Table 1:
QOL Module Teaching Objectives, Teaching Strategies,
Evaluation, and (Future) Challenges
| Objective | Teaching Method | Evaluation | Challenges |
|
List what's important in your life. Imagine how things would be different if you had a serious illness. Try to imagine how things might be different for one of your classmates in a similar situation. | Useful
tool for second-year medical school "ethics" sources
Useful as an initial exercise for providing definition of QOL (see next objective). Most learners (60-75%) fully appreciate problems with attempting to assess important elements for another person. |
Allow
learner to imagine a situation that might change his or her
self-assessment of QOL so he or she can begin to assess others.
At the same time, the use of "artificial situations" requires the facilitator to direct some discussion toward real situations to "bring out" general QOL dimensions in Objective 2. |
|
Students
should list "what's important" and, using white board or flip
chart, the group can list QOL dimensions.
Use of a presently available QOL tool may emphasize these dimensions, including physical (pain), functional (ability to eat), psychological (depression), social (family support), and spiritual, etc. Students then use specific information obtained from their patients that allows them to assess different QOL dimensions. |
Several studies suggested by listing "what's important" learners can identify quality of dimensions. When used with two different groups, a standardized QOL tool was felt to be unnecessary and time-consuming. Also, real case samples show how important issues can involve many domains' i.e., cancer pain is the physical domain but also affects emotional and psychological domains. | Once the dimensions are identified, the facilitators must introduce ways to assess these dimensions in patients. Thus, not only must specific questions be asked, but also ways to objectively interpret answers or statements objectively are important. The best prelude to assessing individual patients is to emphasize (again) the importance of objective empath4tic listening. |
|
Case-specific example: A 79-year-old man with prostate cancer has partially treated pain and is bed-bound but remarks that this last month of his life is of high quality and each day is a gift. Learners then identity QOL dimensions that are very positive for this patient, i.e., social, spiritual, etc. Students then use specific information obtained from their patients that allows them to assess different QOL dimensions. | Four groups of students overwhelmingly thought that the use of cases, especially their own, was important in eliciting different perceptions by patients as to their QOL. One focus group of five students all agreed that a QOL assessment is best undertaken by using what patients say, as well as getting input from family and other members of the health care team as to what "the patient would want." In particular, different teaching methods might apply for resident physicians as compared with medical students (see follow-up results). | The facilitator must encourage the students to obtain and interpret information from patients. However, over interpretation is to be avoided. If a patient frequently makes comments such as "I'm fine, I want to be left alone" or "how did I get this disease," responses such as "are you sure you're fine?" or your cells are changed by an oncogene: are usually inappropriate. However, proper assessment of these comments can facilitate an effective response. Effective prioritization and implementation of any intervention is best done with input from other members of the health care team. |
|
Using case-based material, students use their patient assessments to discuss how QOL issues can be improved using various services. In particular, the student would suggest intervention by other health care professionals on the team. | Eliciting case discussion by asking for perceived ethical problems encountered on the wards provides a surprisingly high number of appropriate cases. Most "ethical problems" are due to disagreements about appropriateness of care and lack of focus about what the patient "really wants." Most students readily agree that assessing "really wants" relates to QOL issues and improving things often requires help from persons in nursing, social work, pastoral care, etc. | In order to focus this discussion, the facilitator might elicit case discussions at the beginning of the module. Usually the first or second case discussed is appropriate for the exercise. After this initial discussion the facilitator might the go thorough the exercise (Objectives 1-3) and then come back to the specific case (later) during this part of the module. Perhaps the team can even go to the bedside. |