• Nicola White, Linda Jm Oostendorp, Christopher Tomlinson, Sarah Yardley, Federico Ricciardi, Hülya Gökalp, Ollie Minton, Jason W Boland, Ben Clark, Priscilla Harries, and Patrick Stone.
• Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK.
• Palliat Med. 2020 Jan 1; 34 (1): 134144134-144.

BackgroundRecognising dying is a key clinical skill for doctors, yet there is little training.AimTo assess the effectiveness of an online training resource designed to enhance medical students' ability to recognise dying.DesignOnline multicentre double-blind randomised controlled trial (NCT03360812). The training resource for the intervention group was developed from a group of expert palliative care doctors' weightings of various signs/symptoms to recognise dying. The control group received no training.Setting/ParticipantsParticipants were senior UK medical students. They reviewed 92 patient summaries and provided a probability of death within 72 hours (0% certain survival - 100% certain death) pre, post, and 2 weeks after the training. Primary outcome: (1) Mean Absolute Difference (MAD) score between participants' and the experts' scores, immediately post intervention. Secondary outcomes: (2) weight attributed to each factor, (3) learning effect and (4) level of expertise (Cochran-Weiss-Shanteau (CWS)).ResultsOut of 168 participants, 135 completed the trial (80%); 66 received the intervention (49%). After using the training resource, the intervention group had better agreement with the experts in their survival estimates (δMAD = -3.43, 95% CI -0.11 to -0.34, p = <0.001) and weighting of clinical factors. There was no learning effect of the MAD scores at the 2-week time point (δMAD = 1.50, 95% CI -0.87 to 3.86, p = 0.21). At the 2-week time point, the intervention group was statistically more expert in their decision-making versus controls (intervention CWS = 146.04 (SD 140.21), control CWS = 110.75 (SD 104.05); p = 0.01).ConclusionThe online training resource proved effective in altering the decision-making of medical students to agree more with expert decision-making.

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