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Chao et al. BMC Medical Education (2024) 24:1285
https://doi.org/10.1186/s12909-024-06304-2 BMC Medical Education
*Correspondence:
Chih-Chia Wang
tsghccwang@gmail.com
Full list of author information is available at the end of the article
Abstract
Background Taiwan enacted the Hospice Palliative Care Act in 2000 and the Patient Autonomy Act in 2016. However,
medical education has emphasized palliative care skills over ethical and legal integration. This study developed a
curriculum for pre-clinical students, focusing on applying these issues in end of life care.
Methods The participants were fourth-year medical students enrolled in a 1-credit medical ethics and law course at
a medical school in Taiwan. The study employed a two-stage design, combining quantitative pretests and posttests
with qualitative data obtained through the Know-Want-Learn strategy. The curriculum, called the video-triggered
expert-led debrief module, included a video scenario on end of life care, insights shared by three interprofessional
experts, and students debrief. In 2021, 168 students participated, and a quantitative questionnaire using a pretest-
posttest design was applied to assess the curriculum’s impact on students’ knowledge and attitudes toward end of
life care. In 2022, 157 students participated, and the survey used open-ended questionnaires (the Know-Want-Learn
strategy) to evaluate what students already knew and what they wanted to know before the module, as well as what
they had learned afterward.
Results In 2021, we collected 166 (98.8%) valid responses in the quantitative questionnaire. Seven of the eight
knowledge-based questions and four of the seven learning motivation items showed signicant improvement in
the posttest (P < 0.05). In 2022, 81 (51.6%) valid responses were obtained from the qualitative questionnaire. Before
the module, students’ understanding was supercial and focused on literal meanings. Three themes emerged in
what they wanted to know: medical decision-making, ethics and laws, and empathetic communication, with eight
subthemes. After the module, three themes and six subthemes were identied in the “what I learned” section.
Students reported gaining knowledge related to ethics and laws, and empathetic communication.
Conclusions The video-triggered expert-led debrief module can eectively teach the application of medical ethics
and laws in end of life care. This approach has shown positive results among young medical students. It enhances
Enhancing medical students’ understanding
of end-of-life care ethics and law through
video-triggered expert-led debrieng: a two-
stage study
Yuan-PingChao1,2, Yu-LunTsai3,4, Daphne YihNg1,2, Jen-JiuanLiaw3, Chung-PeiFu5 and Chih-ChiaWang1,2*
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Page 2 of 10
Chao et al. BMC Medical Education (2024) 24:1285
Background
Because of the implementation of the Taskforce of Medi-
cal School Curriculum Reform, since 2013, medical
education in Taiwan has involved a 6-year rather than a
7-year program. In the 7-year program, after completing
the 4-year medical school curriculum, medical students
underwent a 1-year clerkship followed by a 2-year intern-
ship at a hospital. ey graduated from medical school
upon completion of this training. By contrast, students
participating in 6-year medical programs typically grad-
uate upon successful completion of 2 years of clerkship
training following the initial 4-year medical school cur-
riculum. is reduction in the number of years of medi-
cal school may influence students’ competency-based
education in end of life (EoL) care, including the related
ethical and legal knowledge.
EoL care is regarded as a crucial component of medi-
cal education [1, 2]; however, the training in this area is
often inadequate [3, 4]. erefore, numerous medical
educators have designed specialized courses to equip
students with the skills necessary for delivering EoL care
and engaging in EoL discussions with patients and their
families. For example, utilizing role-playing and group
discussions, training with simulated patients, and pro-
viding online videos [5–7]. Moreover, medical education
experts had developed reliable tools to assess EoL care
learning [8]. However, courses for pre-clinical students
remain scarce, and those integrating EoL care with eth-
ics and laws are limited by the territoriality of laws and
regional cultural values.
is study aims to teach EoL care-related ethical and
legal issues before students enter clinical rotations. Medi-
cal students generally lack prior clinical experience, and
therefore, they have an educational gap in their practical
knowledge of EoL care before they enter clinical rota-
tions. If students lack prerequisite knowledge and experi-
ence, they are unlikely to apply the methods mentioned
in the previously cited articles to their learning. Further-
more, as medical students who have not yet entered clini-
cal practice, it is not appropriate to have them interact
directly with patients.
erefore, in this study, we adopted a video-triggered
expert-led debrief (VED) module to teach medical stu-
dents about the ethical and legal issues related to EoL
care. is two-year study first compared the differences
in medical students’ understanding and learning motiva-
tion through pretests and posttests. Subsequently, based
on the students’ reflections, the study examined their
initial doubts before the course and whether the module
helped address those doubts.
Methods
Participants and study design
e study participants were fourth-year medical stu-
dents who were enrolled in a 1-credit mandatory course
on medical ethics and law in a 6-year program at a medi-
cal school in Taiwan. Convenience sampling was used to
recruit medical students who were enrolled in this course
from August 2021 to May 2023. e curriculum of this
course was developed in accordance with the principles
of situational and experiential learning [9, 10]. We devel-
oped a comprehensive 100-minute module to cultivate
students’ competency in EoL care-related ethical and
legal issues; the module was designed to be seamlessly
integrated into the curriculum of the medical ethics
and law course. e module comprised three sessions: a
description of foundational knowledge and a video sce-
nario highlighting the ethical and legal concerns related
to EoL care; sharing of insights by three interprofessional
experts (IPEs), namely, an EoL care clinician, a medical
humanities educator, and a psychosocial counselor; and a
structured discourse forum involving the three IPEs and
the medical students (Fig.1).
is study applied a two-stage approach. In the first
year of the study, online quantitative data were collected
before and after the module was employed. Eligible stu-
dents voluntarily completed pretest and posttest ques-
tionnaires and a postclass satisfaction survey. In the
second year, qualitative data were collected. Students’
feedback was obtained before and after the module by
using the Know-Want-Learn (KWL) strategy developed
by Ogle in 1986. e focus of this strategy is identifying
what students already know (“Know”), what they want
to learn (“Want”), and what they have learned from the
module (“Learned”) [11].
Measurements
e pretest and posttest questionnaires used to collect
quantitative data comprised two parts. e first part of
the questionnaire assessed students’ understanding of
EoL care-related ethical and legal issues (Additional file
1). It comprised eight multiple-choice questions, with
four answer options provided for each question. e
questions were primarily authored by Dr. Chih-Chia
Wang, with contributions from three IPEs in the design
process. Dr. Wang holds a master’s and PhD in law from
Taiwan and has extensive experience in medical disputes
students’ learning motivation, deepens their understanding of ethics and laws, and empathetic communication. It
further encourages them to reect deeply on the meaning of healthcare.
Keywords Video triggered, End-of-life care, Know-want-learn strategy
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Chao et al. BMC Medical Education (2024) 24:1285
and medical ethics and law issues [12–14]. e three
experts who contributed to the design are from the fields
of EoL care, medical humanities education, and psychol-
ogy. A questionnaire developed by Hwang and Chang
[15] was used in the second part of the questionnaire
to assess changes in the students’ learning motivation.
It comprises seven items rated on a 5-point scale; the
Cronbach’s alpha value for the questionnaire was 0.964.
In the postclass satisfaction survey, which was concur-
rently conducted with the posttest, students were asked
to rate their satisfaction with the learning approach as
highly dissatisfied, dissatisfied, neutral, satisfied, and
highly satisfied. is 5-point scale satisfaction assessment
was based on the scale developed by Judy C.R. Tseng et
al. [16]. e Cronbach’s alpha value was 0.976 for this
survey.
For the qualitative feedback, we used the KWL strat-
egy to collect qualitative data [11]. Before the module, we
gathered what students already knew (Know) and what
they wanted to know (Want). After the module, we col-
lected what they had learned (Learn). e questionnaire
included blank fields, allowing students to write freely.
Statistical analyses
is study employed a two-stage approach for analyses,
conducting both quantitative and qualitative analyses.
e reliability of the questionnaires was evaluated by
calculating Cronbach’s α values, which are an indicator
of internal consistency. A Cronbach’s α value equal to or
exceeding 0.7 was deemed satisfactory in this study [17].
Quantitative data were evaluated using a two-tailed
paired t-test. Statistical analyses were conducted using
Version 18.0 of Statistical Product and Service Solutions
for Windows (SPSS Inc., Chicago, IL, USA). For quali-
tative data analysis, we employed thematic analysis to
identify and organize themes within the data [18]. Subse-
quently, the results were categorized by using the induc-
tive method [19].
Results
Quantitative analysis
In the 2021 academic year, 168 students (131 men and
37 women) participated in this study. For the first part
of the questionnaire, the multiple-choice section, we col-
lected 166 (98.8%) valid responses. Table1 presents the
results of the analysis of the number of correct responses
for each question before and after the test. Significant dif-
ferences were identified between the pretest and posttest
Fig. 1 Medical ethics and law curriculum owchart. The module on medical ethics and law comprised 30min of video trigger appreciation, 40min of
insights being shared by interprofessional experts, and 30min of student discussion. Dierent mechanisms of feedback collection were applied in the
rst and second school years
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Chao et al. BMC Medical Education (2024) 24:1285
scores for seven questions. e question that did not
show significant improvement (P = 0.113) is as follows:
“Which of the following descriptions of ‘advance medi-
cal directives’ and ‘advance care planning and health-
care decision-making documents’ is correct?” e
learning motivation scale showed significant improve-
ment (P < 0.05) in four out of seven items in the posttest
(Table2). e satisfaction survey showed that students’
satisfaction scores were all above 4.6 out of 5 (Table3).
Qualitative analysis
Qualitative data were collected utilizing the KWL strat-
egy, which is based on constructivist philosophy. In the
2022 academic year, 157 medical students (116 men and
41 women) participated in the course, and a total of 81
KWL questionnaires (51.6%) were collected. e follow-
ing themes were identified on the basis of the students’
feedback (Fig.2):
ree main themes were identified in the students’
feedback for the “What I know” section: the Hospice Pal-
liative Care Act, the Patient Autonomy Act, and advance
Table 1 Analysis of correct responses in pre-test and post-test multiple-choice questions (n = 166)
Multiple-choice question items Pretest
n (%)
Posttest
n (%)
p value
Q1: According to the Hospice Palliative Care Act, if a patient is unable to express their wishes and if their adult family
members do not prefer cardiopulmonary resuscitation for the patient, what is the “priority order” for the nearest
relatives?
104
(62.7)
119
(71.7)
0.007*
Q2: Which of the following regarding ‘not performing cardiopulmonary resuscitation’ and ‘terminating or withdrawing
cardiopulmonary resuscitation’ for terminally ill patients is correct?
82 (49.4) 90 (54.2) <0.001*
Q3: According to the Patient Autonomy Act, which description of a medical proxy is correct? 22 (13.3) 29 (17.5) 0.001*
Q4: According to the Patient Autonomy Act, who should be involved in advance medical care consultations before
advance medical decisions are made?
98 (59.0) 105 (63.3) <0.001*
Q5: According to the Patient Autonomy Act, when advance medical directives are in place, in which of the following
clinical conditions may health-care institutions or physicians terminate life-sustaining treatment in accordance with
the patient’s advance medical directives?
42 (25.3) 63 (38.0) <0.001*
Q6: According to the Patient Autonomy Act, who can establish advance medical directives? 108
(65.1)
112 (67.5) <0.001*
Q7: Which of the following descriptions of “advance medical directives” and “advance care planning and health-care
decision-making documents” is correct?
32 (19.3) 36 (21.7) 0.113
Q8: When discussing the Patient Autonomy Act, which of the following issues is not often compared with? 82 (49.4) 85 (51.2) <0.001*
*: Indicates a s tatistically signi cant dierence (p < 0.05)
Table 2 Learning motivation (n = 166)
Items Pretest Posttest p value
Mean ± SD Mean ± SD
1. I think that the course is interesting and valuable. 4.43 ± 0.66 4.6 ± 0.54 0.018*
2. I would like to learn more and observe more in the course. 4.43 ± 0.67 4.55 ± 0.58 0.106
3. The content of the course is worth learning. 4.45 ± 0.66 4.67 ± 0.51 0.001*
4. It is important that I suciently learn the course content. 4.49 ± 0.65 4.64 ± 0.53 0.034*
5. It is important to acquire the course knowledge related to our living environment. 4.48 ± 0.66 4.59 ± 0.54 0.141
6. I will actively search for more information and learn about the topics discussed in the course. 4.33 ± 0.76 4.49 ± 0.62 0.064
7. It is important that everyone take this course. 4.48 ± 0.67 4.62 ± 0.55 0.047*
*: Indicates a s tatistically signi cant dierence (p < 0.05)
Table 3 Satisfaction with the learning approach (n = 166)
Items Mean ± SD
1. This learning activity helped me to better understand how to identify and classify the features of the target learning objects. 4.60 ± 0.67
2. I attempted to identify the dierences between the target learning objects in this learning activity. 4.61 ± 0.67
3. The goal of this learning activity is dicult to achieve, but I can easily understand the instruction. 4.63 ± 0.59
4. Learning in this course was more challenging and interesting than learning through traditional approaches is. 4.62 ± 0.60
5. I made new discoveries or gained new information regarding the target learning objects from the course. 4.64 ± 0.58
6. I have developed new manners of thinking or thinking styles with respect to learning because of the course. 4.63 ± 0.60
7. The course has helped me to learn how to identify the features of the target learning objects. 4.64 ± 0.61
8. The course has helped me to identify dierences within the target learning objects. 4.61 ± 0.63
9. In this course, I learned how to observe the target learning objects from new perspectives. 4.66 ± 0.61
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Chao et al. BMC Medical Education (2024) 24:1285
Fig. 2 Student feedback on the EoL care course obtained through the KWL strategy. On the basis of the feedback obtained through the KWL strategy,
the student responses were categorized into themes and subthemes. For “What I Know,” three themes were identied: the “Hospice Palliative Care Act”,
the “Patient Autonomy Act”, and advance medical directives. For “What I Want to Know,” three themes and eight subthemes were identied; the themes
included medical decision-making, ethics and laws, and empathetic communication. For “What I Learned,” three themes and six subthemes were identi-
ed; the themes included ethics and laws, empathetic communication, and the meaning of healthscare
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Chao et al. BMC Medical Education (2024) 24:1285
medical directives. e data indicated that the students
already had a preliminary understanding of these three
themes before the module, but their understanding was
mostly based on textual interpretation.
The hospice palliative care act
A medical student stated the following regarding
EoL care:
EoL care refers to providing relieving and support-
ive medical care for patients with severe illness,
including by relieving symptoms, offering emo-
tional and social support, and respecting patient
wishes regarding treatment decisions such as opt-
ing out of cardiopulmonary resuscitation (CPR).
(Student No. 056)
The patient autonomy act
A medical student stated the following:
According to the Patient Autonomy Act, patients
have the right to sign advance medical directives.
By establishing advance medical directives, they
can decide whether they wish to accept or refuse life-
sustaining treatment, articial nutrition, or other
therapies at the EoL. (Student No. 019)
Advance medical directives
A medical student stated the following regarding
advance medical directives:
The Patient Autonomy Act empowers patients to
establish advance directives. Through these direc-
tives, patients can express their wishes regarding
life-sustaining treatments, artificial nutrition,
and other interventions at the EoL, including
whether they wish to accept or refuse them. (Stu-
dent No. 100)
On the basis of the students’ feedback in the “What I
want to know” section, three themes and eight subthemes
were identified. e themes were medical decision-mak-
ing, ethics and laws, and empathetic communication.
e students’ responses revealed that they wished to gain
insight into practical implementation methods, potential
challenges encountered during implementation, oppor-
tunities for further education, and strategies for enhanc-
ing doctor–patient communication.
Theme 1: Medical decision-making
Interacting with patients and families
A medical student stated the following:
e doctor should rst conrm the patient’s wishes
regarding their care, especially if they have an
advance directive. is document has legal value
and supersedes any objections from family members.
(Student No. 149)
Responsibility and clinical practice
A medical student asked the following question:
Under what circumstances can a patient choose to
forgo life-sustaining treatment and have a peaceful
passing? (Student No. 071)
Balance between medical treatment and EoL care
A student stated the following:
Clinicians are facing a growing challenge in terms of
maintaining the balance between aggressive medical
treatment and EoL care. Maintaining this balance
will likely involve considerations beyond medicine.
(Student No. 026)
Theme 2: Ethics and laws
The patient autonomy act
A medical student asked the following question:
What are the main rights granted by the Patient
Autonomy Act to patients regarding their medical
care? (Student No. 110)
The hospice palliative care act
Medical students asked the following questions:
What criteria must a patient meet to qualify for EoL
care? (Student No. 039)
Is there any training in Taiwan regarding the rel-
evant legal regulations, including the required
course hours for training regarding providing EoL
care, that can enable health-care professionals
to gain knowledge of EoL care and to understand
their responsibilities and obligations within it?
(Student No. 036)
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Chao et al. BMC Medical Education (2024) 24:1285
Advance medical directives
A medical student asked the following question:
What are the initiation timings, decision-making
processes, and nal execution processes for advance
directives? (Student No. 017)
Theme 3: Empathetic communication
Emotional support
Medical students asked the following questions:
How should psychological and emotional support be
provided to patients and their families during EoL
care? (Student No. 036)
Caring
Medical students asked the following questions:
How communication with patients regarding legal
documents pertaining to life and death be initiated,
and who should be responsible for initiating such
communication? (Student No. 049)
On the basis of the students’ feedback in the “What I
learned section,” three themes and six themes were iden-
tified. e three themes were ethics and laws, empathetic
communication, and the meaning of healthcare. e stu-
dents’ responses revealed that the regulatory topics that
they wished to know more about had been discussed in
class. Additionally, they enhanced their understanding of
the medical humanities.
Theme 1: Ethics and laws
The patient autonomy act and the hospice palliative care act
A medical student stated the following:
e Patient Autonomy Act does not adequately
cover adolescents. e right to make life-and-death
decisions should not be solely determined on the
basis of age. (Student No. 002)
Proxies and relatives
A medical student reported the following:
e entities exercising the right to informed consent
are as follows: the patient or relative. Relatives are
not allowed to hinder health-care institutions or
physicians from making decisions on the basis of
patients’ wishes regarding medical options. (Student
No. 120)
Theme 2: Empathetic communication
Caring
A medical student reported the following:
Medical decision-making is a complex process, and
patients’ preferences may evolve over time. As doc-
tors, we play a crucial role in facilitating decision-
making by helping patients explore their core values.
(Student No. 149)
Empathy
A medical student reported the following:
In health-care settings, empathy involves more than
simply thinking from the patient’s perspective. It
involves understanding their emotional experience,
values, and fears. By cultivating empathy, doctors
can more eectively tailor care to meet each patient’s
needs. (Student No. 048)
Theme 3: The meaning of health care
Peaceful death
A medical student reported the following:
Survival is a primal instinct, whereas the desire for
a good death is a conscious choice. Patients facing
terminal illness often hold hope for life but not at
the cost of undue suering. is complex reality is
acknowledged in EoL care. e core principle of EoL
care is to prioritize patient comfort and well-being
to ensure that patients live out their remaining days
with as much dignity and peace as possible. (Student
No. 120)
EoL care
A medical student stated the following:
e aim of EoL care is to fulll the physiological,
psychological, and social needs of patients. Enhanc-
ing the quality of life for both patients and their fam-
ilies is also a key objective. (Student No. 128)
Discussion
Quantitative analysis showed significant progress in the
knowledge part (multiple-choice questions), along with
strong learning motivation and high satisfaction with the
module. Qualitative data supplemented these findings,
confirming that we provided the information students
sought.
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Chao et al. BMC Medical Education (2024) 24:1285
In the first part of the quantitative analysis, we observed
that the correct response rates for multiple-choice ques-
tions were generally low. is may be attributed to the
students’ limited exposure to legal studies, making it
challenging to familiarize themselves with specialized
terminology within a short timeframe. is likely caused
confusion when reading or answering the questions,
resulting in lower overall accuracy and limited progress
in the posttest. Conversely, some questions (Question
1 and 6) had relatively high correct response rates in
the pretest and further significant improvement in the
posttest, possibly due to the question stem and options
involving fewer legal terms. However, the qualitative
analysis showed that students’ vague understanding of
legal and ethical issues in EoL care became more defined.
In the qualitative analysis, the “What I want to know”
and “What I learned” sections shared two common
themes: “ethics and laws” and “empathetic communica-
tion.” is highlights that the module provided students
with the knowledge they were seeking. Additionally, it
showed that despite less-than-ideal performance on the
multiple-choice questions, students still gained a deeper
understanding of relevant issues. Notably, in the “What
I learned” section, under the theme of ethics and laws,
students expressed a strong grasp of issues regarding the
authority of proxies and relatives. is finding also aligns
with our quantitative results, where Question 1 showed
significant improvement in the posttest.
In the second part of the quantitative analysis, the
results indicated that students exhibited a high level of
learning motivation prior to the module. is may be
attributed to the pre-course introduction, where we pro-
vided detailed information regarding the module struc-
ture, including its delivery by a diverse group of experts
(with background information provided), the use of
video-based learning, expert-led interactive sessions, and
the focus on developing essential future competencies.
We also emphasized that the module was ungraded, with
the primary objective being to deepen students’ under-
standing before entering clinical practice. In the posttest,
scores for all learning motivation items increased, and
although only four items reached statistical significance,
the overall trend suggested an enhancement in students’
motivation. Furthermore, the satisfaction survey indi-
cated that all items received ratings above 4.6, which also
supports the observed increase in learning motivation
following the module. In addition, the noticeable change
in students’ learning attitudes may have been influenced
by the concept of embodiment.
e embodied cognition strategy can be used to teach
abstract concepts by grounding them in perceptual,
motor, and emotional systems [20]. VED creates a well-
designed experiential context, enabling the application
of the embodied cognition strategy. In the qualitative
analysis, the theme of “empathetic communication”
appeared in both the “What I want to know” and “What I
learned” sections. Before the module, students expressed
a desire to understand how to provide psychological and
emotional support to patients and their families. After
the module, they not only recognized the complexity of
medical decision-making but also realized that a physi-
cian’s responsibility goes beyond treatment — it includes
helping patients explore their core values and make the
most ethically aligned choices. Besides, these most ethi-
cally aligned choices should not be decided on the basis
of the previous and present actions of doctors [21] 。e
embodied learning facilitated by the VED module may
serve as a key stimulus for the components of “knows”
and “knows how” in Miller’s pyramid [22]. Moreover,
embodiment is a vital component of reflective practice
[23]. Another theme in the “What I learned” section, “the
meaning of healthcare,” revealed that students came to
understand that a “peaceful death” is a conscious choice,
and that physicians must prioritize the comfort and dig-
nity of the patient. is reflects the feedback from stu-
dents’ reflective practice.
Notably, the findings of this study indicate that even
before clinical rotations, fourth-year medical students
have strong interest in developing patient-communi-
cation skills. e postclass reflections revealed that the
students understood the crucial role of empathy engage-
ment and the importance of fostering self-awareness
among patients in effective physician–patient communi-
cation. Interpersonal communication is also emphasized
as a core competency by the Accreditation Council for
Graduate Medical Education (ACGME), aligning with
the findings of this study [24].
Formal curriculum—the prescribed educational format
in medical schools—has several weaknesses in terms of
EoL care teaching. ese weaknesses include inadequate
teaching content; minimal coverage of EoL content in
medical textbooks; and overreliance on lectures as the
primary mode for teaching [25]. Furthermore, inade-
quate funding, insufficient clinical supervision, a lack of
trained faculty, overloaded curricula, and differing views
regarding the importance of EoL care education among
medical school administrators have adversely affected
the quality of EoL care education [4, 26]. Research has
indicated that EoL care-related ethical and legal knowl-
edge can be enhanced by implementing well-structured
teaching plans [27, 28]. In this study, the use of the VED
module may offer a new method for this issue, especially
for medical students who have not yet entered clinical
practice.
is study has several limitations. First, it included
a cohort of fourth-year medical students from a single
institution in Taiwan, which limits the generalizabil-
ity of the results. Second, the high pre-test scores in
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Chao et al. BMC Medical Education (2024) 24:1285
learning motivation make it difficult to fully rule out a
ceiling effect. ird, this study did not assess long-term
retention of knowledge or skills, which limits our ability
to evaluate the long-term impact of the VED approach.
Additionally, although qualitative feedback is valuable,
it may not capture the full range of student experiences.
Fourth, the study lacked a control group, so it cannot be
concluded that the observed improvements were solely
attributable to the VED intervention. Furthermore, stu-
dents’ lower performance in knowledge-based multiple-
choice questions may reflect unfamiliarity with legal
issues. is suggests that future studies should allow
more time for students to understand the background
knowledge. Future research should employ longitudinal
designs, multi-institutional samples, and more rigorous
assessment methods.
Conclusions
e number of hours of EoL care education in medi-
cal schools in Taiwan has been reduced, and therefore,
integrating EoL care education into Taiwan’s medical
curriculum is crucial. In the VED approach, embodied
cognition is applied to transform abstract concepts into
experiential learning. is approach encourages reflec-
tion and empathy in students and has the potential to
improve education on ethics and laws related to EoL care.
Abbreviations
VED Video-triggered expert-led debrief module
EoL End-of-life
KWL Know-Want-Learn
IPE Interprofessional expert
TSGHIRB Tri-Service General Hospital Institutional Review Board
SPSS Statistical Product and Service Solutions
MOST Ministry of Science and Technology
PMN Project Management Number
Supplementary Information
The online version contains supplementary material available at h t t p s : / / d o i . o r
g / 1 0 . 1 1 8 6 / s 1 2 9 0 9 - 0 2 4 - 0 6 3 0 4 - 2 .
Supplementary Material 1
Acknowledgements
The authors would like to thank their colleagues and the students who
contributed to this study. The authors would also like to thank the reviewers
and the editor for their comments on this article.
Author contributions
YPC and CCW contributed to the literature review, plan execution, data
collection and management, and manuscript writing. DYN contributed to
the study design as well as data collection and management, and provided
assistance to the principal investigator in the plan execution. JJL and YLT
contributed to policy advisory, study design, and manuscript structuring. CPF
contributed to policy advisory.
Funding
This work was supported by the Ministry of Education of the Republic of China
(Taiwan) (Grant No: PMN1122301) and the National Science and Technology
Council of the Republic of China (Grant No: MOST110-2511-H-016-002-MY3).
Data availability
The datasets generated and/or analyzed during the current study are
not publicly available due to ongoing research but are available from the
corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of the Tri-Service
General Hospital, National Defense Medical Center (TSGHIRB Nos. B202105040
and 202305042). The survey was executed in accordance with the Declaration
of Helsinki. Informed consent was obtained from all subjects. All participants
were adults with decision-making capacity.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1School of Medicine, National Defense Medical Center, No. 161, Sec. 6,
Minquan E. Rd., Neihu Dist, Taipei City 11490, Taiwan
2Department of Family and Community Medicine, Tri-Service General
Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong
Rd., Neihu Dist, Taipei City 11490, Taiwan
3School of Nursing, National Defense Medical Center, No. 161, Sec. 6,
Minquan E. Rd., Neihu Dist, Taipei City 114201, Taiwan
4Department of Nursing, Tri-Service General Hospital, National Defense
Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist,
Taipei City 114202, Taiwan
5Department of Occupational Therapy, College of Medicine, Fu Jen
Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist, New Taipei
City, Taiwan
Received: 23 August 2024 / Accepted: 5 November 2024
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