Palliative Care Core Competencies in Undergraduate Medical Education: Medical Student End-of-Life Care Training and Experience with Patient Death at Duke University (S767)

Abstract

•Understand the current exposure medical students receive to the care of dying patients on core clinical clerkships, such as medicine and surgery.•Understand the current curricular challenges for teaching core competencies in undergraduate medical education, specifically care of the dying patient, death pronouncement, and self-reflection after death. The current methods of teaching medical students culturally appropriate end-of-life care and palliative care curricula remain non-standardized due to challenges of integrating palliative care principles into existing medical education models. We performed a cross-sectional, observational study to assess end-of-life care training and experience with patient death during clinical rotations for 2nd year (MS2) and 4th year (MS4) medical students at Duke University School of Medicine. Electronic surveys were generated to assess demographic- and study-specific questions regarding exposure to palliative care curriculum and patient deaths. Each participant was assigned a study-specific identification number, and reviewers of surveys were blinded for data analysis. Participants included 29 MS2 and 18 MS4 students. Ninety-three percent (27/29) of MS2 students cared for less than five patients who died, and 24% (7/29) did not experience a patient death during their core clerkships. While 72% (13/18) of MS4 students cared for less than five patients who died, 11% (2/18) did not experience a single patient death by graduation from medical school. Only 21% (6/29) of MS2 and 50% (9/18) of MS4 students witnessed a death pronouncement and exam being performed by an attending or resident. Seventy-percent (19/27) of MS2 and 89% (16/18) of MS4 students report participating in end-of-life discussions, such as family meetings, during medical school. Medical students may be ill prepared to care for patients at the end of life after medical school training. Medical students at Duke University experienced, on average, less than five patients deaths prior to graduation. Few students experienced how to pronounce a patient death, and none received any formal training in this essential end-of-life skill.