A Comparative Study among Medical Students Performing In-person Versus Virtual Workshop in Last Hours of Life Care

Integrating palliative care into undergraduate health education is essential for preparing future professionals to care for patients facing serious illness and at the end of life. Simulation-based learning has emerged as an effective strategy to complement limited clinical exposure, particularly during the last hours of life (LHoL), a phase requiring clinical expertise and emotional sensitivity.

To compare the effectiveness of in-person versus virtual simulation workshops in improving medical students' self-perceived competency in professionalism in the context of LHoL care.

A prospective, comparative pre-post study was conducted with final-year medical students at the University of Navarra. Participants were randomized to either an in-person (n=17) or virtual (n=29) simulation workshop. Both formats used standardized patients or standardized patient-based materials, structured debriefing, and targeted learning objectives. Self-perceived competencies were assessed before and after the workshop using the validated Student's Inventory of Professionalism (SIP), which evaluates seven domains: Holistic Care, Care and Understanding, Personal growth, Teamwork, Patient assessment, Decision-making, and Being a professional. Non-parametric tests analysed within- and between-group changes.

Both groups showed significant improvements in overall professionalism scores post-intervention (in-person: 8.12 to 9.03, p < 0.05; virtual: 8.24 to 9.15, p < 0.05). The in-person group improved significantly across all seven domains, whereas the virtual group improved significantly in four domains but not in Personal growth, Teamwork, or Being a professional. Between-group comparisons showed no significant differences in overall improvement (p = 0.60), nor in six domains. The only exception was Holistic Care, where the virtual modality yielded slightly greater gains than the in-person modality (p = 0.04).

Both virtual and in-person workshops enhance medical students perceived competency in professionalism. LHoL workshops provide a valuable setting to explore emotionally intense and complex scenarios that foster professional identity development. This study also highlights the value of virtual modalities in strengthening clinical reasoning and self-reflection, although their effectiveness may be reduced in areas requiring clinical immersion and collaborative skill development.