- Email: [email protected]
P073 Palliative Care Always: Massive Open Online Education to Build Primary Palliative Care in a Global Audience
Vol. 52 No. 6 December 2016
Selected Abstracts
and less than 28 points the student is considered anxious. Results: Residents of the first and second year medical clinic had an average sum of 33.38 and 37.05, whereas the average of students from first to sixth year was: 21.66; 22.90; 21.71; 25.13; 29.12 and 25.62 respectively. The analysis with ANOVA test showed significant difference between the residents and all the years of graduation (p LT 0.05); among medical students there was significant difference in fifth year medical comparisons with the following: first, second and third year (p LT 0.05). Conclusion: As the residents have a greater contact with severely ill and terminally patients, they have an increased security to handle the situations and communicate better with patient and family. Regarding the students, as it was expected a greater confidence of the sixth year medical students comparing with the fifth year, it is required to exclude the possibility that fifth-year medical students have a false confidence, because they have just began to go to Hospital in the medical internship and were not exposed yet to difficult situations.
P069 Use of Nonfiction Literature to Facilitate a Discussion-Based Palliative Care and End-of-Life Course
Daniel Abazia1,2, Mary Bridgeman1,3 1 Ernest Mario School of Pharmacy - Rutgers, The State University of New Jersey, Piscataway, NJ, United States 2 Capital Health, Trenton, NJ, United States 3 Robert Wood Johnson University Hospital, New Brunswick, NJ, United States An aging population and increasing emphasis on endof-life (EOL) care necessitates incorporation of palliative care education in health professional training. Traditional didactic teaching methods in pharmacy education do not support the incorporation of nontextbook literature. We describe the development of a course in palliative care that incorporates a nonfiction book on death and dying as a model for curriculum design and discussion-based learning. A two credit elective course was offered to third professional year students in the Spring 2014 and 2015 semesters. How We Die, a nonfiction text that examines death in the context of patient anecdotes, was used to facilitate learning. Employing a multidisciplinary group of content experts, each chapter served as the basis for topic discussions. Assessments included a weekly quiz and blog post, advanced directive writing, and a clinical skills practicum. The course was evaluated using the Student Instructional Rating Survey.
e83
Since Spring 2014, twenty eight students have participated in the course. On a scale of 1 (Strongly Disagree/Poor) to 5 (Strongly Agree/Excellent), the twelve students (43%) who completed the survey rated the following: Instructional methods encouraged student learning (4.83); I learned a great deal in the course (4.87); and, I rate the overall quality of this course as excellent (4.90). Development of a didactic course in palliative and EOL care using discussion-based learning was feasible, well-liked, and encouraged student learning. The course serves as a model of instruction for palliative and EOL care in other health professional degree programs or as an opportunity for interprofessional education.
P073 Palliative Care Always: Massive Open Online Education to Build Primary Palliative Care in a Global Audience
Erika Tribett1, Joshua Fronk1, Sandy Chan2, Judy Passaglia2, Kelly Bugos2, Kimberly Sickler2, Lori Klein2, Manuela Kogon1, Lynn Hutton2, Ellen Brown3, Grace Lyo4 1 Stanford University School of Medicine, Stanford, CA, USA 2 Stanford Health Care, Stanford, CA, USA 3 Pathways Health, Palo Alto, CA, USA 4 Stanford University, Stanford, CA, USA Background: Primary palliative care (PC) is critical to improving access to PC. Still, barriers exist to providing primary PC worldwide, including a lack of awareness, time, and training. Interactive online learning experiences can help overcome these. This project describes a massive open online course (MOOC)--Palliative Care Always--designed to build primary PC skills in a global audience. Methods: A team of PC providers and online instructional experts developed 12 modules that included: (1) patient scenes, (2) brief lectures, (3) empathy exercises, and (4) Google Hangout discussions. Course objectives included awareness of PC, practicing effective communication skills, basic symptom assessment and management. The target audience included oncology clinicians; secondary audience included patients and families. The MOOC launched in January 2016. Participant engagement, satisfaction and self-reported knowledge were assessed through pre/post-surveys. Multiple choice assessments captured knowledge gain. Follow-up assessments will be distributed three months post-MOOC. Results: By April 2016, the course reached 1,300 participants from 91 countries - 54% from the US,
e84
Selected Abstracts
followed by India, Brazil, and Canada. 76% were healthcare professionals, the majority being nurses (40%), physicians (19%) and social workers (13%). The remaining 24% included patient, caregivers, and others interested in PC. Reasons for enrollment included interest in PC, personal growth and job relevance. On average, 27% of enrollees actively engaged week-over-week. Eighty-six percent of respondents were ‘very satisfied’ with the amount learned, and over 50% cited learning ‘a great deal’ in: communicating difficult news, goals of care, psychosocial and hospice care. 93% cited being ‘very likely’ to recommend the course. Conclusions: Interactive MOOC experiences have the potential to build PC awareness, primary skills and global PC networks. Upcoming iterations will incorporate: accommodations for varying levels of PC knowledge; additional opportunities for interaction between participants, including social networks; blended learning; and evaluation of impact on practice and healthcare outcomes.
P074 Exploring Healthcare Professionals’ Ambivalence in Difficulty for Communication with Dying Patients
Yuka Urushibara-Miyachi1, Hiroshi Nishigori1, elle Verstegen3, Miho Iwakuma2, Dani€ 4 Fred C.J. Stevens 1 Center for Medical Education, Graduate School of Medicine, Kyoto University, Kyoto, Japan 2 Department of Medical Communication, Kyoto University, School of Public Health, Kyoto, Japan 3 Health, Medicine and Life Sciences, Educational Development and Research, Maastricht University, Maastricht, The Netherlands 4 Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands Objectives: Difficulty in end-of-life communication has been studied to reduce barriers for better communication of healthcare professionals, with increasing needs for better education. The objectives of our study is to explore ambivalence relating to such difficulty in Japanese context and to develop future educational interventions.
Vol. 52 No. 6 December 2016
3) How do healthcare professionals cope with this ambivalence? 4) What are the healthcare professionals’ learning needs and required competencies to deal with this ambivalence in end-of-life communication? Methods: This study was based on the principles of social constructionist grounded theory. We conducted 15 individual interviews with multidisciplinary healthcare professionals, based on the results from precedent large group discussions. Results: Five ambivalent themes emerged, with implications for learning to acquire competencies for coping with ambivalence. These themes were 1) Controlling the dying process versus going with the flow of life, 2) Avoiding death versus prioritizing hope of the patient, 3) Anticipating of patient’s prognosis accurately, versus producing uncertainty, 4) Unveiling the patient’s hopes versus groping embedded hopes in the family, 5) Being a dehumanized technician, or a warm-hearted incompetent. Discussions: Our findings may be beneficial by suggesting a direction for future education to fill the gap of existing simulation-based trainings, with more emphasis on learning idiosyncracy of communication and the meaning of ambiguity through reflecting continuous humanistic development as healthcare professionals.
P079 The Use of Hospice Experiences to Improve Palliative Care Skills in Undergraduate Medical Students: Results of a Systematic Review of the Evidence-Based Teaching Literature Jeremy Weleff, Russell Leong, Dhairya Kiri, Michigan State University College of Osteopathic Medicine, East Lansing, MI, United States Objectives: The primary goal of this study is to assess the quality of evidence for the use of hospice based experiences in undergraduate medical education and their effect on palliative care skill and/or knowledge. The secondary goal of this study is to provide a collection of evidence-based teaching methods for those involved in the curricular development of undergraduate medical education.
Research questions: 1) Do Japanese healthcare professionals experience ambivalence in their communication with dying patients, and if so, what may this be? 2) What are the factors that may influence this ambivalence?
Methods: The databases EMBASE, CINAHL, PSYCHinfo, Pubmed, Cochrane, and SCOPUS were searched using the search terms medical students, death, and teaching. Inclusion criteria required articles to have a teaching intervention, quantitatively assess palliative and EOL learning outcomes, be
Selected Abstracts
and less than 28 points the student is considered anxious. Results: Residents of the first and second year medical clinic had an average sum of 33.38 and 37.05, whereas the average of students from first to sixth year was: 21.66; 22.90; 21.71; 25.13; 29.12 and 25.62 respectively. The analysis with ANOVA test showed significant difference between the residents and all the years of graduation (p LT 0.05); among medical students there was significant difference in fifth year medical comparisons with the following: first, second and third year (p LT 0.05). Conclusion: As the residents have a greater contact with severely ill and terminally patients, they have an increased security to handle the situations and communicate better with patient and family. Regarding the students, as it was expected a greater confidence of the sixth year medical students comparing with the fifth year, it is required to exclude the possibility that fifth-year medical students have a false confidence, because they have just began to go to Hospital in the medical internship and were not exposed yet to difficult situations.
P069 Use of Nonfiction Literature to Facilitate a Discussion-Based Palliative Care and End-of-Life Course
Daniel Abazia1,2, Mary Bridgeman1,3 1 Ernest Mario School of Pharmacy - Rutgers, The State University of New Jersey, Piscataway, NJ, United States 2 Capital Health, Trenton, NJ, United States 3 Robert Wood Johnson University Hospital, New Brunswick, NJ, United States An aging population and increasing emphasis on endof-life (EOL) care necessitates incorporation of palliative care education in health professional training. Traditional didactic teaching methods in pharmacy education do not support the incorporation of nontextbook literature. We describe the development of a course in palliative care that incorporates a nonfiction book on death and dying as a model for curriculum design and discussion-based learning. A two credit elective course was offered to third professional year students in the Spring 2014 and 2015 semesters. How We Die, a nonfiction text that examines death in the context of patient anecdotes, was used to facilitate learning. Employing a multidisciplinary group of content experts, each chapter served as the basis for topic discussions. Assessments included a weekly quiz and blog post, advanced directive writing, and a clinical skills practicum. The course was evaluated using the Student Instructional Rating Survey.
e83
Since Spring 2014, twenty eight students have participated in the course. On a scale of 1 (Strongly Disagree/Poor) to 5 (Strongly Agree/Excellent), the twelve students (43%) who completed the survey rated the following: Instructional methods encouraged student learning (4.83); I learned a great deal in the course (4.87); and, I rate the overall quality of this course as excellent (4.90). Development of a didactic course in palliative and EOL care using discussion-based learning was feasible, well-liked, and encouraged student learning. The course serves as a model of instruction for palliative and EOL care in other health professional degree programs or as an opportunity for interprofessional education.
P073 Palliative Care Always: Massive Open Online Education to Build Primary Palliative Care in a Global Audience
Erika Tribett1, Joshua Fronk1, Sandy Chan2, Judy Passaglia2, Kelly Bugos2, Kimberly Sickler2, Lori Klein2, Manuela Kogon1, Lynn Hutton2, Ellen Brown3, Grace Lyo4 1 Stanford University School of Medicine, Stanford, CA, USA 2 Stanford Health Care, Stanford, CA, USA 3 Pathways Health, Palo Alto, CA, USA 4 Stanford University, Stanford, CA, USA Background: Primary palliative care (PC) is critical to improving access to PC. Still, barriers exist to providing primary PC worldwide, including a lack of awareness, time, and training. Interactive online learning experiences can help overcome these. This project describes a massive open online course (MOOC)--Palliative Care Always--designed to build primary PC skills in a global audience. Methods: A team of PC providers and online instructional experts developed 12 modules that included: (1) patient scenes, (2) brief lectures, (3) empathy exercises, and (4) Google Hangout discussions. Course objectives included awareness of PC, practicing effective communication skills, basic symptom assessment and management. The target audience included oncology clinicians; secondary audience included patients and families. The MOOC launched in January 2016. Participant engagement, satisfaction and self-reported knowledge were assessed through pre/post-surveys. Multiple choice assessments captured knowledge gain. Follow-up assessments will be distributed three months post-MOOC. Results: By April 2016, the course reached 1,300 participants from 91 countries - 54% from the US,
e84
Selected Abstracts
followed by India, Brazil, and Canada. 76% were healthcare professionals, the majority being nurses (40%), physicians (19%) and social workers (13%). The remaining 24% included patient, caregivers, and others interested in PC. Reasons for enrollment included interest in PC, personal growth and job relevance. On average, 27% of enrollees actively engaged week-over-week. Eighty-six percent of respondents were ‘very satisfied’ with the amount learned, and over 50% cited learning ‘a great deal’ in: communicating difficult news, goals of care, psychosocial and hospice care. 93% cited being ‘very likely’ to recommend the course. Conclusions: Interactive MOOC experiences have the potential to build PC awareness, primary skills and global PC networks. Upcoming iterations will incorporate: accommodations for varying levels of PC knowledge; additional opportunities for interaction between participants, including social networks; blended learning; and evaluation of impact on practice and healthcare outcomes.
P074 Exploring Healthcare Professionals’ Ambivalence in Difficulty for Communication with Dying Patients
Yuka Urushibara-Miyachi1, Hiroshi Nishigori1, elle Verstegen3, Miho Iwakuma2, Dani€ 4 Fred C.J. Stevens 1 Center for Medical Education, Graduate School of Medicine, Kyoto University, Kyoto, Japan 2 Department of Medical Communication, Kyoto University, School of Public Health, Kyoto, Japan 3 Health, Medicine and Life Sciences, Educational Development and Research, Maastricht University, Maastricht, The Netherlands 4 Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands Objectives: Difficulty in end-of-life communication has been studied to reduce barriers for better communication of healthcare professionals, with increasing needs for better education. The objectives of our study is to explore ambivalence relating to such difficulty in Japanese context and to develop future educational interventions.
Vol. 52 No. 6 December 2016
3) How do healthcare professionals cope with this ambivalence? 4) What are the healthcare professionals’ learning needs and required competencies to deal with this ambivalence in end-of-life communication? Methods: This study was based on the principles of social constructionist grounded theory. We conducted 15 individual interviews with multidisciplinary healthcare professionals, based on the results from precedent large group discussions. Results: Five ambivalent themes emerged, with implications for learning to acquire competencies for coping with ambivalence. These themes were 1) Controlling the dying process versus going with the flow of life, 2) Avoiding death versus prioritizing hope of the patient, 3) Anticipating of patient’s prognosis accurately, versus producing uncertainty, 4) Unveiling the patient’s hopes versus groping embedded hopes in the family, 5) Being a dehumanized technician, or a warm-hearted incompetent. Discussions: Our findings may be beneficial by suggesting a direction for future education to fill the gap of existing simulation-based trainings, with more emphasis on learning idiosyncracy of communication and the meaning of ambiguity through reflecting continuous humanistic development as healthcare professionals.
P079 The Use of Hospice Experiences to Improve Palliative Care Skills in Undergraduate Medical Students: Results of a Systematic Review of the Evidence-Based Teaching Literature Jeremy Weleff, Russell Leong, Dhairya Kiri, Michigan State University College of Osteopathic Medicine, East Lansing, MI, United States Objectives: The primary goal of this study is to assess the quality of evidence for the use of hospice based experiences in undergraduate medical education and their effect on palliative care skill and/or knowledge. The secondary goal of this study is to provide a collection of evidence-based teaching methods for those involved in the curricular development of undergraduate medical education.
Research questions: 1) Do Japanese healthcare professionals experience ambivalence in their communication with dying patients, and if so, what may this be? 2) What are the factors that may influence this ambivalence?
Methods: The databases EMBASE, CINAHL, PSYCHinfo, Pubmed, Cochrane, and SCOPUS were searched using the search terms medical students, death, and teaching. Inclusion criteria required articles to have a teaching intervention, quantitatively assess palliative and EOL learning outcomes, be