual patient