Improving knowledge in palliative medicine with a required hospice rotation for third-year medical students.

Purpose: The Liaison Committee for Medical Education requires accredited U.S. and Canadian medical schools to teach end-of-life care. The purpose of this study was to evaluate a new required curriculum in palliative medicine for third-year medical students.

Method: Beginning in July 2001, a required four-day (32 hour) curriculum was piloted as part of an ambulatory month in the 12-week medicine clerkship. Students spent Day 1 in the classroom learning core concepts regarding hospice, palliative care, and symptom management. A two-hour session with a standardized patient to break bad news was included. Students spent Days 2 and 3 making home visits or participating in inpatient care. Day 4 was spent in the classroom reviewing cases they had seen with interdisciplinary faculty, making presentations on assigned topics, and discussing professional self-care. Students completed a self-awareness project. Educational outcomes were measured with the students' completion of five pre- and postcourse assessment instruments: (1) self-assessment of competency, (2) attitudes, (3) concerns, (4) a 50-item, multiple-choice knowledge test, and (5) an assessment of elements of the course.

Results: Analysis of 127 paired evaluations showed significant improvements in three instruments: 56% improvement in competence (p <.0001), 29% reduction in concern (p <.0001), and 23% improvement in knowledge (p <.0001). There were no significant changes attitudes (p =.35).

Conclusion: This 32-hour required curriculum in palliative medicine for third-year medical students improved knowledge. They came to the course with appropriate attitudes that did not change.