Learning and coping through reflection: exploring patient death experiences of medical students

Travuth Trivate,Sarah Sholl,Tracey Wilkinson,Ashley A Dennis

doi:10.1186/s12909-019-1871-9

Travuth Trivate, Sarah Sholl + Show 2 more

Open Access

https://doi.org/10.1186/s12909-019-1871-9

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Abstract

BackgroundExisting studies have explored many aspects of medical students’ experiences of patient death and propose the importance of faculty support for coping. However, UK-based literature on this subject and research concerning learning through reflection as part of coping are relatively limited. This study, through the lens of reflection, aims to explore students' experiences with patient death in a UK context. These include coping strategies, support from faculty following patient death and the relationship between these experiences and learning. Our research questions were:How do medical students cope with and learn from their experiences?How does support from ward staff and the medical school help them cope with and learn from these experiences?How can students best be supported following patient death?MethodsWe employed narrative inquiry to explore how medical students made sense of their experiences of patient death. Twelve students participated in our study via an online narrative questionnaire. Thematic analysis and complementary narrative analysis of an exemplar were applied to address our research aim.ResultsCoping strategies comprised internal and external strategies. Internal strategies included (1) re-interpretation of the death into a meaningful experience including lessons learned; (2) normalization; (3) staying busy and (4) enduring negative emotions. External strategies included speaking to someone, which was found to influence normalization, and lessons learned. Both satisfactory and unsatisfactory support from ward staff was identified. Satisfactory support was characterized by the inclusion of emotional and professional support. Unsatisfactory support was often characterized by a lack of emotional support. Narrative analysis further demonstrated how the experience with patient death was re-interpreted meaningfully. Students suggested that support should be structured, active, sensitive, and include peers and near-peers.ConclusionMany coping strategies, internal and external, were employed in students’ experiences with patient death. Student reflections, enhanced by support from ward staff, were shown to be important for learning from patient death. We encourage faculty to have regular sessions in which medical students can reflect on the death incident and discuss appropriately with others, including peers and near-peers.

Highlights

Existing studies have explored many aspects of medical students’ experiences of patient death and propose the importance of faculty support for coping
By exploring narratives of medical students about their experiences with patient death, this study identified many issues related to the research questions
I feel it is very beneficial to carry out this process as a medical student, and I feel better prepared for FY1 as a consequence. 11 12 13 14 I talked through this with both the Foundation year doctor (FY) and my supervisor, and reflected on it in my portfolio

Summary

Introduction

Existing studies have explored many aspects of medical students’ experiences of patient death and propose the importance of faculty support for coping. Medical education literature suggests that the death of a patient can be an emotionally significant event for medical students [1,2,3,4,5,6,7,8,9]. These emotions can be negative, such as fear [1], guilt [1,2,3,4], sadness [2,3,4,5,6,7,8], shock [2, 7,8,9] and anger [3, 8], or be positive, such as feeling uplifted [2, 6]. Potentially difficult, these early experiences provide significant opportunities for learning

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