Analysis of Student Reflections on "What Matters Most" to Palliative Care Patients: A Narrative Medicine Exercise.

Background: Effective communication with ill patients requires practice, yet, the traditional history overlooks patients' personal stories. This information is vital to determining goals of care and facilitates partnership by building trust. Objective: We implemented a narrative medicine exercise for students during their palliative medicine rotation to highlight humanism. Impact was determined through thematic analysis of students' reflections. Design: Students elicited "what matters most" to patients, transcribing this plus a personal reflection. Using an inductive and iterative approach, 100 reflections were analyzed, developing codes then broader themes. Results: Four main themes (Getting to know the patient, Student Reaction, Building-blocks of patient-physician relationship, Student Personal Insights) were identified, with 15 subthemes. Conclusion: The power of uncovering patients' backgrounds and values was demonstrated, reinforcing a palliative medicine approach. Analysis showed a positive impact and the possibility of change to future practice. The intervention was feasible, well received, and encouraged reflection on the physician-patient relationship beyond the medical domain.

Implementation of a Competency-based Pressure Ulcer Curriculum for Medical Students: Outcomes from an Educational Intervention Study.

A paucity of research exists on medical student pressure ulcer education. PURPOSE: This study examines medical student competency outcomes following implementation of a competency-based curriculum that included a pressure ulcer component in its educational intervention. METHODS: Over a 5-year period, 645 medical students completed the curriculum, which included a preceptor-led didactic session, online study resources, clinical experiences, and a brief online competency assessment. The assessment involved knowledge of risk factors, wound staging/classification, and prevention and management strategies and included short answer and extended matching questions. A performance standard was set; students not achieving this standard underwent remediation and reassessment. The curriculum was implemented in 3 phases with quality improvement (QI) between each phase. The average competency assessment score and passing rates were determined for each phase. Mean scores for each phase were compared using an analysis of variance test. RESULTS: Mean competency assessment scores increased significantly after each QI from 17.5 (range 11-23) to 18.3 (range 12-24) to 19.8 (range 12-25) in phases 1, 2 and 3, respectively [F(2,642) = 59.502, P <.001]; the performance standard was raised after both QI points. Overall, 8.7% of students underwent remediation and reassessment, but all achieved the performance standard on their second attempt. CONCLUSION: Through a thoughtful QI process that involved carefully aligning all curricular elements (the instructional activities and the assessment), a focused and accountable curriculum was developed that ensured all medical students in the program would achieve a basic level of competency. Increasingly, accreditation agencies are asking medical schools to move toward competency-based curricula. This curriculum represents an important step in this direction.