Students’ Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students’ Written Reflections

2019 ◽  
Vol 36 (11) ◽  
pp. 999-1007
Author(s):  
Jaideep S. Talwalkar ◽  
John P. Moriarty ◽  
Matthew S. Ellman
Keyword(s):  
Content Analysis ◽  
Medical Students ◽  
End Of Life ◽  
Student Attitudes ◽  
Hospice Care ◽  
Death And Dying ◽  
Emotional Responses ◽  
Emotional Reactions ◽  
Free Text ◽  
Personal Experiences

Background: Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students’ experiences with death and dying, describe the range of students’ emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death. Methods: We provided a writing prompt to newly matriculated medical students asking them to “reflect on experiences you may have had with family or friends near the end of life.” Content analysis was performed to identify themes in the responses. Results: The 104 students in the entering class submitted 90 individual free-text responses (87%). Most (57%) students specifically mentioned at least 1 personal experience with death, with a range of emotional responses including sadness (29%), surprise (14%), and guilt (12%). Distinct themes emerged on content analysis including personal experiences with death, anticipated response to death in future, changes in body or mind of the dying person, thoughts and observations about others, and cognitive or existential responses. Few students wrote about religion or spirituality (8%) or palliative or hospice care (2%). Conclusions: An understanding of students’ premedical school experiences and emotional reactions to death may help educators frame curricula around end-of-life care. Educators could apply enhanced awareness to help students process their own experiences as they begin caring for patients and to focus on areas that were underrepresented in students’ comments, such as religion, spirituality, palliative care, and hospice.

Corresponding about death: Analyzing letters from patients with cancer to medical students.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11021-11021
Author(s):  
Tianyi Zhang ◽  
Mekaleya Tilahun ◽  
Cynthia Perlis ◽  
Sam Brondfield
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Death And Dying ◽  
Severe Illness ◽  
Clinical Environment ◽  
Patients With Cancer ◽  
Coping Process ◽  
Award Winning ◽  
Multiple Paths ◽  
One Year

11021 Background: Clinicians frequently discuss death and dying with patients who have cancer. However, the doctor-patient hierarchy and the unfamiliar clinical environment may prevent these patients from discussing death and dying authentically. Patients may feel more comfortable expressing themselves when given the time and space to write at home. Firefly, an award-winning program at UCSF, facilitates written correspondence between patients with cancer and medical students over the course of one year. Firefly’s archive contains thousands of patient letters and constitutes a unique resource for analyzing authentic patient expression outside of the clinical context. The aim of the current study is to improve curricula pertaining to severe illness and end-of-life by providing educators with an analysis of authentic patient perspectives about death and dying expressed in these letters. Methods: We (two medical students, an expressive artist, and an oncologist) read all Firefly letters written by patients between 2014 and 2019 and identified 12 patients whose letters meaningfully discussed death or dying. We performed a thematic analysis of these letters using the Buckman three-stage model of dying as a reference. Results: Four themes emerged: turmoil; grief; making peace; and past, present and future. The first three themes aligned with the Buckman stages. The fourth theme—past, present and future—spanned the three stages and also elaborated the Buckman model by describing multiple paths that patients may take after passing through these stages. Conclusions: The authentic ways in which patients with cancer discussed death and dying in their letters provided deep insight into their coping process. The Buckman model appears useful for framing death and dying from the patient perspective but may not fully reflect modern oncologic care in which many patients live for years beyond a severe or terminal diagnosis. Educators can use the identified themes to shape medical school curricula pertaining to severe illness and end-of-life care.

Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care

2016 ◽  
Vol 34 (7) ◽  
pp. 637-644 ◽  
Author(s):  
Phylliss M. Chappell ◽  
Jennifer Healy ◽  
Shuko Lee ◽  
Glen Medellin ◽  
Sandra Sanchez-Reilly
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Attitude Change ◽  
Positive Attitude ◽  
Death And Dying ◽  
Signs And Symptoms ◽  
Computer Application ◽  
Fisher Exact Test ◽  
Positive Attitudes ◽  
Dying Patients

Background: The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. Methods: Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ2 or Fisher exact test, and improvement was measured by weighted κ coefficient. Results: On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. Conclusions: Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.

Comfort while Dying: a Transnational History of Pediatric End of Life Care

2018 ◽  
Author(s):  
Emilie Hill-Smith
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Well Being ◽  
Life Care ◽  
The Public ◽  
Depth Analysis ◽  
Personal Experiences ◽  
History Of ◽  
Being There

Through an in-depth analysis of current and historical literature, this thesis explores the question: what is hospice and end of life care for children? I will dissect the various dimensions of children’s hospice care and how it has evolved over time. Also in my thesis, I will draw from my personal experiences in volunteering at a children’s hospice to discuss the support and care that volunteers receive. Through this literature review I hope to bring to light to a subject that is often overlooked or too difficult for people to discuss. I will propose plans to better the care for children and families who are facing the end of life. My thesis will summarize the current literature available about the type of care that children receive worldwide and how this care affects families and children’s well-being. There has been minimal research done on children in end of life due to the topic’s sensitive nature. My goals is to inform the public of an under discussed but important topic in paediatric medicine.

Respecting patient choices: using the ’Go Wish' cards as a teaching tool

2017 ◽  
Vol 8 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Hibah Osman ◽  
Katia El Jurdi ◽  
Ramzi Sabra ◽  
Thalia Arawi
Keyword(s):  
Palliative Care ◽  
Medical Education ◽  
Medical Students ◽  
End Of Life ◽  
Thematic Analysis ◽  
Death And Dying ◽  
Teaching Tool ◽  
Student Reflection ◽  
Second Year ◽  
Self Discovery

BackgroundIndividuals have different values and priorities that can have an important impact on their medical management. Understanding this concept can help physicians provide medical care that is in line with the goals of their patients. Communicating this message effectively to students is challenging.ObjectiveTo report our experience with using Go Wish cards in the medical education setting.DesignA thematic analysis of student reflection papers using grounded theory.Setting/SubjectsSecond-year medical students participated in an activity using the Go Wish cards as part of a course module on palliative care. The activity aimed to encourage students to reflect on their own choices at the end of life and to highlight that different people have different priorities.ResultsForty-two students (42%) mentioned the Go Wish activity in their reflections on the module. They reported that the activity demonstrated the different priorities at the end of life, it illustrated the importance of providing personalised care, it promoted self-discovery, it transformed their view of death and dying, and it increased their appreciation of the importance of palliative care.ConclusionGo Wish cards can be used to help illustrate the variability in priorities of patients. They can be used as an effective to teach medical students about the importance of considering patient preferences when illness progresses.

scholarly journals Potential of feedback during objective structured clinical examination to evoke an emotional response in medical students in Canada

2020 ◽  
Vol 17 ◽  
pp. 5
Author(s):  
Dalia Limor Karol ◽  
Debra Pugh
Keyword(s):  
Medical Students ◽  
Clinical Examination ◽  
Emotional Response ◽  
Emotional Responses ◽  
Emotional Reaction ◽  
Emotional Reactions ◽  
Objective Structured Clinical Examination ◽  
Verbal Feedback ◽  
Web Based ◽  
Subsequent Performance

Feedback has been shown to be an important driver for learning. However, many factors, such as the emotional reactions feedback evokes, may impact its effect. This study aimed to explore medical students’ perspectives on the verbal feedback they receive during an objective structured clinical examination (OSCE); their emotional reaction to this; and its impact on their subsequent performance. To do this, medical students enrolled at 4 Canadian medical schools were invited to complete a web-based survey regarding their experiences. One hundred and fifty-eight participants completed the survey. Twenty-nine percent of respondents asserted that they had experienced emotional reactions to verbal feedback received in an OSCE setting. The most common emotional responses reported were embarrassment and anxiousness. Some students (n=20) reported that the feedback they received negatively impacted subsequent OSCE performance. This study demonstrates that feedback provided during an OSCE can evoke an emotional response in students and potentially impact subsequent performance.

A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015

2016 ◽  
Vol 34 (6) ◽  
pp. 559-565 ◽  
Author(s):  
George E. Dickinson
Keyword(s):  
Palliative Care ◽  
Medical Students ◽  
End Of Life ◽  
Geriatric Medicine ◽  
Death And Dying ◽  
Medical Schools ◽  
The United States ◽  
Institute Of Medicine ◽  
Undergraduate Medical Students ◽  
Frequency Distributions

The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.

Reactions to the Civility and Relevance of Negative Advertisements

2019 ◽  
pp. 82-101
Author(s):  
Kim L. Fridkin ◽  
Patrick J. Kenney
Keyword(s):  
Content Analysis ◽  
Focus Group ◽  
Real Time ◽  
State Of The Art ◽  
Emotional Responses ◽  
Emotional Reactions ◽  
Senate Elections ◽  
Different Types ◽  
Negative Messages

The findings presented in chapter 5 indicate people recognize and make distinctions about the relevance and civility of negative advertisements. Focus group respondents rated advertisements aired in the 2014 senatorial campaigns in ways consistent with the assessments made by the content analysis coders. This finding helps validate the content analysis findings. In addition, state-of-the-art software is used to measure people’s real-time emotional reactions to different negative advertisements aired during the 2014 Senate elections in a second focus group. The results of the emotions analysis reveal that people vary in their emotional reactions to different types of negative messages. Consistent with the tolerance and tactics theory of negativity, people have strong negative reactions to attack advertisements focusing on irrelevant topics compared to messages emphasizing useful topics. Findings also show people’s level of tolerance for incivility influences their emotional responses to negativity.

Important aspects of end-of-life care. Survey of patients visiting the primary care office

2011 ◽  
Vol 152 (27) ◽  
pp. 1082-1092 ◽  
Author(s):  
Ágnes Csikós ◽  
Lajos Nagy ◽  
Csilla Busa ◽  
János Kállai
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Psychosocial Support ◽  
Death And Dying ◽  
Life Care ◽  
Truth Telling ◽  
Convenience Sample ◽  
To Receive

Introduction: Death and dying are still taboo topics in Hungary. The care of the dying, the adequate relief of their symptoms and the psychosocial support of both patients and their caregivers are not yet well addressed. Aims: Authors obtained information about the feelings and thoughts of patients on death and dying, and about their expectations for end-of-life care. Methods: Mailed questionnaire was send to a convenience sample of 29 adult primary care offices where a total of 845 unselected patients completed the questionnaire. Results: More than two thirds (69%) of respondents would like to receive end of life care in their home. Only 19% of respondents would prefer to die in a hospital. Respondents’ greatest fear was to lose their autonomy (55%). The second most noted concern was fear from pain (38%). According to 93% of the participants, truth telling is very important in the event of terminal illness. Conclusions: Hungarian patients prefer to receive end of life care in their home. Our data support the need for improvement in three primary areas, physician communication skills, pain and symptom management, and expansion of home hospice care. Orv. Hetil., 2011, 152, 1082–1092.

scholarly journals Receiving Spiritual Care: Experiences of Dying and Grieving Individuals

2017 ◽  
Vol 76 (4) ◽  
pp. 373-394 ◽  
Author(s):  
Anthony Bonavita ◽  
Oksana Yakushko ◽  
Melissa L. Morgan Consoli ◽  
Steve Jacobsen ◽  
Rev. Laura L. Mancuso
Keyword(s):  
End Of Life ◽  
Spiritual Care ◽  
Qualitative Methodology ◽  
Hospice Care ◽  
Death And Dying ◽  
Vital Role ◽  
Spiritual Needs ◽  
Individual Perceptions ◽  
Hospice And Palliative Care

The study examines the perceptions of interfaith spiritual care, received through a volunteer hospice organization, by 10 individuals facing death and dying. Qualitative methodology based on the Interpretive Phenomenological Analysis was used to collect and analyze the data. Four superordinate themes reflected meanings ascribed to spirituality and spiritual care in facing end of life: Vital Role of Spirituality in the End-of-Life Care, Definitions and Parameters of Spirituality and Interfaith Spiritual Care, Distinct Aspects of Interfaith Spiritual Care, and Unmet Spiritual Needs. The results expand an understanding of the role of spirituality and spiritual care as part of the hospice and palliative care through attention to individual perceptions and experiences, as well as to ways to expand attention to spirituality within the hospice care.

Why Do Students Engage in Elective Courses on Acupuncture and Homeopathy at Medical School? A Survey

2017 ◽  
Vol 24 (5) ◽  
pp. 295-301
Author(s):  
Alexandra Jocham ◽  
Pascal O. Berberat ◽  
Antonius Schneider ◽  
Klaus Linde
Keyword(s):  
Medical Students ◽  
Personal Experience ◽  
Conventional Medicine ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Personal Experiences ◽  
Elective Courses ◽  
Quantitative Analyses

Background: We aimed to investigate why medical students in Germany participate in elective courses on acupuncture or homeopathy. Methods: The study was a nationwide, cross-sectional survey. Elective courses on acupuncture and homeopathy in the academic half-year 2013/14 were identified by inquiries directed to all 37 German medical schools, to student initiatives, and organizations supporting such courses. Participants of courses were asked to fill in a questionnaire consisting of a free-text question on their motives and closed questions regarding personal experiences, personal environment, evidence, role of the therapy as a complement to conventional medicine, and opportunistic aspects in relation to the therapy chosen. Results: Students participating in 16 of 18 identified acupuncture courses (n = 220) and 12 of 13 identified homeopathy courses (n = 113) filled in the questionnaire. Content analysis of the free text showed that personal experience, a feeling that conventional medicine is somehow incomplete, the belief that acupuncture or homeopathy could help to overcome this shortcoming, and positive characteristics attributed to the therapies were the main motives for participation. Quantitative analyses showed that own experiences and considering the therapy a useful complement to conventional medicine were similarly rated motives in both groups, while opportunistic aspects played almost no role. The influence of the personal environment was more important among homeopathy students, while acupuncture students considered their therapy better backed by evidence. Conclusion: In our survey, personal experiences and the belief that acupuncture or homeopathy allows grasping the patient more holistically were primary motives for participation.

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