A Comparative Study among Medical Students Performing In-person Versus Virtual Workshop in Last Hours of Life Care.

BACKGROUND: Integrating palliative care into undergraduate health education is essential for preparing future professionals to care for patients facing serious illness and at the end of life. Simulation-based learning has emerged as an effective strategy to complement limited clinical exposure, particularly during the last hours of life (LHoL), a phase requiring clinical expertise and emotional sensitivity. OBJECTIVE: To compare the effectiveness of in-person versus virtual simulation workshops in improving medical students' self-perceived competency in professionalism in the context of LHoL care. METHODS: A prospective, comparative pre-post study was conducted with final-year medical students at the University of Navarra. Participants were randomized to either an in-person (n=17) or virtual (n=29) simulation workshop. Both formats used standardized patients or standardized patient-based materials, structured debriefing, and targeted learning objectives. Self-perceived competencies were assessed before and after the workshop using the validated Student's Inventory of Professionalism (SIP), which evaluates seven domains: Holistic Care, Care and Understanding, Personal growth, Teamwork, Patient assessment, Decision-making, and Being a professional. Non-parametric tests analysed within- and between-group changes. RESULTS: Both groups showed significant improvements in overall professionalism scores post-intervention (in-person: 8.12 to 9.03, p < 0.05; virtual: 8.24 to 9.15, p < 0.05). The in-person group improved significantly across all seven domains, whereas the virtual group improved significantly in four domains but not in Personal growth, Teamwork, or Being a professional. Between-group comparisons showed no significant differences in overall improvement (p = 0.60), nor in six domains. The only exception was Holistic Care, where the virtual modality yielded slightly greater gains than the in-person modality (p = 0.04). CONCLUSION: Both virtual and in-person workshops enhance medical students perceived competency in professionalism. LHoL workshops provide a valuable setting to explore emotionally intense and complex scenarios that foster professional identity development. This study also highlights the value of virtual modalities in strengthening clinical reasoning and self-reflection, although their effectiveness may be reduced in areas requiring clinical immersion and collaborative skill development.