How Using Generative Learning Strategies Improved Medical Student Self-Competency in End-of-Life Care.

During a mandatory fourth-year core geriatric medicine rotation at our medical school, we discovered that our medical students were struggling with end-of-life (EOL) issues both personally and professionally. We implemented curriculum changes to assist them in developing emotional awareness about death and dying, and to help develop their ability to respond personally and professionally to patients and their families during EOL experiences.In our new curriculum, a seasoned ethicist at our university conducts 2 educational sessions addressing EOL issues. Students complete self-study content before the first session, in which they have a discussion about their own experience with death and dying. Our ethicist facilitates these discussions with a small group (10-14 medical students), allowing the students to explore their own experiences, case studies, and others' experiences in EOL. Before the second session, students prepare a self-reflective narrative essay about an EOL experience. Our facilitator, by using a generative learning strategy, has a rich interaction that attempts to connect previous experiences, present training, and how the student physicians may need to adjust behaviors in order to be advocates for their patients in EOL situations in the future. Students complete a pre- and post-self-assessment in the didactic. Results show significant improvement in their perceived competence in EOL issues. In addition, the students' self-reflection essays reveal intriguing themes for future study.