The effect of patient death on medical students in the emergency department

Abstract

BackgroundThe emotional consequences of patient deaths on physicians have been studied in a variety of medical settings. Reactions to patient death include distress, guilt, and grief. Comparatively, there are few studies on the effects of patient death on physicians and residents in the Emergency Department (ED). The ED setting is considered unique for having more sudden deaths that likely include the young and previously healthy and expectations for the clinician to return to a dynamic work environment. To date, no studies have looked at the effects of patient deaths on the more vulnerable population of medical students in the ED. This study examined aspects of patient deaths in the ED that most strongly influence students’ reactions while comparing it to those of an inpatient setting.MethodsSemi-structured qualitative interviews were carried out with a total of 16 medical students from the American University of Beirut, Medical Center in Lebanon who had recently encountered a patient death in the ED. Questions included their reaction to the death, interaction with patients and their family members, the response of the medical team, and coping mechanisms adopted.ResultsThe analysis revealed the following as determinant factors of student reaction to patient death: context of death; including age of patient, expectation of death, first death experience, relating patient death to personal deaths, and extent of interaction with patient and family members. Importantly, deaths in an inpatient setting were judged as more impactful than ED deaths. ED deaths, however, were especially powerful when a trauma case was deemed physically disturbing and cases in which family reactions were emotionally moving.ConclusionThe study demonstrates that students’ emotional reactions differ as a function of the setting (surprise and shock in the ED versus sadness and grief in an inpatient setting). Debriefing and counseling sessions on ED deaths may benefit from this distinction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0945-9) contains supplementary material, which is available to authorized users.

The impact of death and dying on the personhood of medical students: a systematic scoping review

“…Some students felt more comfortable discussing death and dying after these personal encounters [ 78 , 80 , 86 , 91 ]. They also reported being better able to manage their emotions and cope [ 11 – 13 , 21 , 84 , 89 , 94 , 98 , 99 ]. Indeed, two studies reported improvements in the medical students’ management of sadness, hopelessness, and helplessness [ 18 , 100 ].…”

Students’ Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students’ Written Reflections

“…12 For example, exposure to death and dying in medical school may trigger past feelings of bereavement, which may lead to anxiety, stress, avoidance of related content, 8 and difficulty caring for patients and families who remind students of their own relatives. 8,17 Students with personal experiences with death may try to avoid dying patients and their families, 8 which can create distance in the provider-patient relationship and dissatisfaction in the student's professional role. 12 Students described a wide range of emotions in response to their past experiences with death.…”

“…9 Much has been written about ways to help medical trainees deal with grief and loss related to clinical work. Routine discussions and debriefings about death and dying, 9,12,17 structured reflection sessions, support groups, hospice 7 and palliative care clinical experiences, 9 and supervised attendance at funerals 12 are examples of proposed strategies. However, since the actual and anticipated emotional responses of first-year medical students in our study differed from the emotions of more experienced clinicians (ie, guilt), educational objectives of any structured teaching related to emotional processing may need to be adjusted based on the developmental stage of training.…”

Factors and Beliefs that Condition the Attitude of Health Science Students towards End of Life in Spain and Bolivia: A Multicenter Study

“…Professionals trained in the field of healthcare must face death continuously, working in close contact with the family of the person who has just passed away. Professionals not only face fear towards death but also to the process leading up to it, such as enduring the patient’s agony, pain, and loss of physical and mental faculties [ 4 ]. The importance of a health professional’s attitude towards the process of death and pain is becoming increasingly recognized [ 5 , 6 ].…”