Using a Pocket Card to Improve End-of-life Care on Internal Medicine Clinical Teaching Units: A Cluster-randomized Controlled Trial

Mıkhael, Joseph; Baker, Lindsay; Downar, James

doi:10.1007/s11606-008-0582-4

Cited by 32 publications

(58 citation statements)

References 21 publications

(29 reference statements)

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“…Pocket cards appeared to be a popular method of learning and reinforcing the practice change. This is consistent with previous literature demonstrating the effectiveness of pocket cards as part of educational strategies for implementation of new clinical practices and to improve health care provider knowledge (Blanco et al 2005;Richardson et al 2006;Mikhael et al 2008). Pocket cards are inexpensive, easily implemented and readily available educational tools.…”

Section: Discussionsupporting

confidence: 90%

Clinicians prefer simple educational tools for implementing practice change

Jefferies

Shah

2011

Medical Teacher

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Background: Successful implementation of practice change requires educational tools that engage and motivate clinicians. Aim: To examine clinician usage and preference for different educational tools when a multifaceted strategy was used for implementation of new recommendations for managing newborns at risk of sepsis. Methods: Seminars, web-based tutorial, handouts, pocket cards and web-based management algorithm were used to educate health professionals. Ninety-two clinicians attended seminars and completed feedback questionnaires that included three questions assessing knowledge of the recommendations. After 3 months, an electronic survey containing the same questions was sent to 41 key stakeholders (staff neonatologists, trainee physicians, nurse practitioners and respiratory therapists) who provided patient care during the implementation period. Compliance with recommendations was assessed by chart audit. Results: Seminar content was helpful to 97% of participants and 88% were comfortable using the recommendations. Response rate for the 3-month survey was 80%. The most frequently used and useful tools were pocket cards (76%) and seminars (76%); 79% continued to use the card. Only one respondent used the web tutorial and four used the algorithm. There was no significant difference in percent correct responses to the questions between the two timepoints ( p 4 0.05). Compliance with the recommendations was 83%. Conclusions: When provided with different educational tools, clinicians prefer pocket cards and seminars -tools that are simple and readily accessed.

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Section: Discussionsupporting

confidence: 90%

Clinicians prefer simple educational tools for implementing practice change

Jefferies

Shah

2011

Medical Teacher

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“…Once qualified, participants recalled learning most from ‘just doing their job’, which is consistent with findings in studies conducted outside the UK 24–26 . However, as FY1 doctors were left alone to care for dying patients, it was difficult for them to know what they needed to do.…”

Section: Discussionsupporting

confidence: 72%

Why are newly qualified doctors unprepared to care for patients at the end of life?

2011

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Undergraduate medical education is currently failing to prepare junior doctors for their role in caring for dying patients by omitting to provide meaningful contact with these patients during medical school. This lack of exposure prevents trainee doctors from realising their own learning needs, which only become evident when they step onto the wards as doctors and are expected to care for these patients. Newly qualified doctors perceive that they receive little formal teaching about palliative or end-of-life care in their new role and the culture within the hospital setting does not encourage learning about this subject. They also report that they learn from 'trial and error' while 'doing the job', but that their skills and knowledge are limited and they therefore seek advice from those outside their usual medical team, mainly from nursing staff and members of palliative care teams.

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“…26 We and others have shown that even a simple pocket reference tool can be effective for improving symptom control knowledge and comfort levels among S-58 DOWNAR trainees. 27,28 In most cases, there is no evidence to indicate whether these interventions impact patient care.…”

Section: Methods and Scopementioning

confidence: 99%

Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care

Downar

2018

Journal of Palliative Medicine

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This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the ''hidden curriculum'' in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.

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Using a Pocket Card to Improve End-of-life Care on Internal Medicine Clinical Teaching Units: A Cluster-randomized Controlled Trial

Cited by 32 publications

References 21 publications

Clinicians prefer simple educational tools for implementing practice change

Clinicians prefer simple educational tools for implementing practice change

Why are newly qualified doctors unprepared to care for patients at the end of life?

Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care

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