“…For example, Tsai, et al were able to implement a four-hour curriculum including a lecture, a hospice patient visit, communication skills practice, and group discussion with students in attendance from three local medical schools. 52 Because trainees' self-assessments of their skills may not predict the patient's assessment of the interaction, it is important that educators measure behavioral and patient outcomes, rather than relying solely on student assessments to demonstrate the effectiveness of a curriculum. However, in our sample the vast majority of studies (35 out of 39, 90%) measured outcomes either at the level of satisfaction, perceptions, and attitudes (usually measured by self-assessment on a Likert scale) or at the level of knowledge acquisition (usually measured by multiple-choice examination).…”