Innovative Hospice Education for Trainees (F405B)

Abstract

1.Develop core objectives a generalist should know about the transition to home hospice.2.Describe the design and implementation of online, case-based learning as an innovative approach to knowledge acquisition, critical thinking and application of hospice education for trainees. Residents cite a lack of knowledge and skills as a barrier in facilitating transitions to home hospice from the hospital and clinic. In a fast-paced and compact training environment, curricula must be flexible and targeted. This study utilizes an innovative online, case-based curriculum with a flipped-classroom approach to improve knowledge, self-perceived skills and attitudes about hospice care. We developed educational objectives and an online module with case-based learning for post-graduate year-1 (PGY-1) internal medicine and family medicine trainees. This was followed by a face-to-face debrief and just-in-time cognitive aides including a mnemonic and digital resources. A pre- and post-assessment evaluated knowledge, self-perceived skills and attitudes about hospice. PGY-2 residents served as a historical control. A total of 51 PGY-1s received the curriculum. Post-curriculum knowledge scores increased significantly (p<0.05) on a 100-point scale compared to pre-curriculum (78.3.6±12.9 vs. 66.7±16.5) and were not statistically different from the PGY-2 controls (n=55). On a 5-point Likert scale, post-curriculum PGY-1s had significantly higher (p<0.05) average confidence scores than PGY-2s (4.0±0.6 vs. 3.4±0.6) including sub-domains of talking about hospice (4.2±0.9 vs. 3.6±0.9), facilitating the transition from clinic to hospice (3.1±1.0 vs. 2.3±0.7), and seeking help with hospice dilemmas (4.2±0.9 vs. 3.3±1.1). Post-curriculum PGY-1s satisfaction with their training in hospice and end-of-life care was significantly higher than PGY-2s (4.4±0.7 vs. 3.5±1.1, p<0.05). An online flipped-classroom curriculum increased knowledge, confidence in skills and satisfaction with residency training in hospice care at least as much as the maturation effect of intern year. This innovative design offers curriculum solutions that address competing demands and the new era of social distancing and remote learning.