End of Life Care Medical Education: 48 Hour Hospice Home Immersion Alters Students’ Lives

Abstract

Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their ability to synthesize and demonstrate basic medical knowledge and clinical skills but offers little assessment of the maturation of attitudes or their values. The University of New England College of Osteopathic Medicine (UNECOM), immerses second year medical students in a hospice home for 48 hours to enhance students’ perspectives in interprofessional palliative and end of life care. Methods: This project utilized qualitative ethnographic and autobiographic research designs. Two female second year medical students (27 y/o & 26 y/o) were immersed for 48 hours into a local hospice home, sleeping in a bed where others had died, to answer the question: “What is it like for ME to live in the Hospice Home for 48 hours and how does this contribute to my future as a practitioner?” Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and patient/family encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Themes common to both students that factored in the research question and their prior stated interest areas of medical humanities and person-centered care at end of life were identified. Three themes were selected for this article: 1) Person-Centered Experiences, 2) Spectrum of Communication, and 3) Introspection: Attitudes and Values. The process of living in the hospice home for 48 hours revealed students’ attitudes about various disease processes, their personal experiences with death and dying, and their assumptions about how patients approach death. Conclusion: This Hospice Home Immersion project provided both an educational approach and learning environment that was effective in advancing medical students’ attitudes, skills, and knowledge as evidenced by their self-reported life altering learning about end of life and palliative care.