Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial

White N., Oostendorp L. J. M., Tomlinson C., Yardley S., Ricciardi F., GÖKALP CLARKE H., ...Daha Fazla

PALLIATIVE MEDICINE, cilt.34, sa.1, ss.134-144, 2020 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 34 Sayı: 1
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1177/0269216319880767
  • Dergi Adı: PALLIATIVE MEDICINE
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, ASSIA, CINAHL, EMBASE, MEDLINE, Psycinfo
  • Sayfa Sayıları: ss.134-144
  • Anahtar Kelimeler: Medical education, palliative care, dying, prognosis, decision-making, PALLIATIVE CARE EDUCATION, KNOWLEDGE
  • Ondokuz Mayıs Üniversitesi Adresli: Evet

Özet

Background: Recognising dying is a key clinical skill for doctors, yet there is little training. Aim: To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying. Design: Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training. Setting/participants: Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival - 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)). Results: Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (delta(MAD) = -3.43, 95% CI -0.11 to -0.34, p = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (delta(MAD) = 1.50, 95% CI -0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01). Conclusion: The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.