Even though palliative care (PC) training is now more commonly included in medical school curricula, several obstacles continue to limit the creation and rollout of high-quality educational initiatives. Internet-based distance learning supported by information technology (IT-DL) has the potential to build essential PC knowledge among students; however, questions remain regarding the most effective ways to design these curricula and to implement well-structured learning experiences that help students master the intricate skills needed in palliative care. To outline the application of internet-based education within undergraduate medical palliative care training through a realist theoretical lens. A realist review was performed, which generated a framework—or, using realist terminology, a program theory—designed to clarify what works, for whom, and under what conditions. These elements were articulated using the Context-Mechanism-Outcome configuration. An international panel of palliative care education specialists reviewed and judged the relevance of 256 articles obtained via systematic literature searches and expert recommendations.
The final synthesis, driven mainly by the 43 most pertinent articles, is organized into propositions addressing three main areas: (1) Educational theory, in which (a) Cognitivism (learning viewed as the acquisition of knowledge); (b) Constructivism (learning understood as a social, cultural, and negotiated activity); and (c) Behaviorism (learning seen as a measurable change in behavior) align well with the intended learning outcomes in PC. (2) Desired impact of the technology, which highlights that simply adopting IT-DL does not automatically add value; instead, it must successfully address the practical limitations of traditional face-to-face teaching. (3) Contextualization and length of the curricular activity, proposing that PC training should be embedded organically and legitimately into the broader medical curriculum. This area is projected to expand rapidly in the coming years. Both existing and upcoming studies could benefit from applying a realist approach of the kind presented here to better understand and integrate the multiple factors at play.
