This study is interesting, and important for our students, many of whom will encounter death and dying for the first time during med school.
How does McMaster handle the issue? This is part of the Professional Competencies (Procomp) curriculum, which runs every Tuesday morning. Our students are divided into 2 groups which stay together for their entire preclerkship. Each group has 2 "Longitudinal Facilitators" - one is a physician and one a non-physician; in our case this year the non-docs are a nurse and a psychologist. The Procomp curriculum is quite comprehensive and covers all the non-scientific elements of being a doctor: professionalism, ethics, legal issues, communication, and more. End of-life is part of the Procomp curriculum. There's quite an intense focus on this, I've seen students quite shaken after some sessions.
There's focus on both appropriate professional behavior as well as the students' own feelings and how to deal with them. Students' intense feelings during these particular Procomp sessions sometimes affect them later - they might be 'out of sorts' during tutorial or clinical skill sessions on those days.
Maybe not clearly a PBL topic but as the PBL Tutors see and hear from our students in a short period more than anyone else on our faculty I thought I would talk about death and dying. Students by this point are doing horizontal electives and are seeing real events in real time. I came across this study and after reading it I thought it’s a good intro to the topic. One of the things I have had trouble remembering about my medical school experience was how I felt. Truth is at McGill in the 1980's I don't think anybody ever asked. I found the conclusions of this study most interesting.
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Background: Medical schools require time for end-of-life topic. However, there is very little medical literature that directly addresses how medical students and residents are to behave, manage emotion, and confront their own grieving process when patients die.
Objective: The purpose of this study was to understand how preclinical medical students describe feelings toward the death of a hypothetical patient in order to affect curricular change at our institution.
Design: Qualitative methods using narrative analysis of student papers to identify patterns, core constructs, and themes related to student's projected feelings on patient death.
Setting/subjects: Federal medical school with volunteer medical students from the class of 2005.
Results: Two thirds of the students (108/162) volunteered to participate. Five significant themes emerged including: (1) affective responses (guilt, fear, blame, and impotence) (2) personal experience with death, (3) survivorship and professionalism, (4) the meaning of death, and (5) the affects of religion and spirituality. Many feared facing families and responding to grief. An active belief in an afterlife was mentioned as a coping strategy by 40% of the students.
Conclusions: End-of-life curriculum is more than teaching about the clinical care of the patient and support of family. These medical students overwhelmingly identified the need for coping strategies when confronting the dying patient. Teaching students these coping strategies should be an integral part of an end-of-life curriculum.
Writing exercises cannot only help students recognize and reflect upon their emotions and feelings, but also allow educators a window into curricular elements that need to be added to death and dying education.
To cite this paper:
Cynthia M. Williams, Cindy C. Wilson, Cara H. Olsen. Journal of Palliative Medicine. April 1, 2005, 8(2): 372-381.
Maynard Luterman
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