Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students

Abstract

Background:

To meet the complex needs of patients with serious illness, health professional students require education in basics aspects of palliative care, including how to work collaboratively on an interprofessional team.

Objectives:

An educational program was created, implemented, and evaluated with students in medicine, nursing, chaplaincy, and social work. Five learning objectives emphasized spiritual, cultural, and interprofessional aspects of palliative care.

Design:

The program blended two sequential components: an online interactive, case-based learning module, and a live, dynamic simulation workshop.

Measurements:

Content analysis was used to analyze students' free-text responses to four reflections in the online case, as well as open-ended questions on students' postworkshop questionnaires, which were also analyzed quantitatively.

Results:

Analysis of 217 students' free-text responses indicated that students of all professions recognized important issues beyond their own discipline, the roles of other professionals, and the value of team collaboration. Quantitative analysis of 309 questionnaires indicated that students of all professions perceived that the program met its five learning objectives (mean response values>4 on a 5-point Likert scale), and highly rated the program and its two components for both educational quality and usefulness for future professional work (mean response values approximately>4).

Conclusions:

This innovative interprofessional educational program combines online learning with live interactive simulation to teach professionally diverse students spiritual, cultural, and interprofessional aspects of palliative care. Despite the challenge of balanced professional representation, this innovative interprofessional educational program met its learning objectives, and may be transferable for use in other educational settings.

Introduction

Meeting the complex needs of patients with serious illness requires health professionals who are competent to address an array of care needs and to function effectively on an interprofessional team. The precepts of palliative care outline skills and strategies for comprehensive and collaborative interprofessional care for health professionals in various specialties who provide care for such patients. While inclusion of palliative care in undergraduate health professional curricula is recognized as important,^1–3 effective education in end-of-life and palliative care is lacking as evidenced by graduates who do not feel adequately prepared to care for patients near the end of life.^4–10 Notable is the cursory attention paid to the spiritual and cultural aspects of palliative care in medical and nursing curricula.^11–13 These domains naturally receive more attention in chaplaincy and social work training. Interprofessional collaboration is essential to develop high-quality, holistic, patient-centered care for patients with serious illness.¹⁴

Education of health professionals has historically taken place in professional silos with few opportunities for students to learn collaboratively how to work on an interprofessional team.^15,16 Three reported interprofessional palliative care educational efforts have included various combinations of medical, nursing, social work, clinical pastoral, physiotherapy, and occupational therapy students.^17–19 Methods used in the programs included student workshops with family care providers,¹⁷ reflections on caring for the dying depicted in literature,¹⁸ and interprofessional case simulations seminars.¹⁹ None of these programs utilized online learning methods or targeted the four core palliative care professions of medicine, nursing, pastoral care, and social work. In this article, we describe the development, implementation, and evaluation of an innovative program that blends online learning with interactive simulation to teach medical, nursing, divinity, and social work students spiritual, cultural and interprofessional aspects of palliative care.

Methods

Design and content of the program

The program was conceived after an evaluation of our medical curriculum revealed a lack of opportunities for interprofessional learning and deficits in spiritual and cultural aspects of palliative care. A group of committed faculty in medicine, nursing, chaplaincy, social work, and palliative care was established and collaborated on the creation of a new interprofessional educational program. The educational objectives were derived from faculty assessments of their respective curricula, with agreement that interprofessional collaboration would be emphasized in the program's structure and content. The five learning objectives of the program were:

1. To understand the basic precepts and goals of palliative care.

2. To recognize and address common misconceptions about opioids.

3. To identify spiritual and cultural needs of patients and understand how to meet these needs.

4. To understand the clinical features of imminent death and how to help the patient/family at that time.

5. To recognize the contributions of all health care professionals and understand the importance of the interdisciplinary team.

We felt that prior clinical exposure to patients with serious illness was necessary for students to appreciate the relevance of the material and to interact meaningfully with students from other professions. Therefore, we included medical students on the second month of medicine clerkship, advanced practice and registered nursing students with inpatient experience, divinity students on or having completed a clinical pastoral inpatient rotation, and social work trainees working toward completion of their master's degrees. The program was required of all medical students. In the second year of implementation, it became required of advanced nursing students in the adult and geriatric tracks, and remained optional for divinity and social work students.

The program has a blended design with two sequential components. The first component is an online interactive, multimedia case module, accessed through a Web-based platform (http://learn.yale.edu/im/palliative2/). An online approach was selected to meet the logistical needs of students with varied schedules²⁰ as well as to provide students with a common exposure to material before participating in a live workshop. The module, designed collaboratively by the interprofessional faculty, was piloted and honed before implementation.

The online case details the clinical course of a 68-year-old African American woman with end-stage metastatic breast cancer. The case explores clinical challenges in the physical and psychosocial domains with particular emphasis on the spiritual and cultural issues impacting the patient, her family, and her medical care. Educational issues in the module address all of the program learning objectives, including addressing the patient's spiritual needs in the context of her Pentecostal faith tradition; recognizing spiritual distress and the impact of her daughter's hope for a miracle on goals of care; and conducting a family meeting. Interactive features, such as rollover definitions and sidebar boxes explain potentially unfamiliar terminology and highlight key learning points. Links are provided to pertinent journal papers and to the Web-based End of Life/Palliative Education Resource Center (EPERC) Fast Facts.²¹ An embedded video created by the faculty and using professional actors depicts the interprofessional team addressing goals of care, symptom management, spiritual challenges, and family conflict with the patient and her family. Students typically complete the module in 30–45 minutes, often within 1 day, but up to several weeks, before participating in the second component of the program, the interprofessional workshop.

To promote engagement and interactivity, students enter free-text responses to four reflection questions during the module, which are forwarded to the faculty for review and were also used in our evaluation of the program. When the case patient is first admitted to the hospital, students respond to Reflection 1: Considering the intake information you have so far, from the point of view of your profession, list 3–5 issues you would want to address in the evaluation and care of this patient. With more details of the patient's clinical course, personal life, family relations, and religious beliefs, students respond to Reflection 2A: What are the spiritual and cultural challenges that arise in this case? And 2B: From your professional perspective, how would you take these into account when caring for Mrs. Green and her family? After viewing the family meeting video, comes Reflection 3 : What was accomplished by having an interdisciplinary family meeting that may not have been achieved otherwise? Finally, with the patient's terminal readmission and care at the time of death, the module ends with Reflection 4: What input from each team member did you notice to be beneficial in the care of this patient? Student responses to the reflections, as well as their age by decade, gender, and profession, were filed in an electronic database for analysis.

The second component of the program is the 90-minute interprofessional workshop, which is offered 6 times per academic year. The workshop utilizes small group, interactive, problem-based learning as important features in interprofessional education.^22–24 The workshop begins with faculty from each of the four professions commenting on the online case and their profession's approach to palliative patients. This discussion models interprofessional team interactions and reinforces the value of multiple perspectives. Students are then assigned to one of four small interprofessional groups comprised of six to eight students each along with a faculty facilitator and complete two tasks. First, each group discusses one of several palliative care challenges designed to highlight the value of input from each profession and collaborative discussion, e.g., “What are your own spiritual or cultural biases that you might bring to the care of dying patients? How have you, or would you respond to patients' request to pray with them?”

The second small group task is a 20-minute simulation of an interprofessional team meeting in which students assume the role of their profession to collaboratively develop a plan of care for a new palliative care case. The case describes a woman of Muslim faith with two young children and who has carcinomatosis with bowel obstruction. With complexity in multiple domains, the case prompts students to experience first-hand the value of interprofessional collaboration. Students develop plans to address cultural and spiritual issues, physical symptoms, psychosocial issues, and coordination of care. Participants then reconvene to the large group and each small group presents a summary of their discussions. Finally, students completed a written evaluation of the program. This study was approved by the Yale Human Investigation Committee.

Evaluation of the program

We conducted two evaluations: one of students' free-text responses on the online module to assess how students in different professions interacted with the educational material; and another of the post-workshop questionnaires to assess students' views on the program's quality and effectiveness at meeting the educational objectives. Student free-text responses from 10 cycles of the program (2009–2010) provided a substantial set of textual data for qualitative analysis. To maximize the number of questionnaire responses, we analyzed data from 14 cycles of the program (2009–2011). Social work students were excluded from both analyses due to low representation.

Analysis of free-text responses to online reflections

We used content analysis to analyze students' free-text responses to the online reflections. Content analysis uses a set of procedures to draw inferences from text.²⁵ Analysis began began with two team members reviewing all responses (M.E., medical; J.C., divinity) to obtain a general sense of the data. Coders' notes were compared to develop a basic coding scheme which was then used to create separate code keys for each profession. Creation of profession-specific code keys served to generate manageable data sets and to maintain nuances in students' professional language as a reflection of professional culture. Each code key was built with coders independently coding each free-text response, detailing established codes and creating new codes as indicated. Codes were discussed in session with a third team member (D.S.-G., gerontology-nursing) so that we could reach consensus on codes and their meanings. Development of the code key proceeded iteratively until all the data were coded. To facilitate comparisons across professions, we synthesized similar codes across professions in order to create common codes that could be applied across professions. For example, for the first reflection, the physician code, “religious expectations and concerns,” the nurse code, “spiritual needs and concerns” and the divinity code, “spiritual and existential angst” became the supercode “spiritual needs/concerns/challenges.” We calculated frequencies for each code within and across professions.

Analysis of postworkshop evaluations

We analyzed nine items on the postworkshop evaluation, to which students responded on a 5-point Likert scale (1=strongly disagree; 5=strongly agree). Five items concerned students' perspectives on the effectiveness of the program meeting its educational objectives. Four items addressed students' perceptions of the quality and value of the two components of the program. Descriptive analysis included frequencies and percentages of each level of agreement for each question in three groups of students: medical, nursing, and divinity. An overall composite score, which included unweighted scores from these nine items, was created and compared among three groups. At item level, the nonparametric Kruskal-Wallis test was implemented to detect differences among groups. Mann-Whitney U was conducted to identify the specific group of difference. Analyses were performed using SPSS/PASW 18, IBM Inc. (SPSS Inc., Chicago, IL).

We followed the same content analytic method to create a code key to analyze students' open-ended responses on the questionnaire; however, we pooled students' responses for analysis because not all provided comments and discerning professional differences was not a priority.

Results

Analysis of free-text responses

Among 211 students in the analysis of the case reflections, 146 were medical students (71 females, 75 males); 15 divinity students (11 females, 4 males), and 50 nursing students. Of the nursing students, 43 were advanced practice registered nurse students (39 females, 4 males) and 5 were registered nurse students (all female) Medical students (95% aged<30 years) were generally younger than nursing (73% aged<30 years) and divinity students (36% aged<30 years).

Table 1 illustrates student responses for the most frequent codes for each reflection. Table 2 shows the three most frequent codes for each reflection by student profession. As some participants did not respond to all of the reflections, data reflect the number of responses, not students.

Table 1.

Illustrative Student Responses to Online Case Reflections

Reflection #1 Considering the intake information you have so far, from the point of view of your profession, list 3–5 issues you would want to address in the evaluation and care of this patient?

“Discussing patient code status and goals of care at this point—Address presence of 9/10 baseline pain with two-pronged approach: radiation therapy for spinal mets+increased baseline pain medication dosage—Better bowel program to address constipation.” (Medical student)

“Linkages to her spiritual community and amount/kinds of support she gains from this; Her sense of what is happening to her health status; Her sense of God's action in her life at this time; and What emotional and spiritual challenges is she having the toughest time with?” (Divinity student)

Reflection #2A What are the spiritual and cultural challenges that arise in this case?

“Mrs. Green is a very spiritual person and stated she feels like she is giving up by not continuing to fight her cancer. She also revealed she feels like she is letting her daughter and God down. I would encourage her to discuss these feelings with her daughter and the chaplain. In addition, I would try to clarify her goals for treatment and the rest of her life.” (Nursing student)

Reflection #2B From your professional perspective, how would you take these into account when caring for Mrs. Green and her family?

“…A cultural challenge may be that Mrs. Green believes her role is to be the “strong” one for her family, not letting them know how she is feeling (physically, emotionally, and spiritually). This can create a sense of isolation for Mrs. Green as well as make it more difficult in discussing care options with the family. The disagreement over care between the son and daughter also present a challenge. In caring for the family, I would first (in my role as a chaplain) talk with the patient, providing an opportunity to talk about her faith, her struggles and allow her to process through some of the difficult questions her prognosis raises….” (Divinity student)

Reflection #3 What was accomplished by having an interdisciplinary family meeting that may not have been achieved otherwise?

“All family members able to get “on same page,” in terms of understanding and agreeing to what is best for Mrs. Green at this point in her illness. Mrs. Green was able to express her hopes in front of her children with the support of the interdisciplinary team. Children were able to hear and accept their mother's prognosis.” (Medical student)

“The patient was able to share her concerns and wishes with her children with the support of the interdisciplinary team. The patient's children were reassured that the team will do everything they can to keep the patient comfortable and to respect her wishes for a peaceful death.” (Nursing student)

Reflection #4 What input from each team member did you notice to be beneficial in the care of this patient?

“Mostly the chaplain's help who guided them through the final stages of death in a very spiritual yet human-to-human manner, with the final 5 messages they wanted to express to Mrs. Green.” (Medical student)

“Doctor: provided the medical treatment options, was clear about patient's prognosis, explained what was medically happening in very clear, but appropriate, terms -chaplain: tending to Mrs. Green's religious and spiritual needs, keeping her church/pastor” (nursing student)

“Health care workers helped the family to understand what was happening to [their] mother, to recognize the changes that are a normal part of the dying process. The social worker was helpful in offering assistance with hospice. The chaplain helped prompt family members to take advantage of the time remaining with their mother to complete any unfinished business and to acknowledge her significance in their lives.” (Divinity student)

Table 2.

Most Frequent Qualitative Codes by Student Profession for Online Case Reflections

Student profession	Most frequent codes	% (n/N)
	#1 Considering the intake information you have so far, from the point of view of your profession, list 3–5 issues you would want to address in the evaluation and care of this patient
Medical	1. Pain/pain management	75 (109/145)
	2. Spiritual needs/concerns/challenges	52 (75/145)
	3. Goals of care	49 (71/145)
Nursing	1. Pain/pain management	71 (37/52)
	2. Symptoms/symptom management	38 (20/52)
	3. Spiritual needs/concerns/challenges	38 (20/52)
Divinity	1. Spiritual needs/concerns/challenges	67 (8/12)
	2. Socialization/informal support	33 (4/12)
	3. Pain/pain management	33 (4/12)
	#2A: What are the spiritual and cultural challenges that arise in this case?
Medical	1. Spiritual/existential dissonance and its severity	56 (78/140)
	2. Tension in family over the relationship between spirituality and care	33 (46/140)
	3. Patient and family balancing hope for a miracle with reality	29 (41/140)
Nursing	1. Spiritual/existential dissonance and its severity	54 (27/50)
	2. Patient letting daughter/family/church down	44 (22/50)
	3. Tension in family over the relationship between spirituality and care	40 (20/50)
Divinity	1. Spiritual/existential dissonance and its severity	62 (8/13)
	2. Patient and family balancing hope for a miracle with reality	54 (5/13)
	3. Prolonging treatment/ End of Life care	54 (5/13)
	#2B: From your professional perspective, how would you take these into account when caring for Mrs. Green and her family?
Medical	1. Connect patient with chaplain and/or pastor for spiritual guidance	30 (42/140)
	2. Help daughter and family understand desires/needs of patient through meeting	18 (22/140)
	3. Encourage patient and family's spirituality through discussion	14 (19/140)
Nursing	1. Connect patient with chaplain and/or pastor for spiritual guidance	50 (25/50)
	2. Help daughter and family understand desires/needs of patient through meeting	46 (23/50)
	3. Arrive at common goals of care	18 (9/50)
Divinity	1. Become familiar with patient's faith tradition and its influence	46 (6/13)
	2. Encourage patient and family's spirituality through discussion	31 (4/13)
	3. Encourage patient to think differently about faith tradition	31 (4/13)
	#3: What was accomplished by having an interdisciplinary family meeting that may not have been achieved otherwise?
Medical	1. Concerns and expectations raised and addressed at once	53 (72/137)
	2. Patient is able to vocalize desires and receive positive responses	36 (49/137)
	3. Patient and family achieve consensus on goals of care	36 (49/137)
Nursing	1. Patient is able to vocalize desires and receive positive responses	58 (28/48)
	2. Concerns and expectations raised and addressed at once	46 (22/48)
	3. Family conflict addressed and resolved	33 (16/48)
Divinity	1. Facilitation of communication and information from attendance	50 (6/12)
	2. Patient is able to vocalize desires and receive positive responses	50 (6/12)
	3. Family refocuses on patient's perspectives/needs/wishes	42 (5/12)
	#4: What input from each team member did you notice to be beneficial in the care of this patient?
Medical	1. Chaplain: Helped address spiritual concerns/challenges and provided guidance	57 (61/107)
	2. Doctor: Clarified prognosis/diagnosis	43 (46/107)
	3. Nurse: Facilitated pain control/management	29 (31/107)
Nursing	1. Doctor: Clarified prognosis/diagnosis	59 (20/34)
	2. Chaplain: Helped address spiritual concerns/challenges	41 (14/34)
	3. Nurse: Educated patient and family on palliative care and facilitated transition	38 (13/34)
Divinity	1. Doctor: Clarified prognosis/diagnosis	75 (9/12)
	2. Nurse: Managed general and palliative care	58 (7/12)
	3. Chaplain: 3 codes “tied”: Helped address spiritual concerns/challenges; Helped patient/family prepare for the end; Helped facilitate discussions/connection between patient and family	33 (4/12)

Reflection 1, on the issue of evaluation of the patient, showed considerable overlap between professions in frequently mentioned patient care priorities, with variation in order by frequency (Table 2). Only medical students frequently mentioned goals of care and only divinity students frequently mentioned socialization/informal support. For Reflection 2A regarding the spiritual and cultural challenges, the most frequent response was the same for all groups (spiritual/existential dissonance and severity), but only medical and nursing students commonly mentioned tension in family over relationship between spirituality and care. In Reflection 2B regarding how to address these challenges, medical and nursing students commonly mentioned connecting the patient with chaplain for spiritual guidance and helping the family understand the desires/needs of the patient, while divinity students' frequent responses involved more specific spiritual attention and involvement. In Reflection 3, all professions listed the enhanced communication as the benefit of the family meeting, although what aspect of communication varied. Only medical students frequently mentioned ability to achieve consensus on goals of care as an accomplishment in the family meeting. In Reflection 4, there was commonality among professions as to the perceived benefit of interprofessional collaboration.

Postworkshop evaluations

Table 3 shows the analysis of 309 student responses (205 medical, 65 nursing, and 39 divinity) to the nine Likert-scale items on the postworkshop questionnaire. Mean responses to the five learning objectives in all student groups was greater than 4 on a scale of 1–5, with no statistically significant differences between professions (Table 3). Students in all groups rated the program highly for educational quality and usefulness for future professional work, with mean Likert ratings all about 4 or greater (Table 3, questions 6–9). Some differences were seen between professions. In response to question 6 concerning the quality of the online module, medical students had statistically significantly lower level of agreement rating (mean score=3.97) than divinity (mean score=4.47; p value 0.18) and nursing (mean score=4.36; p value<0.0001) students. On questions 7 and 8 concerning the learning value of the components of the program, medical students had statistically significantly lower rating level of agreement (mean=4.00) than nursing students (mean level of agreement=4.48, p value=<0.0001).On question 9, regarding the usefulness of the module for future work, medical and divinity students had statistically significantly lower level of agreement (both mean scores=4.13) than nursing students (mean score=4.50; p values=0.001 and 0.015, respectively).

Table 3.

Overall Comparison (Kruskal-Wallis) of Mean Likert Scores ^a Responses to Items on Postworkshop Questionnaire

Evaluation question	Student type	Total	Mean score	Mean rank	Kruskal Wallis p values
1. I have a greater understanding of the basic precepts and goals of palliative care.	Divinity	37	4.11	164.50	0.066
	Med	204	3.97	145.40
	Nursing	64	4.22	170.59
2. I recognize common misconceptions about opioids.	Divinity	36	4.14	154.78	0.737
	Med	205	4.07	150.60
	Nursing	64	4.19	159.69
3. I have a greater understanding of the role of culture in a patient's experience at the end of life.	Divinity	38	4.16	150.89	0.179
	Med	204	4.10	148.71
	Nursing	64	4.36	170.31
4. I have greater understanding of the importance of addressing the spiritual needs of patients with terminal illness.	Divinity	38	4.08	138.33	0.076
	Med	205	4.25	151.05
	Nursing	64	4.50	172.75
5. I have a greater understanding of the contributions of other health care professionals and the importance of the interdisciplinary team in the care of the dying patient.	Divinity	39	4.38	152.76	0.289
	Med	205	4.32	150.54
	Nursing	64	4.56	168.26
6. The online case and supporting materials were instructive, relevant, and challenging.	Divinity	37	4.36	175.13	0.000
	Med	205	3.97	140.81
	Nursing	64	4.47	185.77
7. The Interdisciplinary Workshop and discussion groups were valuable to my training.	Divinity	39	4.28	168.13	0.000
	Med	205	4.00	140.92
	Nursing	64	4.48	189.69
8. The combination online interactive case and the faculty led Interdisciplinary Discussion Groups facilitated learning.	Divinity	39	4.48	166.92	0.000
	Med	205	4.13	140.70
	Nursing	63	4.62	189.28
9. This activity developed important new knowledge and skills that will be essential to my future work in my discipline.	Divinity	39	4.13	144.42	0.003
	Med	205	4.13	145.56
	Nursing	63	4.50	184.82

Likert scale: 1 corresponds to strongly disagree and 5 corresponds to strongly agree.

In the qualitative analysis of open-ended comments, the code key consisted of five main codes: Logistics; Structure/Content–Positive; Structure/Content–Negative; Structure/Content–Neutral; and Suggestions. Positive comments included the quality of the material and inclusion of all professions. Negative comments included uneven student representation from all professions, more focus on practical matters, and redundancy in content. Logistical comments included the timing and duration of the workshop.

Discussion

To our knowledge, this is the first reported interprofessional palliative care education program that targets the four key professions of medicine, nursing, divinity, and social work. Interprofessional in its creation, content, and format, this initiative successfully engaged professionally diverse groups of students in collaborative palliative care learning. We believe that the focus on the often neglected spiritual and cultural aspects of palliative care highlighted the varied professional perspectives and enhanced the collaborative learning.

Content analysis of student online reflections suggests variance in how students of different professions respond to the educational material, which was often consistent with their professional perspectives. These differences enriched interactions and learning when students came together in the simulation workshop. Notably, our analysis showed that students of all professions recognized important issues beyond their own discipline, the roles of other professionals, and the value of team collaboration, indicating that the program met its objective of interprofessional collaborative learning.

Analysis of postworkshop evaluations suggests that students perceived that the program imparted important palliative care content to meet the educational learning objectives and that the blended design facilitated learning. While the differences were small, medical students' ratings were lower in several areas compared to other student groups. Although we have no data addressing the reasons for these differences, a possible explanation includes the focus on spiritual and cultural issues rather than the expected, traditional medical content or a less positive attitude toward interprofessional activities among medical students. While other aspects of palliative care are addressed elsewhere in the curriculum, we believe we believe education in the spiritual, cultural, and interprofessional aspects of palliative care is important for medical students.

A key innovation of this program is its blending of online learning with live interactive simulation. Strengths of online learning, including increased accessibility, control over content and pacing, and interactivity²⁰ facilitated meeting the needs of students with diverse educational and clinical experiences and schedules. Common exposure to the online material allowed students to gain familiarity with the subject and to formulate ideas at their own pace, readying them to interact in the workshop. The simulation workshop is experiential, dynamic, interactive and authentic, all features important for interprofessional learning.^26–28 The simulation workshop promotes students taking active roles and practicing skills in a safe environment.

A few limitations and directions for future work may be noted. Evaluation of the program's effectiveness was limited to students' self-reports. We did not assess higher level learning outcomes, such as acquisition of knowledge and skills or behavior change.²⁹ While general questionnaires for interprofessional learner outcomes are available,²⁹ an evaluative instrument that looks at interprofessional attitudes and skills specific to interprofessional palliative care education would be useful. We are exploring development of an observed structured clinical encounter as a means to evaluate educational outcomes. An additional limitation was that because the postworkshop questionnaire did not include demographics, we were unable to assess possible relationships between student features other than profession (e.g., gender) and responses.

We faced the challenge common to interprofessional initiatives of variable student representation. We are pursuing strategies to increase social work involvement and to include pharmacy and physician assistant students. We believe that the program or the online component alone is transferable to other educational setting for varied combinations of student groups. Resources required are relatively modest: the online module is open access; the live workshop requires multiprofessional faculty of 3–4 facilitators; and we estimate 15%–20% of an administrator's time to coordinate the program.

Conclusions

We created and implemented an interprofessional palliative care educational program for medical, nursing, divinity, and social work students. Our evaluation indicates that student participants meaningfully engaged with the material and perceived the program as effective. This program may prove useful for future efforts in interprofessional and palliative care education.

Footnotes

Acknowledgments

Supported by the State of Connecticut Department of Public Health and the Connecticut Cancer Partnership; Alexandra K. Munroe Fund.

We thank Susan Larkin, Rev. Peg Lewis M.Div., Dr. Ruth McCorkle, Professor of Nursing; Tracy Yale, M.A.; An T. Dinh for assistance with data analysis, and Yale students.

Author Disclosure Statement

No competing financial interests exist.

References

Liaison Committee on Medical Education: Functions, Structure of a Medical School. Standards for Accreditation of Medical Education Programs Leading to the M.D Degree. May 2011Versionwww.lcme.org/functions2011may.pdf. 2012 January 19.

Sullivan

, Warren

, Lakoma

, LIaw

, Hwang

, Block

. End-of-life care in the curriculum: A national study of medical education deans. Acad Med, 2004; 79:760–768.

American Association of Colleges of Nursing (AACN), 2005 American Association of Colleges of Nursing (AACN), Peaceful death. Recommended competencies, curricular guidelines for end-of-life nursing care (2005)Retrievedfromwww.aacn.nche.edu/education/deathfin.htm. 2012 January 19.

Fraser

, Kutner

, Pfeifer

. Senior medical students' perceptions of the adequacy of education on end-of-life issues. J Palliat Med, 2001; 4:337–343.

Billings

, Engelberg

, Curtis

, Block

, Sullivan

. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med, 2009; 13:319–326.

Robinson

. End-of-life education in undergraduate nursing curricula. Dimens Crit Care Nurs, 2004; 23:89–92.

Williams

, Cobb

, Shiels

, Taylor

. How well trained are clergy in care of the dying patient and bereavement support? J Pain Symptom Manage, 2006; 32:44–51.

Christ

, Sormanti

. Advancing social work practice in end-of-life care. Soc Work Health Care, 1999; 30:81–99.

Gwyther

, Altilio

, Blacker

, Christ

et al. Social work competencies in palliative and end of life care. J Soc Work Palliat Care, 2005; 1:87–120.

10.

Schulman-Green

, Ercolano

, LaCoursiere

, Ma

, Lazenby

, McCorkle

. Developing and testing a web-based survey to assess educational needs of palliative and end-of-life health care professionals in Connecticut. Am J Hosp Palliat Med, 2011; 28:219–229.

11.

Narayanasamy

. The impact of empirical studies of spirituality and culture on nurse education. J Clin Nurs, 2006; 15:840–851.

12.

Meyer

. How effectively are nurse educators preparing students to provide spiritual care? Nurse Educ, 2003; 28:185–190.

13.

Puchalski

. Spirituality and medicine: Curricula in medical education. J Cancer Educ, 2006; 21:14–18.

14.

National Consensus Project for Quality Palliative Care. www.nationalconsensusproject.org/Guidelines_Download2.aspx. 2012 January 19.

15.

Greiner

, Knebel

. Health Professions Education: A Bridge to Quality. Institute of Medicine Report. Washington, D.C.: National Academies Press, 2003.

16.

Interprofessional Education Collaborative Expert Panel: Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington D.C.: Interprofessional Education Collaborative, 2011.

17.

Wee

, Hillier

, Coles

, Mountford

, Sheldon

, Turner

. Palliative care: As suitable setting for undergraduate interprofessional education. Palliat Med, 2001; 15:487–492.

18.

Brajtman

, Hall

, Barnes

. Enhancing interprofessional education in end-of-life care: An interdisciplinary exploration of death and dying in literature. J Palliat Care, 2009; 25:125–131.

19.

Forrest

, Derrick

. Interdisciplinary education in end-of-life care: Creating new opportunities for social work, nursing, and clinical pastoral education students. J Soc Work End-of-Life Palliat Care, 2010; 6:91–116.

20.

Ruiz

, Mintzer

, Leipzig

. The impact of e-learning in medical education. Acad Med, 2006; 81:207–212.

21.

End of Life/Palliative Education Resource Center. http://www.eperc.mcw.edu/EPERC. 2012 January 19.

22.

Solomon

, Baptiste

, Hall

, Luke

, Orchard

, Rukholm

, Carter

, King

, Damiani-Taraba

. Student's perceptions of interprofessional learning modules. Med Teach, 2010; 32:e391–e398.

23.

Thompson

. Do interprofessional education and problem-based learning work together? Clin Teach, 2010; 7:197–201.

24.

Curran

, Sharpe

, Forristall

, Flynn

. Student satisfaction and perceptions of small group process in case-based interprofessional learning. Med Teach, 2008; 30:431–433.

25.

Neuendorf

. 2002. The Content Analysis Guidebook. Thousand Oaks, CA: Sage Publications.

26.

D'Eon

. A blueprint for interprofessional learning. J Interprof Care, 2005; 19,Suppl 1:49–59.

27.

Hammick

, Freeth

, Koppel

, Reeves

, Barr

. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach, 2007; 29:735–751.

28.

Van

Soeren M

, Devlin-Cop

, Macmillan

, Baker

et al. Simulated interprofessional education: An analysis of teaching and learning processes. J Interprof Care., 2011; 25:434–440.

29.

Gillan

, Lovrics

, Halpern

, Wiljer

, Harnett

. The evaluation of learner outcomes in interprofessional continuing education: A literature review and an analysis of survey instruments. Med Teach, 2011; 33:e461–e470.