Dealing with Death: Medical Students' Experiences with Patient Loss

Abstract

This article explores medical students' experiences and coping strategies when confronting patient loss in their 3rd and 4th years of their programs. Much of the literature on the impact of patient losses focuses on physicians. This article joins a handful of works aimed at how medical students experience and cope with patient loss. In-depth interviews with 20 medical students provided rich descriptions of their varying experiences coping with death. Consistent with previous work, students experience substantial emotional stress coping with patient deaths, though some were more difficult to bear than others, such as when the dying patient was a child or when treatment errors could have contributed to deaths. Common coping mechanisms included talking through their emotions, thrusting themselves into continuing their rounds, crying, participating in infant death rituals, and turning to religion. When deaths occurred, senior personnel who exhibited empathy toward the deceased and tolerance toward the students' emotional responses were lauded and made the process easier. Also emotionally daunting, in many instances, was dealing with the families of dying patients. Most of the students did not view death as a failure, contrary to much earlier literature, except in instances in which human error or decision making may have played a part in causing the death of a patient.

“That’s not what you expect to do as a doctor, you know, you don’t expect your patients to die.” Death as a learning experience for undergraduate medical students

“…In this study, students recounted emotional distress; employed coping strategies such as socializing and talking with peers and colleagues; and struggled with balancing between becoming emotionally detached and delivering an empathic approach towards their patients. These findings corroborate previous research [ 7 – 10 ]. Support from staff was also highlighted by students in this study as an important and significant mechanism for coping with the death of a patient, reflecting similar findings [ 9 , 10 ].…”

“…When considering educational strategies to help students when experiencing the death of a patient, literature has stressed an emphasis on targeting the clinical years [ 7 – 10 ]. Previous studies have emphasized student perceptions that having pre-clinical training in end-of-life (EOL) care would have limited impact on their experiences with the death of a patient in their clinical years [ 7 , 10 , 11 ].…”

“…When considering educational strategies to help students when experiencing the death of a patient, literature has stressed an emphasis on targeting the clinical years [ 7 – 10 ]. Previous studies have emphasized student perceptions that having pre-clinical training in end-of-life (EOL) care would have limited impact on their experiences with the death of a patient in their clinical years [ 7 , 10 , 11 ]. A focus on positive role-modeling from clinical staff [ 7 – 11 ], training staff for formal or informal debriefing or support sessions [ 7 – 9 , 11 ], mentoring led by staff [ 8 – 11 ], and reflective practice [ 10 ] including keeping reflective journals [ 8 , 11 ] have also been advocated.…”

“…A handful of studies exploring medical students personal experiences of death have only recently appeared [ 7 – 11 ]. All of these studies had the primary aim of examining medical students’ experiences of the death of a patient.…”

Knowledge in Pain and Palliative Care in Medical Students From 2 Universities in Mozambique: A Cross Sectional Study

“…Some studies reveled that health professionals were uncomfortable when talking about death and dying and this may re ects a lack of preparation for coping with death. This study also emphasizes the need to maintain with death and EoL training to be present even in continued medical education process (32,33).…”