Medical student confidence in care of the dying and their family: a systematic review

Abstract

BackgroundThe General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.AimThis systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.DesignA systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.Data sourcesMEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsFifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.ConclusionThis review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.PROSPERO registration numberCRD42019119057.

Shortening the Frommelt Attitude Toward the Care Of the Dying Scale (FATCOD-B): a Brief 9-Item Version for Medical Education and Practice

“…This study examined two revisions of the original 30-item FATCOD in which the scale was reduced to a subset of functioning items [16,17]. Seven items (8,9,11,13,14,26,28) were selected in both studies. Five items (3,5,6,7,15) were only retained in the previous study of the authors [16] and 2 items (25,29) were isolated in the study of Browall and colleagues [17].…”

The Challenges of Caring for People Dying From COVID-19: A Multinational, Observational Study (CovPall)

“…Most countries of the globe lack palliative care doctors, nurses, allied health professionals and trainees to meet their needs ( 27 , 28 ). Undergraduate doctors and nurses receive scant training in palliative care, leaving them lacking in confidence and skills in symptom management, communication and care ( 29 , 30 ). Undergraduate and postgraduate training from expert palliative care clinicians is urgent, as well as developing an adequate palliative care workforce to support services and patients day to day, especially as COVID-19 surges continue.…”

The challenges of caring for people dying from COVID-19: a multinational, observational study of palliative and hospice services (CovPall)

“…25,26 Undergraduate doctors and nurses receive scant training in palliative care, leaving them lacking in confidence and skills in symptom management, communication and care, and resulting in stress following complex encounters. 27,28 Undergraduate and postgraduate training from expert palliative care clinicians is urgent, as well as developing an adequate palliative care workforce to support services and patients day to day, especially as COVID-19 cases increase.…”