University of Utah School of Medicine
One of the most significant barriers for patients receiving hospice services is the lack of medical providers’ knowledge regarding what hospice is and what it offers (JHPN. 2009;11(5):291-301). The AAMC lists “presenting palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease” as one of its minimum competencies for medical students. Yet few physician trainees are provided with formal end-of-life care training (Sullivan AM, Lakoma MD and Block SD. J Gen Intern Med. 2003 Sep;18(9);685-95).
The Medicare Hospice Benefit (MHB) Game is a competency-based educational tool designed to evaluate physician trainee’s knowledge of the MHB and their comfort describing services provided by the MHB while educating them in an interactive format.
- To present palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease.
- To identify services that are covered and not-covered by the Medicare Hospice Benefit.
- To outline the process of certifying a patient as eligible for hospice care.
Effectiveness and Significance
Internal Medicine Interns (n=24) at the University of Utah have played the game during their geriatrics rotation. The interns completed a pre-game survey, which assessed their self-reported knowledge of the MHB and their comfort describing the MHB to patients. The interns were given 10-15 minutes to sort a set of 30 cards with statements about the MHB into a true or false pile and record the statements they miscategorize on an answer sheet. Detailed answers were distributed and a preceptor leads a 30-45 minute interactive discussion about the MHB. At the conclusion of the session the interns completed a post-game survey assessing changes in their knowledge and comfort. Both pre and post-game surveys utilized a 7-point Likert scale for measurement. Prior to playing the game, the interns’ self-reported comfort describing services provided by the MHB was low 2.2 (± 1.1). This was congruent with the objective assessment of the interns’ knowledge of the MHB as measured by the mean game score of 63.9% (± 8.9). The baseline knowledge scores of interns that played the game after completing a substantial portion of their internship were no better than those who played at the beginning. After playing the MHB game the intern’s self-reported comfort describing the MHB improved to 5.9 (± 0.9), they strongly agreed that the game added to their knowledge of the MHB 6.4 (± 0.7) and was enjoyable 6.0 (± 1.1).
Explaining the MHB is an important core competency that is not learned passively through completion of a medicine internship. The MHB game is an effective and enjoyable way to improve physician trainee’s knowledge of the MHB and their comfort explaining hospice services.