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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


Nicola White

Linda JM Oostendorp

Christopher Tomlinson

Sarah Yardley

Federico Ricciardi

Hülya Gökalp

Ollie Minton

Jason W. Boland

Ben Clark

Priscilla Harries

Patrick Stone


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

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

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.

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)).

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).

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


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.

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
Keywords Medical education; Palliative care; Dying, Prognosis; Decision-making
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Copyright Statement
© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

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