Transcript The Development of a Knowledge Tool: For Rapid Assessment of

The Development of a
Knowledge Tool:
For Rapid Assessment of Palliative Medicine
& End of Life Knowledge in Medical
Students
Alyson Brodeur, MD
Pippa Hall
Lynda Weaver
Objectives:
• Develop a quick, easy to use assessment
tool
• Important for tool to be specific and to have
ecological validity (content relative to
medical students)
• Identify possible uses for tool
– needs assessments
– evaluate educational initiatives
– stimulate discussion
The Palliative Care Quiz for
Nursing (PCQN)
• Ross MM, McDonald B, McGuinness J. The
palliative care quiz for nursing (PCQN): the
development of an instrument to measure nurses’
knowledge of palliative care. Journal of advanced
nursing. 1996:23;126-137.
– Dieckmann L, Zarit J, Gatz M. The alzheimer’s disease knowledge test.
The Gerontologist. 1988: 28(3); 402-407.
– Pratt, CC, Wilson, W., Benthin, A., Schmall, V. (1992). Alcohol problems
and depression in later life: Development of two knowledge quizzes.
www-distance.syr.edu/ageans2.html
Development - Stage One
• Advisory committee - To establish
– key knowledge areas
– determine appropriate format & level of difficulty
– generate items
• Ontario palliative undergraduate network common educational objectives for students in an
undergraduate medical curriculum - draft report
2004
Development - Stage One
• Literature Review (ongoing)
– current knowledge tools/quizzes
– Databases = Cinahl & Medline
– Search Terms
• (palliative or hospice or terminal care or terminal illness or
dying or end of life) AND ( (curriculum or education &
evaluation or knowledge & evaluation) OR(knowledge or
education & need assessment or tool or tools or test or testing
or questionnaire) ) AND ( (medical resident or medical
student) OR (undergraduate and (medicine or medical) )
Development - Stage One
• Biswal BM, Zakaria A, Baba AA, Ja’afar R. Assessment of knowledge,
attitude and exposure to oncology and palliative care in undergraduate
medical students. Medical journal of malaysia. 2004:59(1)78-83.
• Burge F, McIntyre P, Kaufman D, Cummings I, Frager G, Pollett A.
Family medicine residents’ knowledge and attitudes about end-of-life
care. Journal of palliative care. 2000:16(3);5-12.
• Dionne L, Dionne A. Global exchange: a questionnaire to medical
students on palliative care and euthanasia. Journal of palliative care.
1996:12(2);39-46.
Development - Stage One
• Fischer SM, Gozansky WS, Kutner JS, Chomiak A, Kramer A.
Palliative care education: an intervention to improve medical residents’
knowledge and attitudes. Journal of palliative medicine.
2003:6(3);391-399.
• Jackson WC, Connor PD, Tavernier L. Antemortem care in an
afternoon: a successful four-hour curriculum for third-year medical
students. American journal of hospice & palliative care.
2002:19(5)338-342.
• Oneschuk D, Fainsinger R, Hanson J, Bruera E. Assessment and
knowledge in palliative care in second year family medicine residents.
Journal of pain and symptom management. 1997:14(5);265-273
Development - Stage Two
• Consultation beyond the advisory group
• Assessment:
– small group (8-12 individuals)
– palliative medicine physicians, fellows, nurses and
pharmacists
– assessed knowledge tool on two different occasions
– goal - assess clarity, relevance, level of difficulty,
accuracy
– end result = two questions significantly changed
Development - Stage Three
• Test-Piloting
– Family Medicine academic half-day
– PGY-1 & PGY-2
– Response rates
• PGY-1 = 100% (n = 17)
• PGY-2 = 70% (n = 8)
– Mean scores (out of 6)
• PGY-1 = 3.4
• PGY-2 = 2.3
Residents’ Assessment of Tool
• The majority of residents thought the quiz was a
fair tool for assessing fourth year medical
students’ knowledge
• Most residents assessed the level of difficulty as
average
– 61% average
– 35% difficult
– 4% easy
Development - Stage Three
• Test-piloting
–
–
–
–
–
–
–
University of Ottawa - fourth year medical students
Location = MCCQE review lecture
Class size = 125
90 students in attendance
Response rate 67%
Incomplete = 5
Assessment based on 50 responses
Medical Students - Year 4
• Mean Score = 1.8
Mode = 1.0
30
25
%
Correct
20
15
Ser i es 1
10
5
0
1
2
3
4
Question Number
5
6
Question One
Mrs. X is taking Long-Acting Morphine tablets 30 mg by mouth every 12
hours for her pain, which has been well controlled. She is now dying,
and unable to take anything by mouth. The appropriate change in
medication should be:
a) 10 mg sc q4h
b) 5 mg sc q4h
c) 5-10 mg sc q4h prn only
d) crush the tablets, dissolve them in water, and administer same
medications bucally
38% of students identified the correct answer
Question Two
Which of the following opioid medication has serious consequences if
given for chronic pain management?
a)
b)
c)
d)
methadone
hydromorphone (Dilaudid)
fentanyl patch (Duragesic)
meperidine (Demerol)
56% of students identified the correct answer
Question Three
Sally has developed signs of toxicity on morphine (some confusion,
hallucinations, myoclonus) and the cancer in her bones is still causing
pain. She is taking 200 mg of morphine per day. To improve her
symptom control, you can:
a)
b)
c)
d)
switch to another strong opioid, such as hydromorphone
add a different, long acting opioid such as the fentanyl patch
add a neuroleptic, such as haloperidol
(a) and (c)
28% of students identified the correct answer
Question Four
Joe was prescribed an opioid for severe pain, due to metastatic prostate
cancer, 2 days ago. The medication has made him feel very nauseated.
The most appropriate antiemetic which has its main effect on the
chemoreceptor trigger zone is:
a)
b)
c)
d)
dexamethasone (Decadron)
haloperidol (Haldol)
dimenhydrinate (Gravol)
scopolamine patch
0% of students identified the correct answer
Question Five
Mr. Y. has end-stage COPD. Despite optimum medical management he
remains short of breath. To improve his symptom control, you can
start:
a)
b)
c)
d)
a fan for his face
an opioid (e.g. morphine)
a neuroleptic (e.g. chlorpromazine)
all of the above
38% of students identified the correct answer
Question Six
You have just written a prescription for hydromorphone (Dilaudid) for a
patient. You must also write a prescription for a laxative. The best
choice is:
a)
b)
c)
d)
a stool softener, such as docusate sodium
an enema, if needed
a bowel stimulant, such as senna derivatives
a glycerine suppository
18% of students identified the correct answer
Development - Stage Four
• Reassess
– Item Difficulty
– Item Clarity
– Total number of Items
• Determine
– Item Discrimination
– Face Validity
– Test-retest Reliability
Development - Stage Four
• Determine if responses vary in accordance
to level of education and experience
• Further comparison of test results for family
medicine residents and fourth year medical
students
• Identify frequent misconceptions