Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Matthew Ellman

Subject Area(s)

Medicine, Educational technology, Education


Basic palliative and end-of-life care skills are necessary for all physicians regardless of their field of specialty. Education should begin during the early stages of medical training, as early as medical school, to ensure that all physicians acquire a basic understanding of these aspects of medical care. At the Yale School of Medicine, the End-of-Life and Palliative Care Curriculum was formalized in 2008 to address this need and was expanded in 2012 to include an original educational online module. This new module was designed specifically for second-year medical students, who had the opportunity to visit hospice patients but do not have dedicated learning prior, to introduce them to specific topics in end-of-life and palliative care in preparation for third-year clerkship rotations during which they are likely to encounter and care for dying patients.

"Life, Death & Medicine: The Dying Process, Hospice Care, and Terminal Care" was developed as a 30-45 minute interactive web-based module that focused on three topics: 1) the physiological signs and stages of the dying process; 2) the common terminal symptoms and their treatments; and 3) the eligibility and services of hospice care. The educational content is literature-based with reference citations embedded within the module. Several interactive features augment this online module, including multiple-choice questions with individualized feedback, drag-and-drop pairing exercises, video clips, and supplementary materials accessed via web-links.

To evaluate the effectiveness of the module, a knowledge-and-attitudes survey was created and administered to second-year Yale medical students randomized to either have or not have access to the module prior to a required half-day hospice/palliative care rotation. A total of 152 students (51% response rate; 62 students in 2012; 66 in 2013; and 24 in 2014) participated in the survey between September 2012 to November 2014, of which 56 students had completed the online module and 85 had not (control group). Multinomial logistic regression was used to analyze the students' knowledge performance based on a series of multiple-choice questions. Multivariate ANOVA was used to analyze the students' attitudes based on their degree of agreement to a series of attitude-assessing statements. Students who completed the online module scored higher (p<.05) on five out of eight of the knowledge-assessing questions. Overall, the students expressed that they felt somewhat uncomfortable caring for dying patients, though they regarded it as part of the physician's duty, and that palliative care education is important in medical curricula. The attitudes did not differ between the students who completed the module and those who did not.

"Life, Death & Medicine: The Dying Process, Hospice Care, and Terminal Care" is a promising tool to introduce pre-clinical medical students to key concepts of terminal care. The application of this online module can be extended to other medical schools to augment teaching of palliative and end-of-life care.


This is an Open Access Thesis.

Open Access

This Article is Open Access