Dr Laura Jones is a junior doctor who previously worked as a teaching fellow at South Tyneside District Hospital in the UK. Earlier poor feedback on didactic teaching methods for final year medical students led Laura to develop her own three-day simulation-based teaching programme with positive results.
Both as a medical student and Foundation Doctor* I was frustrated and upset by how underprepared I was by my undergraduate training to deal with end-of-life care.
Fifty per cent of the UK population die in hospital (1), but most newly qualified doctors feel underprepared to deal with end-of-life care partly owing to few teaching hours as well as the challenges that palliative care creates (1, 2, 3).
Last year I worked as a Teaching Fellow, and one of my roles was to deliver teaching to final year medical students on palliative care. Previously, teaching was delivered through didactic teaching receiving poor feedback. Learners stated they were bored, they did not retain knowledge and most significantly they felt the teaching was irrelevant. I was not able to increase the number of hours of teaching allocated, so I tasked myself with creating a biopsychosocial approach to a teaching session that would engage and challenge the students while helping them understand why the knowledge was relevant to them. We looked at common problems, including recognising a patient is coming to the end of their life, broaching conversations with relatives and patients, starting anticipatory medication and, most importantly, identifying when they needed to seek senior support.
Using a simulation-based (experiential) approach to learning
Simulation is a term used a lot currently in medical education. I see simulation as an educational experience that takes learners away from traditional teaching methods, such as sitting in a classroom, to an experience where they interact with the learning environment around them. Making decisions and performing tasks that change the outcomes of the scenario they are presented with. Often, it is seen that to do simulation you need high tech equipment, which costs a lot of money. But I believe simulation is all about the environment created, the opportunities given, alongside the feeling of realness and challenge for the students. With a little bit of creativity and thought this can be done on a much lower budget and therefore be more widely available. Simulation is a wonderful tool that, if used correctly, can provide a safe bridge for medical students to move from the ability to recite facts to actually becoming the doctor they dreamed of, capable of applying their knowledge to a real patient from day one.
The programme started with tea, cake and an open discussion about a Foundation Doctor’s role in death and dying, allowing learners to understand why the teaching programme was going to be relevant to them, activating prior knowledge and shaking off any preconceptions they might have.
I used a low-fidelity simulation, utilising actors, staff members and mannequins as well as creating patient notes. This allowed for a learner-centred approach where the learners were fully in charge of their patient’s journey from patient assessment on admission to hospital, breaking bad news through discussions with family members, dealing with the patient’s death and learning coping mechanisms for dealing with death as a junior doctor.
I chose to use simulation to ensure that both patient care was not affected and learner’s confidence was not knocked should they make a mistake. This allowed learners to develop their own knowledge constructs through both positive and negative experiences in the simulation.
We used pre-and post-teaching survey evaluation; the results were reassuring with a significant increase in the learner’s confidence in dealing with all major palliative care issues tested. But, most importantly for me, we ascertained that teaching was well received with positive feedback that learners not only enjoyed the programme, they also understood why the teaching was important and engaged with the experience. I would hope that they can take these skills forward when they start work as a Foundation Doctor* and that the programme will be run again in future now I have moved on from this role to continue my training.
* A Foundation Doctor is a grade of medical doctor in the UK undertaking the Foundation Programme – The first two years of being a doctor after medical school and where you start your journey as a junior doctor in the UK. During this time, you develop your skills in a range of medical, surgical and community specialties ensuring all doctors can manage a sick patient acutely and have a basic understanding of a range of different specialties. This creates a solid foundation for all doctors no matter what their chosen speciality is.
- Gibbins J, McCoubrie R, Maher J, Wee B, Forbes K. Recognizing that it is part and parcel of what they do: teaching palliative care to medical students in the UK. Palliative Medicine.2010; 24 (3):299-305.
- Fitzpatrick D, Heah R, Patten S, Ward, H. Palliative Care in Undergraduate Medical Education – How Far Have We Come? American Journal of Hospice & Palliative Medicine. 2016; 34 (8):762-773.
- Field D, Wee B. Preparation for palliative care: teaching about death, dying and bereavement in UK medical schools 2000-2001. Medical Education. 2002; 36(6):561-567.
- Contact (or follow) Laura Jones on twitter @DrLaura_Jones
- Download Laura’s Pallative care poster for more information on the results found.
- Read more about education and training in palliative care on the EAPC blog.