Study On End-of-life Care Education And Its Curriculum For Medical Undergraduates

AimsEnd-of-life care education is to guide people to understand and treat death scientifically and rationally,and use medical death knowledge to serve medical practice and society.Medical students are the pioneers of end-of-life care education,and the caregivers most contacting with dying patients in the future.The knowledge,skills and experience of end-of-life care education acquired by medical students not only affect the individual’s cognition,attitude and response to death,but also directly and indirectly affect the attitude toward care of the dying,and even the quality of life of the dying patients and their families.Death related curriculum is the most effective form of universal and professional end-of-life care education.However,end-of-life care education in China is still in its infancy,the pactice is rare,and a systematic and perfect curriculum system has not yet been formed.The aims of this study is to develop the curriculum standard of end-of-life care education for medical undergraduates based on the theories of curriculum development,which is suitable for China’s national conditions by using a variety of research methods,and exploring the effectiveness of the curriculum through educational experiments,to provide reference for the promotion of end-of-life care education in China.Methods1.The cross-section study of the attitude toward end-of-life care education among medical undergraduates : A cross-sectional survey was conducted to understand the current situation and influencing factors of death attitude and education attitude of medical undergraduates in Shanghai.Structural equation model was used to analyze the influence paths and effects of each path of end-of-life care education attitude.Construction the attitude model of end-of-life care education for medical undergraduates in China based on the characteristics of academic background.2.The comparative study of end-of-life care education curriculum in medical schools at home and abroad: Comparative study was used to describe and compare the current situation of end-of-life care education curriculum in medical schools at home and abroad,and summarized the basic elements including curriculum nature,learning goals,teaching contents,teaching methods,teaching hours,teaching team and curriculum evaluation.3.The curriculum design of the end-of-life care education for medical undergraduates: Using curriculum development theory to design curriculum.Based on Taylor’s goal model as the basic theoretical framework of curriculum development,Bloom’s goal classification theory was used to classify curriculum objectives,and Constructivist learning theory was used for reference in teaching content,methods and evaluation.Combined with the results of comparative study of end-of-life care education and the education attitude of medical undergraduates,the curriculum of end-of-life care education for medical undergraduates in China is proposed,including curriculum nature,learning goals,teaching contents,teaching methods,teaching hours,teaching team and curriculum evaluation.The Delphi method was used to demonstrate the syllabus of the curriculum and finally determined according to the results of statistical analysis and expert opinions.4.The Evaluation on the educational experiment of the end-of-life care education curriculum : Design an educational experiment to explore the effectiveness of the "End-of-life care education" curriculum.A mixed-method design of quantitative methods and qualitative methods was used and the experiment evaluation tool was developed.The students in the experimental group and the control group were analyzed and compared pre-and post-test study,to understand the differences between the two groups in death related knowledge,attitude toward care of the dying and death coping competence.A qualitative study using semi-structured interview was carried out to learn about the gains and changes of students’ participation in the curriculum,as well as the evaluation and suggestions of the curriculum.Results1.The results of the attitude toward end-of-life care education among medical undergraduates: The scores of medical undergraduates’ attitude towards end-of-life care education is 3.739±0.575.The path analysis results of end-of-life care education attitude show that: gender,age,family discussion about death,the contact experience of dying patients and the understanding of end-of-life care education are five exogenous variables,and death attitude,death anxiety and the attitude toward care of the dying are three mediators.And the age,the attitude toward care of the dying,death attitude,and death anxiety all have a direct impact on their attitude toward end-of-life care education,the gender,understanding of end-of-life care education,contact experience of dying patients and family discussion about death have indirect effects on their attitude toward end-of-life care education through mediator;in addition,age,death attitude and death anxiety have direct and indirect effects through mediator,so the paths are statistically significant(P < 0.05).2.The comparative results of end-of-life care education curriculum in medical schools at home and abroad: The curriculum of end-of-life care education in medical schools is mainly for pre-clinical students in the form of elective curriculum,the learning goals are mostly set in three fields: cognition,emotion and behavioral skills;the content focuses on the basic theoretical knowledge of death and end-of-life care education, knowledge and technology of end-of-life care,and dying and death coping,but the emphasis is different in different countries;The integration of theory and practice teaching method is the main teaching strategy of end-of-life care education,and the experiential teaching of clinical practice is the most widely used practice teaching method;the hours are consistent with the curriculum content,but different among countries;mainly by multidisciplinary team;a combination of quantitative and qualitative methods used for evaluation.3.The results of curriculum design of the end-of-life care education for medical undergraduates: Based on Taylor’s goal model,the curriculum standard of end-of-life care education for undergraduates in medical schools was designed,including curriculum nature,learning goals,teaching contents,teaching methods,teaching hours,teaching team and curriculum evaluation.The learning goals include three dimensions of cognition,emotion and motor skills,with a total of 17 items;the teaching contents cover three topics of theoretical knowledge of death and end-of-life care education,knowledge and technology of end-of-life care,and dying and death coping,with 8 chapters and 27 items.A variety of teaching methods was used.In total 24 class hours,including 10 for theory and 14 for practice.4.The results of the educational experiment of the end-of-life care education curriculum: The results showed that:(1)pre-test,there were no significant differences between the experimental group and the control group in the three dimensions of death related knowledge cognition,the attitude toward care of the dying and death coping competence(P >0.05).(2)post-test:(1)knowledge related to end-of-life care education,the scores of accuracy of most items in the experimental group post-test were significantly higher than pre-test(P <0.05),and the scores of accuracy of each item in the experimental group post-test were significantly higher than those in the control group(P < 0.05);(2)the attitude toward care of the dying,the scores of attitude towards care of dying patients in the experimental group preand post-test had no significant difference,and there was no significant difference between the experimental group and the control group in post-test(P > 0.05),but there were significant differences in the score of caring attitude towards the family members of patients before and after the curriculum in the experimental group(P < 0.05).(3)death coping competence,there was a significant difference in the score of death coping competence between the experimental group and the control group pre-and post-test(P < 0.05).The qualitative results of the research can be extracted 8 themes and 25 sub themes.(1)Individual harvest and change,including 4 themes and 11 sub themes,there are the deepening of death cognition,the change of death attitude,the improvement of death coping ability and extended thinking.(2)The evaluation and suggestions of the curriculum,including4 themes and 14 sub themes,there are the advantages of the curriculum,the shortcomings of the curriculum,the evaluation of self-expression,the suggestions of the curriculum.Conclusions1.The attitude of medical undergraduates towards end-of-life care education is generally positive,but affected by many factors.The curriculum should start from the lower grades and take into full consideration the background and experience of the students,be positioned as a general expansion course with the characteristics of medical colleges,2.There is a lack of systematic and standardized curriculum system for end-of-life care education in China.The curriculum should be in line with the national background and the learning characteristics of teaching objects,and pay attention to the practical application of experiential teaching methods,to promote the multi-dimensional curriculum evaluation.3.The curriculum of end-of-life care education has fully considered the national background of our country and the learning situation of the learning objects.It includes universal and professional end-of-life car education,emphasizes the teaching methods of combining theory with practice,the students’ active learning,and the application of experiential teaching.4.The "end-of-life care education" curriculum can change students’ death cognition,improve students’ coping with death competence,and promote students to establish a correct outlook on life and death,life attitude and professional attitude;the students have higher evaluation on the curriculum,the suggestion proposed by them may direct improvement and revision of the follow-up,and also provide a reference for the development and promotion in China.