title: Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students.
abstract: OBJECTIVE
  Meeting the needs of patients with life-limiting and terminal illness requires effectively trained physicians in all specialties to provide skillful and compassionate care. Despite mandates for end-of-life (EoL) care education, graduating medical students do not consistently feel prepared to provide this care.
  
  
  METHODS
  We have developed a longitudinal, integrated, and developmental 4-year curriculum in EoL care. The curriculum's purpose is to teach basic competencies in EoL care. A variety of teaching strategies emphasize experiential, skill-building activities with special attention to student self-reflection. In addition, we have incorporated interprofessional learning and education on the spiritual and cultural aspects of care. We created blended learning strategies combining interactive online modules with live workshops that promote flexibility, adaptability, and interprofessional learning opportunities.
  
  
  BACKGROUND
  The curriculum was implemented and evaluated in the 4-year program of studies at Yale School of Medicine.
  
  
  RESULTS
  A mixed-method evaluation of the curriculum included reviews of student written reflections and questionnaires, graduating student surveys, and demonstration of 4th-year students' competency in palliative care with an observed structured clinical examination (OSCE). These evaluations demonstrate significant improvements in students' self-reported preparedness in EoL care and perceptions of the adequacy in their instruction in EoL and palliative care, as well as competency in primary palliative care in a newly developed OSCE.
  
  
  CONCLUSIONS
  A 4-year longitudinal integrated curriculum enhances students' skills and preparedness in important aspects of EoL care. As faculty resources, clinical sites, and curricular structure vary by institution, proven and adaptable educational strategies as described in this article may be useful to address the mandate to improve EoL care education. Teaching strategies and curricular components and design as just described can be adapted to other programs.
authors.affiliation: a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ellman
authors.affiliation: a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA.
authors.forename: Auguste H
authors.initials: AH
authors.lastname: Fortin
authors.affiliation: a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Putnam
authors.affiliation: a Department of Medicine , Yale School of Medicine , New Haven , Connecticut , USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Bia
mesh_terms: D002983:Clinical Competence; D003237:Connecticut; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D006040:Goals; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D013727:Terminal Care
keywords: curriculum development; end-of-life care; medical student education; palliative care