Developed by Daniel Swagerty, MD, MPH
Instructors:   Jerry Menikoff, JD, MD
                    Martha Montello, PhD

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Specific Learning Objectives:

1. Introduction:

   Before reviewing the learning objectives and content, please take the following Pre-Test.  You must do this before you can proceed with the module.   The answers are given in the Post-Test that complete the module.

   Please review the Objectives, Content material, and Case Study before our class session.   We will apply the tasks in the Skills Objectives to the case study, and you should think about them ahead of time.

2. Pre-Test

3. Attitudes - First year medical students should be able to:
   1. Realize the importance of establishing the wishes of the patient prior to a time of incompetence when surrogacy would be required.
      
   2. Realize the importance of the role of the health care provider in providing a realistic and clear understanding of the patient's clinical situation and likely prognosis.
      
   3. Acquire an ability to effectively engage patients and families in discussion of these issues.

4. Knowledge - First year medical students should be able to:
   1. Discuss the entity called a Living Will, including the definition, acquisition, utility, and limitations.
   2. Discuss the entity called a Health Care Treatment Directive, including the definition, acquisition, utility, and limitations.
   3. Discuss the entity called a DNR, including the definition, acquisition, utility, and limitations.
   4. Discuss the entity called a Durable Power of Attorney for Health Care, including the definition, acquisition, utility, and limitations.
   5. Recognize the cognitive and emotional qualities which contribute to the assessment of competency and decision-making capacity.
   6. Recognize the scope and importance of the legal context of advanced directives.
   7. Recognize the importance of selected issues relating to advanced directives.
   8. Describe how to appropriately begin the advanced directive discussion.
   9. Describe the importance of communicating with families and surrogates concerning advanced directives.
   10. Describe the importance of clarifying unclear statements.
   11. Describe the best approach to documenting the discussion of advanced directives.

    

5. Readings
   

6. Skills - First year medical students should be able to:

1. Define the following entities and discuss how one acquires such a document:
• Living Will
• Health Care Treatment Directive
• DNR
• Durable Power of Attorney for Health Care
2. Participate in a family "discussion" about these entities and recommend appropriate interventions for the patients presented in the case that follows and the Standardized Patient Encounter..

3. Create a framework for how one would initiate and/or discuss such issues with real patients and families.
   
   

7. Case Study

Mr. J.

9. Post-Test

10. If you have not already done so please fill out the Student Feedback Form.  Remember this feedback form is for credit.

    Be sure to complete the Ethics Module

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