An Authentic Learning Experience for Medical Students on Conducting a Family Meeting.

Mariana Khawand-Azoulai, Elisse Kavensky, Julia Sanchez, Ileana M Leyva, Corinne Ferrari, Marcio Soares, Khin M Zaw, Maria H van Zuilen
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Abstract

Background: Medical schools often lack training for serious illness conversations with patients and caregivers. We developed a curriculum in our elective Transitioning to Residency medical student course, focused on end-of-life discussions. This paper provides an overview of the curriculum and outcomes from an advanced preparation assignment and student evaluations.

Methods: The curriculum included a "hands-on" skills session delivered via Zoom. Small groups of students (3-4) assumed roles on an interprofessional team (Intensivist, cardiologist, nurse, social worker). They met with two adult children, played by palliative/geriatric clinical staff, of a 79-year-old patient with a complex cardiac history and on ventilator support to address: (1) the patient's status, (2) goals of care, and (3) withdrawal of ventilator support. Using a flipped classroom format, students reviewed the case, role assignments, a family meeting webinar, and other materials in advance. They completed a survey reflecting on the upcoming family meeting. Afterwards, students evaluated the session.

Results: Eighty students (19.6%) participated in 2021 and 2022. The reflection survey shows students agreed the patient's prognosis was poor and decision-making should be shared. They anticipated difficulty accepting prognosis, discordance between family members and/or the team, and challenging emotions. Results show a difference between the anticipated roles of the assigned physicians compared to the other disciplines. Post-session evaluations ranged from 4.7 to 4.9/5 (1 = strongly disagree, 5 = strongly agree).

Conclusion: The pre-session reflection helped students prepare for their roles. The training was well received, and we hope it prepares students to take on serious illness discussions during residency.

医学生开展家庭会议的真实学习体验。
背景:医学院通常缺乏与病人和护理人员进行重病谈话的培训。我们在医学生过渡到住院医生的选修课程中开发了一门课程,重点是生命末期的讨论。本文概述了该课程以及高级准备作业和学生评估的结果:该课程包括通过 Zoom 提供的 "实践 "技能课程。小组学生(3-4 人)扮演一个跨专业团队(重症监护医生、心脏病专家、护士、社会工作者)的角色。他们与一名有复杂心脏病史并使用呼吸机支持的 79 岁患者的两名成年子女会面,由姑息治疗/老年病临床工作人员扮演,以解决以下问题:(1) 病人的状况,(2) 护理目标,(3) 呼吸机支持的撤销。学生们采用翻转课堂的形式,提前复习了病例、角色分配、家庭会议网络研讨会和其他材料。他们完成了一项调查,对即将举行的家庭会议进行了反思。之后,学生们对课程进行了评估:2021年和2022年共有80名学生(19.6%)参加了此次活动。反思调查显示,学生们同意患者预后不佳,应共同做出决策。他们预计接受预后会有困难,家庭成员和/或团队之间会出现分歧,并且会出现具有挑战性的情绪。结果显示,与其他学科相比,指定医生的预期角色有所不同。会后评价从 4.7 到 4.9/5 不等(1 = 非常不同意,5 = 非常同意):会前反思有助于学生为自己的角色做好准备。培训受到好评,我们希望它能帮助学生为在住院医生实习期间进行重病讨论做好准备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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