A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

Abstract

The medical students’ well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students’ clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The “Interpretive Description” approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students’ subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.

How Supportive Ethical Relationships Are Negatively Related to Palliative Care Professionals’ Negative Affectivity and Moral Distress: A Portuguese Sample

“…Indeed, moral distress among palliative care professionals may be attributed to manifold aspects: relationships with patients and caregivers, including the presence of a conspiracy of silence, communication problems, the desire for unnecessary aggressive treatments or palliative sedation and a lack of knowledge of patient values and desires, which cause pain to the patient; factors related to the organizational environment, including the presence of a poor ethical climate, hospital policies, inadequate staffing, and pressures to decrease costs; legal/ethical concerns, including fear of being judged by colleagues, and a lack of adequate knowledge of palliative care and bioethics; and personal issues, including the management of negative emotions and complexity in decision-making for the implementation of appropriate palliative care treatments [ 4 , 7 , 23 , 24 , 25 , 26 ]. Consequently, palliative care professionals frequently experience situations of powerlessness and interpersonal conflict in dealing with end-of-life issues and work-related constraints, such as problems in disclosing information to patients and families, restraints imposed by excessive workload, and ethical conflicts [ 4 , 7 , 19 , 27 ].…”