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Engel KG, Millham LRI, Yeh IM, Malecha PW, Brizzi K, Schwartz AW, Tolchin DW. Assessing the Impact of a Hospice and Palliative Medicine Mentored Clinical Shadowing Experience for First-Year Medical and Dental Students: A Pilot Study. Am J Hosp Palliat Care 2024; 41:1018-1028. [PMID: 37950642 DOI: 10.1177/10499091231214787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Background: All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives: To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design: Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements: The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results: 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions: Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care.
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Affiliation(s)
- Kirsten G Engel
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucia R I Millham
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Irene M Yeh
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick W Malecha
- Harvard Medical School, Boston, MA, USA
- Section of Palliative Care, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorothy W Tolchin
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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Ibrahim H, Oyoun Alsoud L, West K, Maraka JO, Sorrell S, Harhara T, Nair SC, Vetter CJ, Krishna L. Interventions to support medical trainee well-being after patient death: A scoping review. J Hosp Med 2024. [PMID: 39154261 DOI: 10.1002/jhm.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Medical trainees are at the forefront of end-of-life care provision in the hospital setting but often feel unprepared to manage the complex emotions after patient death. OBJECTIVES To systematically identify and synthesize the published literature on interventions to support medical trainees dealing with patient death. METHODS Searches were conducted in MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL, and ERIC from inception to June 30, 2023. English language peer-reviewed publications of interventions to support medical students and residents/fellows dealing with patient death. Studies of practicing clinicians and nonphysician healthcare trainees were excluded. Two reviewers independently determined study eligibility. Discrepancies were resolved through consensus and a third reviewer served as a tiebreaker if needed. RESULTS Of the 9107 articles retrieved, 973 underwent full-text review, and 50 studies met inclusion criteria. Most interventions targeted residents (n = 32; 64%) and were conducted in North America (n = 45, 90%). Types of interventions included preventive measures involving educational lectures and workshops (n = 19; 38%), clinical placements (n = 10; 20%), and postventions (n = 16; 32%), including debriefing and memorial services. Several interventions incorporated the arts (n = 5; 10%), including movies, drama, and artwork, and most incorporated reflective narratives (n = 16; 32%). Most interventions were limited in frequency and duration. CONCLUSIONS This review identified several interventions to support trainees through the experience of patient death but also highlighted areas for improvement. Strengthening support for medical trainees will foster emotionally resilient physicians who are better equipped to deliver high-quality, empathetic care to dying patients and their families.
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Affiliation(s)
- Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Leen Oyoun Alsoud
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Kelsey West
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jude O Maraka
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Sara Sorrell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Satish C Nair
- Department of Academic Affairs, Tawam Hospital, Al Ain, UAE
- United Arab Emirates University, Al Ain, UAE
| | - Cecelia J Vetter
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lalit Krishna
- Division of Supporting Care and Palliative Care, National Cancer Centre, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, Liverpool, UK
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Li S, Zhang Z, Zhang X. A qualitative study exploring nursing students' perspectives on and attitudes towards hospice care in China. NURSE EDUCATION TODAY 2022; 119:105384. [PMID: 35750535 DOI: 10.1016/j.nedt.2022.105384] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With the fast growth of the older population and the increasing rates of chronic illnesses, the demand for hospice care is increasing at a rapid pace. This is bringing great challenges to the healthcare system in China. Given that nursing students will be the main healthcare workforce in the future, and as such, have responsibilities to prepare for these challenges. Therefore, understanding nursing students' perspectives and attitudes towards hospice care in China is important to promote the development of hospice care services. OBJECTIVES To explore the perspectives and attitudes of Chinese nursing students towards hospice care. METHOD The descriptive phenomenology of a qualitative approach was used for the study. Data were collected through semi-structured individual interviews from 11 nursing students in China between April and June 2021. Data were analysed using Colaizzi's seven-step approach. FINDINGS Three main themes were identified: (1) Lack of knowledge and skills; (2) lack of clinical experience; and (3) needs for service improvement. These findings indicated the problems of hospice care education and hospice care services in China. CONCLUSION The nursing students in this study lacked theoretical knowledge and the practical skills of hospice care. This suggests that medical educational institutions and the government should take action to increase hospice care training for nursing students, in order to increase the capacity and availability of hospice care services. It also informs policy-makers, health professionals, and health educators about the further need for the development of hospice care services in China.
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Affiliation(s)
- Shouqin Li
- School of Nursing, Lanzhou University, Lanzhou 730000, China.
| | - Zhaoxin Zhang
- School of Nursing, Lanzhou University, Lanzhou 730000, China
| | - Xiubin Zhang
- School of Nursing, Lanzhou University, Lanzhou 730000, China.
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Sagin A, Ellman MS, Shariff RR, Jones CA, Tindall K, Siropaides CH. A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective. Am J Hosp Palliat Care 2020; 38:1126-1134. [PMID: 33143465 DOI: 10.1177/1049909120971565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The medical student experience of a clinical elective in palliative care (PC) remains understudied. Reflective narrative interventions can help students hone narrative competency skills, make sense of their clinical experiences and shed light on their perception of the rotation. OBJECTIVES To evaluate medical student written reflections after a PC clinical elective. DESIGN Students were asked to write a short reflective essay after PC clinical electives using open-ended writing prompts. SETTING Essays were collected from third and fourth-year medical students after completion of a PC elective at three geographically diverse academic medical centers in the United States. MEASUREMENTS Essays were coded for themes using a conventional content qualitative method of analysis. RESULTS Thirty-four essays were analyzed and four major themes emerged: reflection on the mission of medicine or motivation for being in medicine, reflection on professional skills or lessons learned, reflection on patient's experience and personal responses to PC rotation. Sub-themes were also identified. CONCLUSIONS Themes underscore the utility of the PC clinical elective as a meaningful experience that imparts useful skills, builds empathy, reminds students of their own motivations for being in medicine and serves as a catalyst for reflection on their own lives and relationships with their patients. Awareness of medical students' personal and emotional responses to a PC elective can help inform educators as they support their students and provide opportunities for reflection and education.
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Affiliation(s)
- Alana Sagin
- Palliative Care Program, Department of Medicine, 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Matthew S Ellman
- Department of Internal Medicine, 12228Yale School of Medicine, New Haven, CT, USA
| | - Ruhi R Shariff
- Palliative Care Program, 12245Rush Medical College, Chicago, IL, USA
| | - Christopher A Jones
- Section of Palliative Care, 12277Duke University School of Medicine, Durham, NC, USA
| | - Kate Tindall
- Section of Supportive and Palliative Medicine, Department of Medicine, 25989UT Southwestern Medical School, Dallas, TX, USA
| | - Caitlin H Siropaides
- Section of Supportive and Palliative Medicine, Department of Medicine, 25989UT Southwestern Medical School, Dallas, TX, USA
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Wong KY, Li WTV, Yiu PY, Tong TK, Ching OH, Leung LY, Cheung TY, Chan SC, Law HY, Cheng CH. New Directions in Pediatric Palliative Care Education for Preclinical Medical and Nursing Students. MEDICAL SCIENCE EDUCATOR 2020; 30:445-455. [PMID: 34457688 PMCID: PMC8368940 DOI: 10.1007/s40670-020-00928-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Since insufficient education has partially contributed to challenges in providing pediatric palliative care (PPC), a cross-sectional questionnaire study was conducted to explore the knowledge, attitudes, and educational needs of preclinical medical and nursing students in Hong Kong. METHODS Pretested self-administered 44-item questionnaires with written informed consent were distributed to 241 medical and nursing students at Li Ka Shing Faculty of Medicine, the University of Hong Kong, between February and March 2019. This questionnaire covered eleven categories related to participants' knowledge of and attitudes towards PPC. A convenience sampling method was used. Data analysis was performed with descriptive statistics, chi-squared, and Fisher's exact test. RESULTS Only 38.3% of participants had heard of PPC before, but 73.5% advocated for its local commencement. A large number, with more in nursing, misunderstood fundamental palliative concepts and pain assessment methods. Many reported that undergraduate curricula should include PPC since they were not prepared to deal and cope with dying children. More medical students identified multidisciplinary approaches in PPC while less believed that they were mentally prepared to discuss death and dying. The majority indicated family as the final decision maker, even for teenage patients. Although a large proportion agreed that PPC should be delivered at home since the diagnosis of a life-limiting illness, only a few were aware of the suggested referral structure. CONCLUSIONS Most healthcare students were supportive of PPC despite their limited exposure. PPC education on palliative principles, pain management, multidisciplinary approaches, and emotional coping skills is needed and welcomed among students.
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Affiliation(s)
- Kan Yin Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wai Tak Victor Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Pui Yu Yiu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Kiu Tong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - On Hang Ching
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lok Yin Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Yau Cheung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sze Chai Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hoi Ying Law
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cheuk Hei Cheng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Talwalkar JS, Moriarty JP, Ellman MS. Students' Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students' Written Reflections. Am J Hosp Palliat Care 2019; 36:999-1007. [PMID: 31046393 DOI: 10.1177/1049909119847965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were to ascertain matriculating medical students' experiences with death and dying, describe the range of students' emotional responses, and identify reactions, behaviors, and perceived roles related to these and future experiences with death. METHODS We provided a writing prompt to newly matriculated medical students asking them to "reflect on experiences you may have had with family or friends near the end of life." Content analysis was performed to identify themes in the responses. RESULTS The 104 students in the entering class submitted 90 individual free-text responses (87%). Most (57%) students specifically mentioned at least 1 personal experience with death, with a range of emotional responses including sadness (29%), surprise (14%), and guilt (12%). Distinct themes emerged on content analysis including personal experiences with death, anticipated response to death in future, changes in body or mind of the dying person, thoughts and observations about others, and cognitive or existential responses. Few students wrote about religion or spirituality (8%) or palliative or hospice care (2%). CONCLUSIONS An understanding of students' premedical school experiences and emotional reactions to death may help educators frame curricula around end-of-life care. Educators could apply enhanced awareness to help students process their own experiences as they begin caring for patients and to focus on areas that were underrepresented in students' comments, such as religion, spirituality, palliative care, and hospice.
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Affiliation(s)
- Jaideep S Talwalkar
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,2 Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - John P Moriarty
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Ellman
- 1 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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