Abstract
Abstract
Background:
Education for medical students is crucial to providing pediatric palliative care (PPC). However, few comprehensive curricula of PPC exist in Japan.
Objective:
This study aimed to identify and explore the need for education of, as well as the impact of that education on, medical students in Japan.
Participants:
The participants were 5th-year medical students (n = 30) who studied in our hospital from April 2009 to March 2010.
Design/Methods:
The first survey questionnaire was administered before, during, and after a small group lecture on PPC, followed by a discussion. The lecture discussed and imparted knowledge about general principles of PPC. The second survey questionnaire was administered in September 2010 to determine students understanding and attitudes about PPC.
Results:
In the first survey, none of the students reported any exposure to PPC through textbooks or lectures prior to the lecture. In addition, all of them defined PPC as pain management in end-of-life care for children with cancer. The survey also indicated that after the lecture, they understood the principles of PPC well. Although they scored low in their understanding of PPC in the second survey, their attitude toward the lecture was positive.
Discussions/Conclusions:
This study provided the first opportunity to effectively understand the effect of education on PPC in the short term. However, this effect was inadequate in the long term. Development of organized medical education systems with a primary focus on PPC is urgently needed. Discussion with professionals from multiple disciplines with regard to ethical, legal, and cultural issues, and social consensus are necessary to develop good educational systems.
Introduction
Overall Objectives
The objectives of this study were to identify and explore the need for, as well as the impact of, education about PPC on medical students through the lecture, and to identify and explore the challenges in the education of PPC in Japan through this educational experience.
Methods
The first survey questionnaire was administered before and after a small group lecture on PPC followed by a discussion. Participants were the 5th-year medical students (n = 30) who studied in our hospital from April 2009 to March 2010. The group lecture comprised one or two students and lasted for about 60 minutes. The lecture discussed and imparted knowledge about PPC (including the definition of PPC, pain management for children, the unique characteristics of PPC, and challenges for the future) using the resources from Western countries.1–9 The lecture included assessment of the following: students' previous exposure to PPC during their medical education and general lives before the lecture, their knowledge of PPC during the lecture, and their understanding of the principles of PPC after the lecture. Two objectives of the first survey were to identify and explore the need for, as well as the impact of, education about PPC through the assessment.
The second survey questionnaire was administered in September 2010 to the same participants about the definition of PPC as well as their attitude toward PPC. The objectives of the second survey set were to estimate their understanding of PPC 6 to 18 months after the lecture and to explore their perception of the lecture.
Results
First survey
All participants responded to all parts of the questionnaire. None of the students reported any exposure to PPC through textbooks, lectures, or general experience prior to the lecture. Only one student had an experience of a child with cancer at end-of-life care in his clinical practice. Before the lecture, all of them defined PPC as pain management in end-of-life care for children with cancer. Five students mentioned the necessity of solving psychological issues. None of them had learned about pain management for children. All of them understood the definition of PPC after the lecture, for example, eligible children, timing of the initiation, main content, and involving professionals. This lecture was the first chance for all of them to provide them with an opportunity to effectively understand PPC.
Second survey
Twenty medical students responded to the second questionnaire. The rates of correct answers about eligible children, timing of the initiation, main content, and involving professionals pertaining to PPC were 10%, 55%, 70%, and 60%, respectively. The number of students with perfect understanding about these four content points was only two. The results showed that 50% and 20% of them remembered the lecture as very useful and somehow useful, respectively. Ten students who remembered the lecture as very useful and somehow useful responded that the reasons were the uniqueness of PPC and no other opportunity of learning about PPC. Others responded that it was difficult to estimate if the lecture was useful or not.
Discussion
The necessity of undergraduate medical education pertaining palliative care has been understood for a couple of decades in Western countries. 10 Some educational programs pertaining to PPC have already developed in Western countries.11–15 Education pertaining to general principles of PPC is essential for all medical students.16,17 Educational programs pertaining to palliative care for adults have already developed in Japan. 18 An educational program for pediatricians developed in Japan in May 2010. 19 However, educational programs pertaining to PPC for medical students have not developed yet in Japan. This unique program was the first to provide them with an opportunity to effectively understand PPC.
The results of this study are representative of the lack of the opportunities pertaining to PPC during the current undergraduate medical education. A large misconception pertaining to the principle of PPC because of inadequate knowledge, as well as the difficulty of education through the conventional clinical practice because of the infrequency of child cases was discovered. However, all of the participants understood the principle of PPC after the lecture. This suggests the effectiveness of this approach to understanding PPC. The reason for this may be the participants' enthusiastic involvement in a small group, optimal amount of time, and optimal timing of this program.
However, many challenges remain. The content of the lecture was originally created by the lecturer using resources from Western countries.1–9 One reason is that Japanese society is in the development stage in palliative care for adults with medical consensus. 18 The crucial information pertaining to legal, ethical, and social issues of PPC does not exist in Japan. Another reason is that some parts of palliative care are impacted by cultural diversity,20,21 although some parts are universal or have similarities. 22 Therefore, discussion with multiprofessionals with regard to ethical, legal, and cultural issues, and social consensus is necessary to develop good educational systems. Moreover, the effect of this lecture was inadequate. Continued education is necessary. The contents and the measures should be stepped up to include techniques such as role-playing to develop students' communication skills and to provide the opportunity to enable them to share their clinical experiences, as needed.
Some limitations of this study exist, for example, small number of participants, only one institute, no randomized control study, and the qualitative and narrative nature of the study. Therefore, further study considering optimal participants, content about PPC, educational measures, and assessment measures is necessary.
Conclusion
This study provided the first opportunity to effectively understand the need for education about PPC in the short term for undergraduate 5th-year medical students. However, the effect of the education was inadequate. Development of medical education systems with a primary focus on PPC is urgently needed. Discussion with multiprofessionals with regard to ethical, legal, and cultural issues, and social consensus is necessary to develop good educational systems.
Footnotes
Author Disclosure Statement
No competing financial interests exist.