Chronic respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD) are a common cause of death in many countries. Further “graying” of the population will result in an increasing prevalence of and mortality from these so-called “non-malignant” conditions. End-of-life care for patients with chronic (respiratory) disease is an important aspect of health care delivery. Those caring for patients nearing the end-of-life must be proficient in the principles and practice of palliative care. Our study was designed to evaluate the use of facilitated, small group discussions focusing on illustrative cases (cognitive simulation) to teach/learn this essential knowledge.
Consenting medical students (all from the University of Alberta) and resident physicians (from medical schools across Canada) were given a “primer” reviewing the principles of end-of-life care (numerous guidelines exist). They then participated in two small group sessions during which they were asked to manage a hypothetical but plausible patient dying from advanced COPD. Finally, a questionnaire regarding their experience was completed.
100% of participants disagreed with the statement, “end-of-life care is well-represented in the training programs in which I have been enrolled”. 100% of participants, however, agreed or strongly agreed that “end-of-life management is an important part of health care”, and that it would be an “important part of (their) future duties”. 57% and 43% strongly agreed or agreed that “small group discussions are an excellent way to learn end-of-life care”, and all either agreed or strongly agreed that they would “recommend the experience to a colleague”. An analysis of the intervention’s effect on both general (conceptual) and specific (recall of practical details) learning outcomes indicates that participants perceived an improved understanding in several dimensions of end-of-life care.
End-of-life care is likely underrepresented in medical training programs across Canada. Case-based, facilitated small group discussions appear to be a highly acceptable method with which to teach and learn end-of-life care.
The potential exists to improve end-of-life patient care through standardized, case-based, small group discussions/simulations.
Ronald Damant, None.