Reflections on an end-of-life care course for preclinical medical students

J Formos Med Assoc. 2009 Aug;108(8):636-43. doi: 10.1016/s0929-6646(09)60384-3.


Background/purpose: Undergraduate medical education lacks standardized curricula for teaching end-of-life care and only sporadic curricula evaluations have been reported. The objectives of this study were to evaluate the effect of a multimodal teaching program on preclinical medical students' knowledge of palliative care, and their beliefs relating to ethical decision-making.

Methods: This study had a quasi-experimental design. The teaching formats included didactic lectures, bedside patient care, and interactive discussions. A structured questionnaire evaluated the effects of educational intervention---in terms of knowledge of palliative care and beliefs about common ethical dilemmas relating to end-of-life care in Taiwan.

Results: All 118 students who participated in the study completed the questionnaire. Students showed significant improvement (score of 9.97 pre-test vs. 12.73 post-test; p < 0.001) in the 18-item palliative care knowledge questionnaire after educational intervention. Among the four common ethical dilemmas, students' beliefs of truth-telling (4.22 vs. 4.54; range 1-5; t = -4.66; p < 0.001) and place of care (4.37 vs. 4.52; range 1-5; t = -2.43; p < 0.05) were significantly improved. Logistic regression showed that the improvement in beliefs about ethical decision-making was not significantly influenced by improved knowledge of palliative care.

Conclusion: A 1-week multimodal curriculum for preclinical medical students can improve the knowledge and beliefs about ethical decision-making in managing terminally ill patients. Clinical skills of symptom management, especially pain control, and ethical decision-making regarding artificial nutrition and hydration should be emphasized in medical education, to promote students' competence in end-of-life care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Curriculum
  • Decision Making / ethics
  • Education, Medical, Undergraduate*
  • Female
  • Humans
  • Knowledge
  • Male
  • Students, Medical*
  • Terminal Care*