The Impact of a Clinical Rotation in Hospice: Medical Students' Perspectives

Abstract

Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.

The Utility of Reflective Writing after a Palliative Care Experience: Can We Assess Medical Students' Professionalism?

“…38 The literature supports this trend with examples of recently implemented medical student PC curricula incorporating reflective essays. [39][40][41][42][43] These publications highlight the powerful impressions and important lessons students wrote about, 39,40 and report student themes focused on what was learned, including about themselves, the patient, and being a doctor, and what was experienced, including internal emotional responses and self-transformation. 41 These authors however, did not use the specific lens of professionalism to analyze their essay data.…”

Junior Doctors’ Views of How Their Undergraduate Clinical Electives in Palliative Care Influenced Their Current Practice of Medicine

“…5 Many training initiatives have been implemented at different points throughout undergraduate medical training. [6][7][8][9][10][11][12][13] These have included 20-hour mandatory coursework sessions 7 ; 1-day visits to a hospice 8 ; 16 hours in a community hospice 9 ; a 4-day curriculum 6,10 ; and 1 week, 2 weeks, or 3 weeks of palliative care attachments (i.e., clinical electives) during the clinical years. [11][12][13] However, there is little information available to guide medical educators in how to best incorporate the teaching of palliative care into medical curricula.…”

“…6,7,11 Studies report that students learn about the value of hospice care, the value of empathy, the value of the doctor-patient relationship, 12 and what it means to be a doctor 13 ; acknowledge a difference between resignation and acceptance; and start to understand death as a natural event. 8 Furthermore, students describe feeling more support and having a richer experience of role modeling after training in palliative care.…”

“…8 Furthermore, students describe feeling more support and having a richer experience of role modeling after training in palliative care. 12 However, newly graduated doctors are still found to be poorly prepared to manage the death and dying issues of their patients. 14,15 Available findings in this growing field of undergraduate palliative care education, such as those described, provide valuable insight into determining only immediate or short-term usefulness and benefits.…”

Clinical Observation Reflections From Students in an Interdisciplinary Palliative Care Course

“…As others have observed from similar studies, students were aware of the value of hospice and palliative care, identified the role of palliative care team members and understood death as a natural event through learning experiences in palliative care and hospice settings. 12,13 14 Unlike other studies with students in one discipline [12][13][14][15] , this study could be useful in understanding the dynamics of incorporating teamwork concepts within an interdisciplinary educational experience. In addition, other studies did not consider student suffering that could result from this type of clinical observation experience.…”