Online training improves medical students’ ability to recognise when a person is dying: The ORaClES randomised controlled trial

White, Nicola; Oostendorp, Linda JM; Tomlinson, Christopher; Yardley, Sarah; Ricciardi, Federico; Gökalp, Hülya; Minton, Ollie; Boland, Jason W.; Clark, Ben; Harries, Priscilla; Stone, Patrick

Abstract

Background:
Recognising dying is a key clinical skill for doctors, yet there is little training.

Aim:
To assess the effectiveness of an online training resource designed to enhance medical students’ ability to recognise dying.

Design:
Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors’ weightings of various signs/symptoms to recognise dying. The control group received no training.

Setting/participants:
Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival – 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants’ and the experts’ scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran–Weiss–Shanteau (CWS)).

Results:
Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (δMAD = −3.43, 95% CI −0.11 to −0.34, p = < 0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (δMAD = 1.50, 95% CI −0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01).

Conclusion:
The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.

Citation

White, N., Oostendorp, L. J., Tomlinson, C., Yardley, S., Ricciardi, F., Gökalp, H., …Stone, P. (2020). Online training improves medical students’ ability to recognise when a person is dying: The ORaClES randomised controlled trial. Palliative medicine, 34(1), 134-144. https://doi.org/10.1177/0269216319880767

• Journal Article Type: Article
• Acceptance Date: Sep 23, 2019
• Online Publication Date: Nov 14, 2019
• Publication Date: Jan 1, 2020
• Deposit Date: Jan 31, 2020
• Publicly Available Date: Feb 3, 2020
• Journal: Palliative Medicine
• Print ISSN: 0269-2163
• Electronic ISSN: 1477-030X
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 34
• Issue: 1
• Pages: 134-144
• DOI: https://doi.org/10.1177/0269216319880767
• Keywords: Medical education; Palliative care; Dying, Prognosis; Decision-making
• Public URL: https://hull-repository.worktribe.com/output/3170619