End -of -life care training in medical school: An examination of medical students' knowledge, attitudes, preparedness to provide care, and the hidden curriculum.

Author

Emily H. Bower

Date of Graduation

2009

Document Type

Dissertation/Thesis

Abstract

End-of-life (EOL) care discussions between physicians and patients promote positive patient health outcomes (Stewart, 1995). However, medical students receive limited training in EOL care (Sullivan, Lakoma, & Block, 2003). To be able to improve curricula, it is important to understand the current training experience and its effects on student attitudes and behavior. The purpose of the current study was twofold: (1) to examine predictors of self-rated preparation to provide EOL care, and (2) to examine predictors of attitudes about EOL care in a medical student population. Additionally, the moderating effect of “hidden” or informal curriculum on the relation between learning experiences and attitudes about EOL was examined. Medical students across all four years of training (n = 169) completed measures about their preparation to provide EOL care, attitudes, knowledge, “learning experiences” (knowledge and didactic education, i.e., formal curriculum), and perception of a hidden curriculum about EOL care. Results regarding the first aim of the study revealed that self-rated preparation to provide care was predicted by more didactic education, perception of less hidden curriculum, and greater confidence in communication skills. Results regarding the second aim revealed that positive attitudes pertaining to beliefs about clinician responsibility for providing EOL care was predicted by greater knowledge. A perception of less hidden curriculum moderated the relation between learning experiences and positive attitudes pertaining to beliefs about clinician responsibility (i.e., an interaction with knowledge and didactic education). Further, attitudes regarding beliefs about patient reactions to EOL care discussions were predicted by greater knowledge. In contrast, learning experiences did not predict attitudes about practical barriers to an EOL care discussion or beliefs about physician emotions associated with EOL care. The results highlight the value of further examining formal education, in particular, as a predictor of attitudes about EOL care. Clarification of the relations between variables could inform targets for educational intervention. To this end, future research should examine how the EOL care learning experiences-attitude relation influences student communication behavior. Such advances would facilitate a thorough understanding of how students learn and apply knowledge, develop beliefs about professional responsibility, and build sensitivity for patients’ concerns regarding end-of-life care. Distally, strengthening the EOL care training curriculum would promote meaningful improvements in patients’ health outcomes.

Recommended Citation

Bower, Emily H., "End -of -life care training in medical school: An examination of medical students' knowledge, attitudes, preparedness to provide care, and the hidden curriculum." (2009). Graduate Theses, Dissertations, and Problem Reports. 8514.
https://researchrepository.wvu.edu/etd/8514