Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial.

Abstract

Recognising dying is a key clinical skill for doctors, yet there is little training. To assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying. Online multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training. Participants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival - 100% certain death) pre, post, and 2 weeks after the training. <i>Primary outcome</i>: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. <i>Secondary outcomes</i>: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)). Out of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (<i>δ</i>_MAD = -3.43, 95% CI -0.11 to -0.34, <i>p</i> = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (<i>δ</i>_MAD = 1.50, 95% CI -0.87 to 3.86, <i>p</i> = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); <i>p</i> = 0.01). The online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.