TY - JOUR
T1 - Online training improves medical students' ability to recognise when a person is dying
T2 - the ORaClES randomised controlled trial
AU - White, Nicola
AU - Oostendorp, Linda J.M.
AU - Tomlinson, Christopher
AU - Yardley, Sarah
AU - Ricciardi, Federico
AU - Gökalp, Hülya
AU - Minton, Ollie
AU - Boland, Jason W.
AU - Clark, Ben
AU - Harries, Priscilla
AU - Stone, Patrick
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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 (╬┤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 (╬┤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.
AB - 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 (╬┤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 (╬┤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.
KW - Allied health professions and studies
UR - https://www.ncbi.nlm.nih.gov/pubmed/31722611
U2 - 10.1177%2F0269216319880767
DO - 10.1177%2F0269216319880767
M3 - Article
C2 - 31722611
SN - 0269-2163
VL - 34
SP - 134
EP - 144
JO - Palliative Medicine
JF - Palliative Medicine
IS - 1
ER -