Purpose: Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay. Methods: This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula. Results: Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good “starting point” for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning—interpreted through the lens of Bloom’s taxonomy—occurred. Conclusion: Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom’s taxonomy.

Original languageEnglish (US)
Pages (from-to)453-462
Number of pages10
JournalMedical Science Educator
Issue number2
StatePublished - Jun 15 2019

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Education


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