How do you teach empathy and good communication skills online? This MOOC on palliative care featured a fictional drama and structured Google hangouts discussions.
As a specialist in palliative care, Kavitha Ramchandran had a big conundrum: no seat time. Palliative care is generally not formally taught in healthcare training programs. However, research suggests that palliative care techniques improve patient wellness outcomes. Therefore, she asked Stanford's Office of the Vice Provost for Teaching and Learning to help her to create a MOOC.
One of the greatest challenges of this MOOC is that the most important learning objectives are practice oriented. We wanted participants to emerge from the course better able to compassionately deliver difficult news. We wanted them to emerge better able to practice empathetic listening skills, and better able to understand the patient perspective. In short, the primary skills taught are those that are typically difficult to teach in an online setting.
This unusual course accomplishes these goals by centering the educational content around a fictional patient, Sarah Foster, a 40-year-old woman who is newly diagnosed with colon cancer. Each week, a new episode in Sarah's story is revealed. Participants watch as Sarah receives her initial diagnosis from her medical oncologist, as she goes through chemotherapy, as she struggles with nausea and fatigue, as she goes into remission only to have the cancer recur. They meet her husband and hear about her son, and follow along until the end, when she is transferred to hospice care.
Sarah's story enables participants to witness examples of palliative care principles in practice. It asks participants to analyze actual patient encounters, and see for themselves the intricacies of navigating such encounters. It also shows Sarah as a whole person and not just a patient through blog posts and photos of her daily life.
Additionally, Sarah's story teaches healthcare specialists about all of the other types of specialists a patient might be going to and how specialists can work together as a team. Along the way, Sarah works with 10 healthcare workers: an oncologist, a palliative medicine physician, a palliative care nurse, a social worker, a survivorship nurse practitioner, a chaplain, a palliative care psychiatrist, a child social worker, and a hospice physician. Each specialist introduces his or her specialty, and participants see how the whole team works together.
Sarah's story is complemented by structured Google hangouts discussions. These discussions are organized using a platform called talkabout (talkabout.stanford.edu), which allows instructors to specify discussion group sizes and times. When participants go to the platform at the specified time, they are randomly assigned to a Google hangouts group of the specified size. Each week, participants are provided with discussion prompts and role-plays. The discussions count towards participants' statements of accomplishment and are a required part of the course.
In the process of developing the course, Kavitha and her team of 10 faculty members discovered a number of additional benefits.
First and foremost, several of the faculty members reported that the course creation process caused them to change their own practices. Each faculty member played him or herself in the scenes with Sarah and wrote an initial script (which was touched-up by a screenwriter). The process of writing and revising the script caused the faculty members to reflect upon their own interactions with patients and to think about exactly how they communicate.
Second, several of the faculty members have expressed an interest in remixing the course into new courses.
Third, every year, there are palliative care oncology fellows who need to be trained. These fellows will now have the opportunity to participate in talkabout sessions with peers across the world. Because it is important that they understand people who were very different from themselves in order to perform optimally with their patients, this is a boon.
Come and hear about Sarah's story and how it got created! We will discuss preliminary course outcomes, the creation process, and show some of the actual videos.