Planning an End of Life Education Program

The first step in the design of any educational intervention is to conduct a needs assessment, to understand the gap between what is being taught and evaluated and the ideal. A

variety of multidimensional palliative care needs assessments have been reported for different populations of learners.

Once the needs assessment has defined important domains for focused education, specific learning objectives can be developed. Objectives communicate to the learner what is expected of the educational encounter and form the basis for evaluating the impact of training. Learning objectives are broadly defined as those directed at attitudes, knowledge or skills. Given the pervasive and often negative attitudes, which shape caring for the dying, it is advisable to include a mixture of attitude, knowledge, and skill objectives in all training experiences. Thus, it is also desirable to include a mixture of teaching methods in each educational exercise. Addressing attitudes tends to be the most challenging feature of end-of-life education. It is a truism of medical education that attitudes can not be taught. Rather, a shift in attitudes requires the learner to feel safe and respected enough to give up one attitude (e.g. I am afraid to use opioids for fear of causing addiction) for another (e.g. opioids rarely lead to addiction, they are safe and improve quality of life). Providing information to address knowledge objectives can be done via lectures, self-study guides, journal articles, videotapes and audiotapes. Teaching directed at skill objectives requires the learner to practice and demonstrate a defined skill such as patient counseling, calculating equianalgesic doses or pronouncing death.

As with teaching methods, different assessment methods work best when appropriately matched to the learning objective. Attitudes are best assessed through personal interactions, directed questioning and surveys. Knowledge can be assessed via oral or written examinations and skills through direct observation, feedback from patients, or written problem solving (e.g. calculating opioid equianalgesic doses).

Awareness of adult learning principles is essential when developing an end-of-life educational encounter. These include keeping the experience learner-centered, with relevant information keyed to the learners need to know, and understanding that adult learners make choices about their participation (e.g. they leave the room if the information is not relevant to their needs).

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