Education and Training: Perceived educational impact, ­challenges and opportunities of hospice placements for foundation year doctors: a qualitative study

Abstract

Foundation year one doctors (F1s) are expected to recognise and care for dying patients, but previous studies have found they can feel unprepared, stressed and unsupported when faced with such situations. Although hospice placements can provide good experiential learning for junior doctors, no studies to date have included F1s. This study used an interpretivist approach to explore educational opportunities and challenges in hospice placements from an F1's perspective. Six F1s who had recently completed hospice placements were interviewed individually. Data analysed qualitatively showed that F1s valued informal experiential learning and felt well supported by senior doctors. The most important learning outcome was the acquisition of enhanced communication skills and challenges included the risk of becoming medically deskilled. F1s felt their medical practice had changed as a result of hospice placement, most commonly in communication skills and recognition of the dying phase. The author recommends increased utilisation of hospice placements in foundation training programmes.

Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis

“… 17 There was one exception where junior doctors reported hospice placements as medically deskilling experiences, but this had a low weight of evidence. 20 …”

“…All the papers provided evidence that the majority of junior doctors provide palliative and end-of-life care for many patients early in their careers 11–49. An average of 40% (range: 36%–46%) of junior doctors cared for 1–10 patients, while 51% (range: 40%–61%) of junior doctors cared for more than 10 patients 16 26 38 44…”

“…26 28 There was one exception, with a low Gough's weight of evidence study, which reported working in an inpatient hospice was not emotionally draining. 20 Overall early career experiences of death and dying are significant and memorable for doctors throughout their careers. 29 36 39 Junior doctors' personal attitudes towards palliative and end-of-life care varied.…”

“…17 There was one exception where junior doctors reported hospice placements as medically deskilling experiences, but this had a low weight of evidence. 20 Other learning methods valued by junior doctors include observation of senior colleagues 14 17 21 31 37 40 43 49 and reflection in clinical contexts 14 17 24 40 41 or social settings. 17 39 There is a preference for practical and casebased teaching 12 15 22 40 41 46 49 particularly addressing symptom control, 15 32 38 40 44 46 48 prescribing 21 the dying process 12 20 21 and role-playing difficult conversations.…”

Medical student experiences and perceptions of palliative care in a middle eastern country

“…Studies have also found that clinical experience during clerkships has the greatest impact in improving student end-of-life care knowledge and competence [ 10 , 30 ]. Increased clinical exposure is positively correlated with increased confidence [ 31 , 32 ]. However, our respondents described isolated workshops that lacked strategy or cohesion and short-term rotations with limited clinical exposures to palliative patients.…”