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Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

ABSTRACT: BACKGROUND:Recognising dying is a key clinical skill for doctors, yet there is little training. AIM:To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying. DESIGN:Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training. SETTING/PARTICIPANTS:Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72?hours (0% certain survival - 100% certain death) pre, post, and 2?weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)). RESULTS:Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (?MAD?=?-3.43, 95% CI -0.11 to -0.34, p?=?<0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (?MAD?=?1.50, 95% CI -0.87 to 3.86, p?=?0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS?=?146.04 (SD 140.21), control CWS?=?110.75 (SD 104.05); p?=?0.01). CONCLUSION:The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.

SUBMITTER: White N

PROVIDER: S-EPMC6952943 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

White Nicola N Oostendorp Linda Jm LJ Tomlinson Christopher C Yardley Sarah S Ricciardi Federico F Gökalp Hülya H Minton Ollie O Boland Jason W JW Clark Ben B Harries Priscilla P Stone Patrick P

Palliative medicine 20191114 1

<h4>Background</h4>Recognising dying is a key clinical skill for doctors, yet there is little training.<h4>Aim</h4>To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying.<h4>Design</h4>Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The ...[more]

PMID: 31722611

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Project description:ObjectivesRecent research suggests that the gender of health care providers may affect their medical performance. This trial investigated (1) the effects of the gender composition of resuscitation teams on leadership behaviour of first responders and (2) the effects of a brief gender-specific instruction on leadership behaviour of female first responders.MethodsThis prospective randomised single-blinded trial, carried out between 2008 and 2016, included 364 fourth-year medical students of two Swiss universities. One hundred and eighty-two teams of two students each were confronted with a simulated cardiac arrest, occurring in the presence of a first responder while a second responder is summoned to help. The effect of gender composition was assessed by comparing all possible gender-combinations of first and second responders. The gender-specific instruction focused on the importance of leadership, gender differences in self-esteem and leadership, acknowledgement of unease while leading, professional role, and mission statement to lead was delivered orally for 10 min by a staff physician and tested by randomising female first responders to the intervention group or the control group. The primary outcome, based on ratings of video-recorded performance, was the first responders' percentage contribution to their teams' leadership statements and critical treatment decision making.ResultsFemale first responders contributed significantly less to leadership statements (53% vs. 76%; P = 0.001) and critical decisions (57% vs. 76%; P = 0.018) than male first responders. For critical treatment decisions, this effect was more pronounced (P = 0.007) when the second responder was male. The gender-specific intervention significantly increased female first responder's contribution to leadership statements (P = 0.024) and critical treatment decisions (P = 0.034).ConclusionsFemale first responders contributed less to their rescue teams' leadership and critical decision making than their male colleagues. A brief gender-specific leadership instruction was effective in improving female medical students' leadership behaviours.

Project description:Distress and burnout among medical and psychology professionals are commonly reported and have implications for the quality of patient care delivered. Already in the course of university studies, medicine and psychology students report mental distress and low life satisfaction. There is a need for interventions that promote better coping skills in students in order to prevent distress and future burnout. This study examines the effect of a seven-week Mindfulness-Based Stress Reduction (MBSR) programme on mental distress, study stress, burnout, subjective well-being, and mindfulness of medical and psychology students.A total of 288 students (mean age =?23 years, 76% female) from the University of Oslo and the University of Tromsø were randomly allocated to an intervention or control group. The control group continued with their standard university courses and received no intervention. Participants were evaluated using self-reported measures both before and after the intervention. These were: the 'General Health Questionnaire, Maslach Burnout Inventory Student version, Perceived Medical School Stress, Subjective Well-being, and Five Facet Mindfulness Questionnaire' and additional indices of compliance.Following the intervention, a moderate effect on mental distress (Hedges'g 0.65, CI =?.41, .88), and a small effect on both subjective well-being (Hedges'g 0.40, CI =?.27, .63) and the mindfulness facet 'non-reacting' (Hedges'g 0.33, CI =?.10, .56) were found in the intervention group compared with the control group. A higher level of programme attendance and reported mindfulness exercises predicted these changes. Significant effects were only found for female students who additionally reported reduced study stress and an increase in the mindfulness facet 'non-judging'. Gender specific effects of participation in the MBSR programme have not previously been reported, and gender differences in the present study are discussed.Female medical and psychology students experienced significant positive improvements in mental distress, study stress, subjective well-being and mindfulness after participating in the MBSR programme.NCT00892138.

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Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

Publications

Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

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