***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the impact , retention , and magnitude of effect of a required didactic and experiential palliative care curriculum on third-year medical students ' knowledge , confidence , and concerns about end-of-life care , over time and in comparison to benchmark data from a national study of internal medicine residents and faculty . DESIGN Prospect i ve study of third-year medical students prior to and immediately after course completion , with a follow-up assessment in the fourth year , and in comparison to benchmark data from a large national study . SETTING Internal Medicine Clerkship in a public accredited medical school . PARTICIPANTS Five hundred ninety-three third-year medical students , from July 2002 to December 2007 . MAIN OUTCOME MEASURES Pre- and postinstruction performance on : knowledge , confidence ( self-assessed competence ) , and concerns ( attitudes ) about end-of-life care measures , vali date d in a national study of internal medicine residents and faculty . Medical student 's reflective written comments were qualitatively assessed . INTERVENTION Required 32-hour didactic and experiential curriculum , including home hospice visits and inpatient hospice care , with content drawn from the AMA-sponsored Education for Physicians on End-of-life Care ( EPEC ) Project . RESULTS Analysis of 487 paired t tests shows significant improvements , with 23 % improvement in knowledge ( F(1,486)=881 , p<0.001 ) , 56 % improvement in self-reported competence ( F(1,486)=2,804 , p<0.001 ) , and 29 % decrease in self-reported concern ( F(1,486)=208 , p<0.001 ) . Retesting medical students in the fourth year showed a further 5 % increase in confidence ( p<0.0002 ) , 13 % increase in allaying concerns ( p<0.0001 ) , but a 6 % drop in knowledge . The curriculum 's effect size on M3 students ' knowledge ( 0.56 ) exceeded that of a national cross-sectional study comparing residents at progressive training levels ( 0.18 ) Themes identified in students ' reflective comments included perceived relevance , humanism , and effectiveness of methods used to teach and assess palliative care education . CONCLUSIONS We conclude that required structured didactic and experiential palliative care during the clinical clerkship year of medical student education shows significant and largely sustained effects indicating students are better prepared than a national sample of residents and attending physicians Background By 2013 Palliative Care will become a m and atory examination subject in the medical curriculum in Germany . There is a pressing need for effective and well- design ed curricula and assessment methods . Debates are on going as how Undergraduate Palliative Care Education ( UPCE ) should be taught and how knowledge and skills should be assessed . It is evident by this time that the development process of early curricula in the US and UK has led to a plethora of diverse curricula which seem to be partly ineffective in improving the care for the seriously ill and dying offered by newly qualified doctors , as is demonstrated in controlled evaluations . The goals of this study were to demonstrate an evidence -based approach towards developing UPCE curricula and investigate the change in medical students ’ self-perceived readiness to deal with palliative care patients and their families . Methods To evaluate the effects of the UPCE curriculum we chose a prospect i ve , controlled , quasi-experimental , pre , retrospective-pre , post study design . A total of n = 37 3rd and 4th –year medical students were assigned to the  intervention group ( n = 15 ; 4th -year ) and to the  control group ( n = 22 ; 3rd-year ) . Resting on the self-efficacy concept of B and ura the measurement was conducted by a refined test-battery based on two independent measurements ( the revised Collet-Lester-Fear-of-Death-Scale and the instrument of the “ Program in Palliative Care Education and Practice ” at Harvard Medical School ) including 68 items altogether in a five-point Likert-scale . These items were design ed to test elementary skills in caring for the dying and their relatives as perceived by medical undergraduates . Data sets from both groups were analysed by paired and independent two- sample t-test . The TREND statement for reporting non-r and omized evaluations was applied for reporting on this quasi-experimental study . Results Three constructs showed statistically significant differences comparing the intervention group before and after . Willingness to accompany a dying patient increased from 21.40 to 37.30 ( p < .001 ) . Self-estimation of competence in communication with dying patients and their relatives increased from 12.00 to 23.60 ( p = .001 ) . Finally , self-estimation of knowledge and skills in Palliative Care increased from 8.30 to 13.20 ( p = .001 ) . Conclusions This study is a small but systematic step towards rigorous curricular development in palliative care . Our manualised curriculum is available for scrutiny and scientific feedback to support an open and constructive process of best- practice comparison in palliative care OBJECTIVE : To assess the status of medical education in end-of-life care and identify opportunities for improvement . DESIGN : Telephone survey . SETTING : U.S. academic medical centers . PARTICIPANTS : National probability sample of 1,455 students , 296 residents , and 287 faculty ( response rates 62 % , 56 % , and 41 % , respectively ) affiliated with a r and om sample of 62 accredited U.S. medical schools . MEASUREMENTS AND MAIN RESULTS : Measurements assessed attitudes , quantity and quality of education , preparation to provide or teach care , and perceived value of care for dying patients . Ninety percent or more of respondents held positive views about physicians ’ responsibility and ability to help dying patients . However , fewer than 18 % of students and residents received formal end-of-life care education , 39 % of students reported being unprepared to address patients ’ fears , and nearly half felt unprepared to manage their feelings about patients ’ deaths or help bereaved families . More than 40 % of residents felt unprepared to teach end-of-life care . More than 40 % of respondents reported that dying patients were not considered good teaching cases , and that meeting psychosocial needs of dying patients was not considered a core competency . Forty-nine percent of students had told patients about the existence of a life-threatening illness , but only half received feedback from residents or attendings ; nearly all residents had talked with patients about wishes for end-of-life care , and 33 % received no feedback . CONCLUSIONS : Students and residents in the United States feel unprepared to provide , and faculty and residents unprepared to teach , many key components of good care for the dying . Current educational practice s and institutional culture in U.S. medical schools do not support adequate end-of-life care , and attention to both curricular and cultural change are needed to improve end-of-life care education Prompted by directives from the GMC , ‘ care of the dying ’ is identified as ‘ core curricula ’ for undergraduate medical education . However , there are many technical and interpersonal challenges faced in learning the practice of palliative medicine . Accordingly , the design and delivery of education programmes need to be both carefully considered and evaluated . Using B and ura ’s Social Cognitive Theory as a driver , appropriate methodology for evaluating a novel education programme in palliative medicine was drafted . A pre- and post-survey of an education programme and palliative care placement  for fourth year medical undergraduate students from Liverpool University ( n = 216 ) was completed using a composite question naire containing ; i )  Self-efficacy in Palliative Care Scale ( SEPC ) and ii )  Thanatophobia Scale . Both scales have shown reliability and validity within the sample population . Additionally , a r and omly selected Focus Group was conducted to provide qualitative information on the students ’ experience . A total of 139 pre- and post- question naires ( 64 % ) were completed . Analysis identified significant improvements in perceived efficacy ( SEPC Communication t = −16.41 , P < 0.001 ; SEPC Patient Management t = −22.31 , P < 0.001 ; SEPC Multidisciplinary Teamwork t = −15.56 , P < 0.001 ) . Significant improvements in thanatophobia were also recorded ( z = −7.51 , P < 0.001 ) although some interesting anomalies were noted . This study demonstrates that considered and appropriately structured clinical education has been shown to significantly improve  students ’ belief in their ability to practice palliative medicine and to improve their attitude towards care . In accordance with the study ’s theoretical driver , it is reasonable to propose that the engaged active learning will have a positive effect on the future care of dying patients Purpose Few studies have compared the effect of Web-based eLearning versus small-group learning on  medical student outcomes .  Palliative and end-of-life ( PEOL ) education is ideal for this comparison , given uneven access to PEOL experts and content nationally . Method In 2010 , the authors enrolled all third-year medical students at the University of California , Davis School of Medicine into a quasi-r and omized controlled trial of  Web-based interactive education ( eDoctoring ) compared with small-group education ( Doctoring ) on PEOL clinical content over two months . Students participated in three 3-hour PEOL sessions with similar content . Outcomes included a 24-item PEOL-specific self-efficacy scale with three domains ( diagnosis/treatment [ Cronbach alpha = 0.92 ; CI : 0.91–0.93 ] , communication/prognosis [ alpha = 0.95 ; CI : 0.93–0.96 ] , and social impact/self-care [ alpha = 0.91 ; CI : 0.88–0.92 ] ) ; 8 knowledge items ; 10 curricular advantage/disadvantages ; and curricular satisfaction ( both students and faculty ) . Results Students were r and omly assigned to  Web-based eDoctoring  ( n = 48 ) or  small-group Doctoring ( n = 71 ) curricula . Self-efficacy and knowledge improved equivalently between groups ( e.g. , prognosis self-efficacy , 19 % ; knowledge , 10%–42 % ) . Student and faculty ratings of the Web-based eDoctoring curriculum and the small-group Doctoring curriculum were equivalent for most goals , and overall satisfaction was equivalent for each , with a trend toward decreased eDoctoring student satisfaction . Conclusions Findings showed equivalent gains in self-efficacy and knowledge between students participating in a Web-based PEOL curriculum in comparison with students learning similar content in a small-group format . Web-based curricula can st and ardize content presentation when local teaching expertise is limited , but it may lead to decreased user satisfaction Purpose . To describe attitudes and practice s of end-of-life care teaching in the undergraduate medical curriculum in the United States as reported by administrative leadership and identify opportunities for improvement . Method . A telephone survey of associate deans for medical education or curricular affairs at a r and om sample of 62 accredited U.S. medical schools was conducted in 2002 . Results . Fifty-one deans participated ( 82 % response rate ) . Most ( 84 % ) described end-of-life care education as “ very important ” and supported incorporating more end-of-life care teaching into the undergraduate curriculum . Sixty-seven percent reported that insufficient time is currently given to palliative care in their curriculum . Although a majority opposed required courses ( 59 % ) or clerkships ( 70 % ) that focused on end-of-life care , they did unanimously endorse integrating teaching end-of-life care into existing courses or clerkships . Key barriers to incorporating more end-of-life care into the curriculum included lack of time in the curriculum , lack of faculty expertise , and absence of a faculty leader . Conclusion . Associate deans for medical education or curricular affairs in the United States support integrating end-of-life care content into existing courses and clerkships throughout the undergraduate medical curriculum . Successful integration will require institutional investment in faculty development , including both the development of faculty leaders to drive change efforts , and the education of all faculty who teach students and exert influence as role models and mentors . The strong support for end-of-life care education expressed by academic leaders in this study , combined with the high level of interest expressed in the authors ’ 2001 national survey of students , provide evidence of the potential for meaningful change in the undergraduate medical curriculum Aim This study evaluates the impact of an interprofessional home hospice visit ( HHV ) on third-year medical students ’ attitudes toward , and underst and ing of , end-of-life care and the visit 's effect on students ’ views of their emerging professional roles and identities . Methods All third-year medical students at Stony Brook School of Medicine in Stony Brook , New York , USA , participated in an HHV .  A didactic session preceded the HHV . Subsequently , students were required to su bmi t a piece of reflective writing detailing the impact of the visit . We conducted a qualitative analysis of a r and om sample drawn from the 467 su bmi tted reflections . Results Six themes emerged from the student reflections : three were related to the students ’ direct observations during the HHV , and three were related to the reflective learning of the students based on their HHV experience . Conclusion The qualitative analysis of the reflective writings showed that the students gained a deep appreciation of the human identity of hospice patients and a humanistic underst and ing of their own role as future physicians The purpose of this study was to assess the impact of an  elective geriatric palliative care course  on medical students '  attitudes , knowledge , and behaviors regarding communication with terminally ill patients . Surveys were administered at the beginning and end of the elective . Despite a significant increase in knowledge about geriatric and palliative medicine ( F = 24.80 ; P < .001 ) , there were no significant changes in students ' self-reported behaviors when applying curriculum-based communication strategies . However , 
    Output:
    
Results : There is greater consistency in the content being delivered as part of end-of-life care education within medical schools .
The most frequently taught topics include attitudes to death and dying , communication skills , and pain management .
Pediatric care and religious/cultural issues are less frequently addressed .
Teaching institutions are also utilising a broader range of teaching modalities .
Conclusion : There is significant progress in palliative care education within medical schools .
Ongoing challenges relate to correlating our current practice in medical education to professional recommendations and the expressed needs of junior doctors to practice competent end-of-life care