Learning end-of-life care: Outcome measures of a medical student humanities curriculum

Purpose: Medical humanities education varies widely and lacks robust outcomes data, grounded partly in disagreement over the appropriateness of quantitative assessment for this topic. End-of-life education likewise lacks standardization, and learners consistently desire improvement. Methods: We created a humanities intervention to teach foundational end-of-life concepts then taught it electively to 42 preclinical second-year medical students (MS2s). All MS2s (n = 182) completed quantitative end-of-life skills assessments, including a novel standardized patient (SP) encounter. Post-encounter measures included the Revised Collett-Lester Fear of Death Scale (CL-FODS), PANAS-X emotional reactivity scales, and student and SP performance assessments; students also completed the CL-FODS longitudinally during the year and gave summative curricular preparedness feedback. Results: Intervention students reported higher death anxiety than controls when measured longitudinally, but lower death anxiety immediately after the SP encounter. SPs assessed intervention students performed worse on jargon use and respect for autonomy versus controls. At end-of-year, intervention students rated their curricular preparedness better than controls. All other measures including other performance skills and the PANAS-X showed no differences. Conclusions: Intervention students showed mixed results on death anxiety suggesting task-specific and cognitive more than affective benefits. These results suggest a need for further refinement of quantitative pedagogical evaluation of humanities curricula.