Values and Uncertainty at End of Life: A Standardized Patient Case for Preclinical Medical Students

Physician learners desire more and higher-quality education on end-of-life care. Challenges include the inherent difficulties of clinical uncertainty and how to provide meaningful experiences for early learners. This standardized patient (SP) encounter features a patient facing a newly terminal diagnosis. The patient's goals and values are not specific, and the encounter has an open-ended resolution. This low-stakes formative exercise was administered to preclinical medical students.

Designed as part of a broader research project on using humanities to teach end-of-life care to medical students, our case was administered to 178 second-year students (98% of the class) as a required part of their simulation curriculum. Students (n = 171, 96%, consented for research participation) and SPs answered posttest Likert-scale questions assessing student comfort, confidence, and performance during the encounter. Students (n = 175, 96% of the class) later provided feedback as part of an overall curriculum evaluation.

Students found the case anxiety-provoking (M = 4.8/7.0) but felt comfortable while performing (M = 4.7/7.0) and expressed confidence in their ability to admit uncertainty (M = 5.7/7.0). SPs found students performed well at eliciting goals of care (M = 5.8/7.0) and creating plans (M = 6.3/7.0). On retrospective evaluation, students felt the case accessed the uncertainty learning objective (98% agreed or strongly agreed).

The case feasibly targeted the uncertainty- and prognosis-related learning objectives. Students found it challenging but performed well and rated their experience positively. We discuss overall strengths and areas for improvement as well as options for future implementation.