Terminal Illness
Conditions
Keywords
Medical Students, Education, Prognosis, Online training resource
Brief summary
This study evaluates whether an online training resource can improve the performance of medical students in recognising imminently dying palliative care patients.
Detailed description
Clinicians are routinely asked to provide survival estimates for palliative care patients, but recognition of imminent death (last 72 hours of life) is often inaccurate. We developed an online training resource, based on a previous study that identified the symptoms or signs that were most influential in forming expert palliative care doctors' prognostic decisions about imminent death. This double-blind randomised controlled trial will evaluate the effectiveness of this online training resource in improving the performance of medical students in recognising imminently dying palliative care patients. Participants are asked to visit the study website and review three series of vignettes describing patients referred to palliative care. For each vignette, participants are asked to provide an estimate (0-100%) about the probability that the patient will die in the next 72 hours. After the first series of vignettes, students randomised to the intervention arm are given access to an online training resource showing how experts weighted the relative importance of symptoms and signs. All participants are asked to complete a second series of vignettes. After two weeks, all participants are asked to return to the website and complete a third series of vignettes to assess if any effect has been maintained.
Interventions
OTHEROnline training resource
Please see information included in the description of the intervention group.
Sponsors
Brunel University
Imperial College London
Marie Curie Hospice, Belfast
Hull York Medical School
University College, London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Over 18 years of age 2. Enrolled on a registered medical course within the United Kingdom 3. In the penultimate or final year of medical school 4. Sufficient English language proficiency 5. Willing and able to provide consent as indicated by taking part in the online survey
Exclusion criteria
None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Survival estimates - immediate effect | Second series of vignettes, taking into account the estimates from the first series. Students can participate at their convenience and will have a four week window to complete the first and second series of vignettes. | The primary outcome will be a continuous survival estimate provided from the students for the second series of vignettes; ranging from 0-100%. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Survival estimates - follow-up | Third series of vignettes, taking into account the estimates from previous series. Two weeks after completing the first and second series of vignettes, students will be asked to complete a third series of vignettes within a four week window. | Survival estimates provided from the students at the two week follow-up; ranging from 0-100%. |
| Cue weighting | Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window. | Cue weighting of the individual students as compared to the experts; that is the coefficient of each factor as part of their judgement policy. |
| Level of expertise | Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window. | The level of expertise will be assessed with the Cochran-Weiss-Shanteau (CWS) score. This score details the level of ability to discriminate and the level of consistency. |
Countries
United Kingdom
Outcome results
None listed