Abstract
Purpose
Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay.
Methods
This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula.
Results
Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good “starting point” for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning—interpreted through the lens of Bloom’s taxonomy—occurred.
Conclusion
Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom’s taxonomy.
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Acknowledgments
The authors would like to acknowledge Common Practice, LLC, for permitting the use of the Hello for the purposes of this research study and Erik Lehman for assistance with statistical analyses.
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Conflict of Interest
LJV is an unpaid, scientific advisor to Common Practice, LLC, who is the creator of the game that was included in the mini-curriculum tested in this manuscript. Common Practice, LLC was not involved in the study design, implementation, analysis, or publication of this work. Dr. Green is a co-principal of Making Your Wishes Known, LLC, a company that developed an online platform for helping individuals engage in advance care planning. The original version of Making Your Wishes Known was created for research purposes and continues to be available free of charge. A second version that can be widely distributed has been developed in partnership with a private commercial enterprise, with whom Drs. Green has a consulting agreement and equity interest.
Ethical Approval
IRB approval was obtained from the Penn State Hershey IRB board (IRB 00007987). The study was deemed exempt from full review. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed Consent
All participants provided implied consent by completing the questionnaires. Focus group participants provided informed consent.
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Van Scoy, L.J., Green, M.J. & Volpe, R. Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay. Med.Sci.Educ. 29, 453–462 (2019). https://doi.org/10.1007/s40670-019-00713-5
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DOI: https://doi.org/10.1007/s40670-019-00713-5