How can training in care of the dying be improved?

Gajebasia, Sareena; Pearce, Jessica; Redman, Melody; Johnson, Miriam J.; Finn, Gabrielle M.

doi:10.1111/tct.12999

Cited by 4 publications

(9 citation statements)

References 7 publications

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“…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…”

Section: Resultsmentioning

confidence: 99%

“…Junior doctors’ personal attitudes towards palliative and end-of-life care varied. Many report a belief in the importance of palliation,14 17 20 21 24 34 37 41 44 45 47 48 some describing it as a privilege to care for patients at the end of their life 30 45. Some view palliative care as similar to other aspects of medicine, describing it as problem-solving patients’ symptoms 25 39 45.…”

Section: Resultsmentioning

confidence: 99%

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

Bharmal

Morgan

Kuhn

et al. 2019

BMJ Support Palliat Care

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BackgroundPalliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.AimTo review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.MethodsSystematic literature review and narrative synthesis.ResultsA search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.ConclusionMedical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Bharmal

Morgan

Kuhn

et al. 2019

BMJ Support Palliat Care

View full text Add to dashboard Cite

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Introduction Teaching in palliative care (PC) is an important component of medical education. Yet, studies in many countries document a fragmented and inconsistent approach to PC teaching. The goal of this study is to assess PC education, experience, and comfort levels in providing end-of-life care in recently graduated medical students. Methods A survey was distributed to medical student applicants to residency programs at a large academic medical center in the United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies. Results Of 226 surveys, 183 were completed (80.7% response). Over half of respondents (104/183, 56.8%) did not receive any formal PC education or training in medical school. General introduction to PC (64%), pain management (68%), and non-pain symptom management (56%) were the most common topics. Only 13% (24/183) of medical students participated in PC rotations. Only 25% of participants (46/183) reported assessment of PC knowledge or skills. Gender differences were noted, with women more comfortable discussing prognosis (Pearson Chi-square value 8.67, df 3, p < 0.013) and assessing decision-making capacity (Pearson Chi-square value 15.02, df 3, p < 0.005). Few students expressed comfort with any aspect of PC. The majority of respondents (174/183, 95%) felt that it is important to receive PC education in medical school. Conclusions Most newly graduated medical students reported limited education in PC, with minimal clinical experience. The vast majority described a lack of comfort in providing care for dying patients and their families. Educational reform is necessary to embed PC knowledge and skills into medical school curricula.

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“…The General Medical Council recommends that all medical students receive core teaching on care of the dying,2 3 however junior doctors continue to report distress and a lack of confidence when looking after the dying, often providing care in isolation and out of hours 4. As such, junior doctors often desire greater representation of palliative medicine teaching within undergraduate curricula 5…”

Section: Introductionmentioning

confidence: 99%

Care of the dying – medical student confidence and preparedness: mixed-methods simulation study

Wells

Llewellyn

Hiersche

et al. 2022

BMJ Support Palliat Care

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ObjectivesOf all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.MethodsA mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.ResultsThirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.ConclusionUsing simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

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How can training in care of the dying be improved?

Cited by 4 publications

References 7 publications

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

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

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

Care of the dying – medical student confidence and preparedness: mixed-methods simulation study

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