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A comparison of Web-based and small-group palliative and end-of-life care curricula: a quasi-randomized controlled
Frank C Day1, Malathi Srinivasan, Claudia Der-Martirosian
1Dr. Day is associate professor, Emergency Medicine, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California. Dr. Srinivasan is associate professor, Internal Medicine, University of California, Davis School of Medicine, Sacramento, California. Dr. Der-Martirosian is a health research scientist, Veterans Emergency Management Evaluation Center (VEMEC), Veterans Affairs, North Hills, California. Dr. Griffin is a senior statistician, University of California, Davis School of Medicine, Sacramento, California. Dr. Hoffman is professor of medicine emeritus, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California. Dr. Wilkes is professor of medicine, Office of the Dean, University of California, Davis School of Medicine, Sacramento, California.
Purpose:
Few studies have compared the effect of Web-based eLearning versus small-group learning on medical student outcomes. Palliative and end-of-life (PEOL) education is ideal for this comparison, given uneven access to PEOL experts and content nationally.
Method:
In 2010, the authors enrolled all third-year medical students at the University of California, Davis School of Medicine into a quasi-randomized controlled trial of Web-based interactive education (eDoctoring) compared with small-group education (Doctoring) on PEOL clinical content over two months. Students participated in three 3-hour PEOL sessions with similar content. Outcomes included a 24-item PEOL-specific self-efficacy scale with three domains (diagnosis/treatment [Cronbach alpha=0.92; CI: 0.91-0.93], communication/prognosis [alpha=0.95; CI: 0.93-0.96], and social impact/self-care [alpha=0.91; CI: 0.88-0.92]); 8 knowledge items; 10 curricular advantage/disadvantages; and curricular satisfaction (both students and faculty).
Results:
Students were randomly assigned to Web-based eDoctoring (n=48) or small-group Doctoring (n=71) curricula. Self-efficacy and knowledge improved equivalently between groups (e.g., prognosis self-efficacy, 19%; knowledge, 10%-42%). Student and faculty ratings of the Web-based eDoctoring curriculum and the small-group Doctoring curriculum were equivalent for most goals, and overall satisfaction was equivalent for each, with a trend toward decreased eDoctoring student satisfaction.
Conclusions:
Findings showed equivalent gains in self-efficacy and knowledge between students participating in a Web-based PEOL curriculum in comparison with students learning similar content in a small-group format. Web-based curricula can standardize content presentation when local teaching expertise is limited, but it may lead to decreased user satisfaction.
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