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Implementation of palliative care as a mandatory cross-disciplinary subject (QB13) at the Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany Translated title: Implementierung der Lehre im Querschnittsbereich Palliativmedizin (QB13) an der Medizinischen Fakultät der Heinrich-Heine-Universität Düsseldorf

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      Abstract

      Background: By means of the revision of the Medical Licensure Act for Physicians (ÄAppO) in 2009, undergraduate palliative care education (UPCE) was incorporated as a mandatory cross sectional examination subject (QB13) in medical education in Germany. Its implementation still constitutes a major challenge for German medical faculties. There is a discrepancy between limited university resources and limited patient availabilities and high numbers of medical students. Apart from teaching theoretical knowledge and skills, palliative care education is faced with the particular challenge of imparting a professional and adequate attitude towards incurably ill and dying patients and their relatives.

      Project description: Against this background, an evidence-based longitudinal UPCE curriculum was systematically developed following Kern’s Cycle [ 1] and partly implemented and evaluated by the students participating in the pilot project. Innovative teaching methods (virtual standardised/simulated patient contacts, e-learning courses, interdisciplinary and interprofessional collaborative teaching, and group sessions for reflective self-development) aim at teaching palliative care-related core competencies within the clinical context and on an interdisciplinary and interprofessional basis.

      Results: After almost five years of development and evaluation, the UPCE curriculum comprises 60 teaching units and is being fully implemented and taught for the first time in the winter semester 2014/15. The previous pilot phases were successfully concluded. To date, the pilot phases (n=26), the subproject “E-learning in palliative care” (n=518) and the blended-learning elective course “Communication with dying patients” (n=12) have been successfully evaluated.

      Conclusion: All conducted development steps and all developed programmes are available for other palliative care educators (Open Access). The integrated teaching formats and methods (video, e-learning module, interprofessional education, group sessions for reflexive self-development) and their evaluations are intended to make a contribution to an evidence-based development of palliative care curricula in Germany.

      Zusammenfassung

      Einleitung: Im Rahmen der Novellierung der Ärztlichen Approbationsordnung (ÄAppO) im Jahr 2009 fand die Palliativmedizin als 13. Querschnittsbereich (QB 13) Eingang in die ärztliche Ausbildung als Pflichtlehr- und Prüfungsfach. Die Implementierung des neuen QB stellt nach wie vor Medizinische Fakultäten vor große Herausforderungen. Geringe Lehrressourcen und nur geringe Zahlen von Patienten stehen einer hohen Anzahl von Studierenden gegenüber. Neben der Vermittlung von Wissen und Fertigkeiten liegt in der Lehre der Palliativmedizin auch eine besondere Herausforderung in der Vermittlung einer ärztlichen Haltung gegenüber unheilbar erkrankten und sterbenden Menschen und deren Angehörigen.

      Projektbeschreibung: Vor diesem Hintergrund wurde an der Medizinischen Fakultät der Heinrich-Heine-Universität und dem Universitätsklinikum Düsseldorf ein evidenzbasiertes longitudinales Curriculum systematisch nach dem Kern-Zyklus [ 1] entwickelt und teilweise bereits implementiert sowie durch die Studierenden im Pilotprojekt evaluiert. Innovative Lehrmethoden (Virtuelle Schauspielpatienten, eLearning-Kurse, interprofessionelle Lehre und reflexive Selbstentwicklungsgruppe) wurden mit dem Ziel eingesetzt, palliativmedizinische Kernkompetenzen interdisziplinär und interprofessionell im klinischen Kontext zu vermitteln.

      Ergebnisse: Das gesamte in diesem Prozess entwickelte Curriculum Palliativmedizin (60 UE) wird nach einer nahezu 5-jährigen Entwicklungsphase ab dem Wintersemester 2014/2015 erstmalig in vollem Umfang durchgeführt. Die vorangestellten Pilotphasen wurden erfolgreich abgeschlossen. Bisher liegen Evaluationsergebnisse der Pilotierungsphasen (n=26), des Teilprojektes eLearning in der Palliativmedizin (n=518) und dem Blended-Learning Wahlpflichtfach „Kommunikation mit Sterbenden“ (n=12) vor.

      Schlussfolgerung: Alle durchgeführten Schritte und entwickelten Programme stehen anderen Fakultäten zur Umsetzung frei zugänglich zur Verfügung (Open Access-Verfahren). Die eingesetzten Lehrkomponenten (Spielfilm, eLearning-Module, interprofessionelle Lehre, reflexive Selbstentwicklungsgruppe) und deren Evaluation sollen einen Beitrag zur evidenzbasierten Entwicklung palliativmedizinischer Curricula in Deutschland leisten.

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      The impact of E-learning in medical education.

      The authors provide an introduction to e-learning and its role in medical education by outlining key terms, the components of e-learning, the evidence for its effectiveness, faculty development needs for implementation, evaluation strategies for e-learning and its technology, and how e-learning might be considered evidence of academic scholarship. E-learning is the use of Internet technologies to enhance knowledge and performance. E-learning technologies offer learners control over content, learning sequence, pace of learning, time, and often media, allowing them to tailor their experiences to meet their personal learning objectives. In diverse medical education contexts, e-learning appears to be at least as effective as traditional instructor-led methods such as lectures. Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part of a blended-learning strategy. A developing infrastructure to support e-learning within medical education includes repositories, or digital libraries, to manage access to e-learning materials, consensus on technical standardization, and methods for peer review of these resources. E-learning presents numerous research opportunities for faculty, along with continuing challenges for documenting scholarship. Innovations in e-learning technologies point toward a revolution in education, allowing learning to be individualized (adaptive learning), enhancing learners' interactions with others (collaborative learning), and transforming the role of the teacher. The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency.
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        Evaluating an evidence-based curriculum in undergraduate palliative care education: piloting a phase II exploratory trial for a complex intervention

        Background By 2013 Palliative Care will become a mandatory examination subject in the medical curriculum in Germany. There is a pressing need for effective and well-designed curricula and assessment methods. Debates are on going as how Undergraduate Palliative Care Education (UPCE) should be taught and how knowledge and skills should be assessed. It is evident by this time that the development process of early curricula in the US and UK has led to a plethora of diverse curricula which seem to be partly ineffective in improving the care for the seriously ill and dying offered by newly qualified doctors, as is demonstrated in controlled evaluations. The goals of this study were to demonstrate an evidence-based approach towards developing UPCE curricula and investigate the change in medical students’ self-perceived readiness to deal with palliative care patients and their families. Methods To evaluate the effects of the UPCE curriculum we chose a prospective, controlled, quasi-experimental, pre, retrospective-pre, post study design. A total of n = 37 3rd and 4th –year medical students were assigned to the intervention group (n = 15; 4th -year) and to the control group (n = 22; 3rd-year). Resting on the self-efficacy concept of Bandura the measurement was conducted by a refined test-battery based on two independent measurements (the revised Collet-Lester-Fear-of-Death-Scale and the instrument of the “Program in Palliative Care Education and Practice” at Harvard Medical School) including 68 items altogether in a five-point Likert-scale. These items were designed to test elementary skills in caring for the dying and their relatives as perceived by medical undergraduates. Datasets from both groups were analysed by paired and independent two-sample t-test. The TREND statement for reporting non-randomized evaluations was applied for reporting on this quasi-experimental study. Results Three constructs showed statistically significant differences comparing the intervention group before and after. Willingness to accompany a dying patient increased from 21.40 to 37.30 (p < .001). Self-estimation of competence in communication with dying patients and their relatives increased from 12.00 to 23.60 (p = .001). Finally, self-estimation of knowledge and skills in Palliative Care increased from 8.30 to 13.20 (p = .001). Conclusions This study is a small but systematic step towards rigorous curricular development in palliative care. Our manualised curriculum is available for scrutiny and scientific feedback to support an open and constructive process of best-practice comparison in palliative care.
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          The use of elearning in medical education: a review of the current situation.

          Computers are increasingly used in medical education. Electronic learning (elearning) is moving from textbooks in electronic format (that are increasingly enhanced by the use of multimedia adjuncts) to a truly interactive medium that can be delivered to meet the educational needs of students and postgraduate learners. Computer technology can present reliable, reusable content in a format that is convenient to the learner. It can be used to transcend geographical boundaries and time zones. It is a valuable tool to add to the medical teacher's toolkit, but like all tools it must be used appropriately. This article endeavours to review the current "state of the art2 in use of elearning and its role in medical education alongside non-electronic methods-a combination that is currently referred to as "blended" learning.
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            Author and article information

            Affiliations
            [1 ]Heinrich-Heine-University, Medical Faculty, Interdisciplinary Centre for Palliative Medicine, Düsseldorf, Germany
            [2 ]Department of Psychiatry, Harvard Medical School and Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, USA
            [3 ]University Hospital Düsseldorf, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Düsseldorf, Germany
            [4 ]University Hospital Düsseldorf, Institute of General Medicine, Düsseldorf, Germany
            [5 ]University Hospital Dusseldorf, Institute of Transplantation Diagnostics and Cell Therapeutics and Clinical Ethics Committee, Düsseldorf, Germany
            [6 ]University Hospital Düsseldorf, Roman Catholic Healthcare Chaplaincy, Düsseldorf, Germany
            [7 ]University Hospital Düsseldorf, Protestant Healthcare Chaplaincy, Düsseldorf, Germany
            [8 ]Heinrich-Heine-University, Medical Faculty, Deanery of Student Affairs, Düsseldorf, Germany
            [9 ]Heinrich-Heine-University, Medical Faculty, Institute of Forensic Medicine, Düsseldorf, Germany
            [10 ]University Hospital Düsseldorf, Centre for Education and Professional Development in Healthcare, Düsseldorf, Germany
            [11 ]Heinrich-Heine-University, Medical Faculty, Clinic of Anaesthesiology, Düsseldorf, Germany
            Author notes
            *To whom correspondence should be addressed: André Karger, University Hospital Düsseldorf, Clinical Institute of Psychosomatic Medicine and Psychotherapy, Moorenstraße 5, D-40225 Düsseldorf, Germany, E-mail: andre.karger@ 123456med.uni-duesseldorf.de
            Journal
            GMS Z Med Ausbild
            GMS Z Med Ausbild
            GMS Z Med Ausbild
            GMS Zeitschrift für Medizinische Ausbildung
            German Medical Science GMS Publishing House
            1860-7446
            1860-3572
            11 February 2015
            2015
            : 32
            : 1
            4330636
            zma000948
            10.3205/zma000948
            Doc6 urn:nbn:de:0183-zma0009488
            Copyright © 2015 Schulz et al.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.

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