The impact of a hybrid online and classroom-based course on palliative care competencies of family medicine residents

Abstract

The University of Calgary offers a palliative care course that involves both classroom- and web-based learning for rural-based family medicine residents. This study assessed the impact of the course on palliative care-related competencies for two classes: 2004 and 2005. Instruments were developed to evaluate pre- versus post-course changes in knowledge (15-item quiz), attitudes (12-item survey), self-perceived comfort levels (19-item survey) and skills (3 long Objective Structured Clinical Examination stations (OSCEs), with accompanying standardised score sheets). In all, 16 and 20 residents participated in the 2004 and 2005 classes, respectively. Internal reliability values were acceptable to very good (Knowledge Quiz, Kuder-Richardson 20 = 0.5; Attitude Scale, alpha = 0.68-0.78; OSCE score sheets, alpha = 0.63-0.89; Self-Perceived Comfort Survey, alpha = 0.89-0.92). Inter-rater reliability values of the OSCE score sheets were alpha = 0.87 to 0.92. There was a significant improvement in the pre- versus post-course performances in OSCE 2 for 2004 and 2005 (P = 0.01; P = 0.01; d = 1.42 and 1.94, respectively). Despite statistically insignificant changes in the other OSCEs, acceptable to large effect sizes were noted (d = 0.4-1.34) for OSCE 1 in 2004 and OSCEs 3 in 2004 and 2005. Knowledge improved significantly pre-versus post-course in 2004 and 2005 (t = 4.44 and 8.99; d = 2.29 and 2.24, respectively). Significant improvements and large effect sizes were noted in the comfort scales, but a ceiling effect was noted in the communication subscale. This hybrid course resulted in significant improvements across four domains, knowledge, attitudes, self-perceived comfort scale, and skills, in 2 consecutive classes.

Addressing the systems-based practice requirement with health policy content and educational technology

“…As demonstrated in previous studies (Kerfoot et al 2007;Cook et al 2008;Pereira et al 2008), the web/podcast participants were as successful on their post-test as those participating in the live lecture (although it is not known how those who did not complete the post-test would have performed, as mentioned in the ''Study limitations'' section). The participants in this study are part of generation ''y'' and ''x'' (Sandars & Morrison 2007).…”

Validación de dos herramientas para la evaluación de cambios en las actitudes de alumnos en situaciones frecuentes en cuidado paliativo

“…Dicho instrumento fue elaborado a partir del PallCare Comfort Scale desarrollado por Pereira et al (9) . Para la determinación de los ítems se eligieron actividades que correspondieran con las específicas y más frecuentes del abordaje de aspectos psicosociales y que se trabajarían a lo largo del curso.…”

“…De manera similar, las personas que se sientan cómodas con la realización de una tarea tenderán a hacerla de forma más frecuente. La escala de confort desarrollada por Pereira et al (9) cuenta con adecuada consistencia interna (Alfa de Cronbach 0,78) (ver la escala en el apéndice 1). (10) .…”

“…La escala de confort desarrollada por Pereira et al (9) mostró adecuada consistencia interna. En el estudio se encontró que los niveles de confort incrementaban de forma significativa después de un curso de cuidados paliativos hibrido (con componente presencial y online) dirigido a residentes en medicina interna.…”

“…Puntualmente, los hallazgos indican que cursos dirigidos a incrementar conocimientos y habilidades en el manejo de pacientes en estado terminal puede tener un impacto importante en las actitudes ante los cuidados paliativos y la muerte (9,16,17). De hecho, Kaye y Loscalzo (17) encontraron que un curso orientado a la educación sobre la muerte en estudiantes de medicina mostró diferencias pre y post-curso con respecto a las actitudes en torno a la atención de pacientes moribundos, aunque no se encontraron diferencias significativas respecto al miedo a la muerte.…”