Experiences of Simulated Phone Death Notification.

Background: Physicians perform many difficult skills, but notifying loved ones about the death of a family member is a particularly challenging skill that requires specific training. Descriptions of such training are lacking in the literature. We developed a formative standardised patient encounter on death notification over the telephone for fourth-year medical students and evaluated their qualitative perspectives, including emotional safety.

An Advanced Communication Skills Workshop Using Standardized Patients for Senior Medical Students.

Introduction: Medical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students.

A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective.

Background: The medical student experience of a clinical elective in palliative care (PC) remains understudied. Reflective narrative interventions can help students hone narrative competency skills, make sense of their clinical experiences and shed light on their perception of the rotation.

Objectives: To evaluate medical student written reflections after a PC clinical elective.

Are Internal Medicine Residents Meeting the Bar? Comparing Resident Knowledge and Self-Efficacy to Published Palliative Care Competencies.

Background: There is a need for improved primary palliative care (PC) education and resident comfort with providing end-of-life care.

Objective: Utilize a new instrument derived from published PC competencies to assess baseline Internal Medicine (IM) resident knowledge and self-efficacy in PC to identify educational gaps and create new PC curricula.

Design: We created a 2-part instrument including a Knowledge Test (KT) and a Self-Efficacy Inventory (SEI) addressing 18 PC resident competencies across 5 domains: Pain and Symptom Management (PSM), Communication (COMM), Psychosocial, Spiritual, and Cultural Aspects of Care (PSC), Terminal Care and Bereavement (TCB), and Palliative Care Principles and Practice (PCPP).

The day the residents left: lessons learnt from COVID-19 for ambulatory clinics.

As the COVID-19 pandemic began, the residents from our ambulatory clinics were pulled to cover the increasing numbers of hospitalised patients. To provide care for our 40 000 patients, without resident support, we needed to develop quickly a new culture of communication and innovation. We accomplished this by regular, transparent meetings with senior leadership and key stakeholders who were empowered to make rapid decisions.

Assessing Advanced Communication Skills via Objective Structured Clinical Examination: A Comparison of Faculty Versus Self, Peer, and Standardized Patient Assessors.

: The construct addressed in this study is assessment of advanced communication skills among senior medical students. : The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback.

A New Competency-Based Instrument to Assess Resident Knowledge and Self-Efficacy in Primary Palliative Care.

Context: There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions.

Objectives: To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC.

Physicians Should Play a Role in Ensuring Safe Firearm Ownership.

The USA is unique among industrialized nations in its dramatic rate of firearm violence. Unfortunately, firearm-related issues in America are politically divisive and fraught with controversy, thus impeding the study and implementation of safety strategies. Despite the lack of consensus, there is agreement that firearms should be kept away from individuals with criminal intent and those who are dangerous due to medical impairment.

Students' Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students' Written Reflections.

Background: Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students' experiences with death and dying, describe the range of students' emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death.

Methods: We provided a writing prompt to newly matriculated medical students asking them to "reflect on experiences you may have had with family or friends near the end of life.

Simulation training in palliative care: state of the art and future directions.

Background: The growing need for palliative care (PC) among patients with serious illness is outstripped by the short supply of PC specialists. This mismatch calls for competency of all health care providers in primary PC, including patient-centered communication, management of pain and other symptoms, and interprofessional teamwork. Simulation-based medical education (SBME) has emerged as a promising modality to teach key skills and close the educational gap.

Assessing Resident Palliative Care Education: Lessons Learned for Curriculum Mapping in Graduate Medical Education.

This article was migrated. The article was marked as recommended. Charged with implementing a new curriculum within an established residency, we describe the application of curriculum mapping, a tool underutilized in GME.

Comparison of Perioperative Adverse Event Rates After Total Knee Arthroplasty in Patients With Diabetes: Insulin Dependence Makes a Difference.

Background: Total knee arthroplasty (TKA) is an effective treatment option for patients with advanced osteoarthritis and has become one of the most frequently performed orthopedic procedures. With the increasing prevalence of diabetes mellitus (DM), the burden of its sequela and associated surgical complications has also increased. For these reasons, it is important to understand the association between DM and the rates of perioperative adverse events after TKA.

Online Learning Tools as Supplements for Basic and Clinical Science Education.

Undergraduate medical educators are increasingly incorporating online learning tools into basic and clinical science curricula. In this paper, we explore the diversity of online learning tools and consider the range of applications for these tools in classroom and bedside learning. Particular advantages of these tools are highlighted, such as delivering foundational knowledge as part of the "flipped classroom" pedagogy and for depicting unusual physical examination findings and advanced clinical communication skills.

Modifying the Primary Care Exception Rule to Require Competency-Based Assessment.

Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training.

Demonstrating Medical Student Competency in Palliative Care: Development and Evaluation of a New Objective Structured Clinical Examination Station.

Background: The observed structured clinical examination (OSCE) is an important tool to assess clinical competencies; however, there are no reported palliative care OSCEs for medical student assessment.

Objective: We aimed to develop, implement, and evaluate the characteristics of a palliative care OSCE for fourth-year medical students.

Methods: We created a representative case and a checklist of 14 history items from three core palliative care competency domains.

Preclinical Medical Students' Diverse Educational and Emotional Responses to a Required Hospice Experience.

Background: Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care.

Objective: To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE).

Development, implementation and evaluation of a terminal and hospice care educational online module for preclinical students.

Objectives: To explore the application of an online learning tool to teach preclinical medical students terminal and hospice care in a blended curricula.

Methods: We created and evaluated a 30 min interactive online module at the Yale School of Medicine. Second-year medical students were randomly assigned to complete the online module or not (control group) prior to attending a required half-day hospice clinical experience.

Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students.

Problem: Meeting the needs of patients with life-limiting and terminal illness requires effectively trained physicians in all specialties to provide skillful and compassionate care. Despite mandates for end-of-life (EoL) care education, graduating medical students do not consistently feel prepared to provide this care.

Intervention: We have developed a longitudinal, integrated, and developmental 4-year curriculum in EoL care.

Implementing the patient-centered medical home in residency education.

Background: In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings.

Using online learning and interactive simulation to teach spiritual and cultural aspects of palliative care to interprofessional students.

Background: To meet the complex needs of patients with serious illness, health professional students require education in basics aspects of palliative care, including how to work collaboratively on an interprofessional team.

Objectives: An educational program was created, implemented, and evaluated with students in medicine, nursing, chaplaincy, and social work. Five learning objectives emphasized spiritual, cultural, and interprofessional aspects of palliative care.

Benefits of teaching medical students how to communicate with patients having serious illness: comparison of two approaches to experiential, skill-based, and self-reflective learning.

Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-Life Care Assignment. These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum.