BackgroundUndergraduate teaching currently fails to adequately prepare doctors to deliver ‘end-of-life’ care. Despite much evidence supporting simulation-based teaching, its use in medical undergraduate palliative and ‘end-of-life’ care curricula remain low.AimThis study assesses whether simulation can improve the confidence and preparedness of medical students to provide holistic care to dying patients and their families, from clinical assessment to symptom management, communication and care after death.MethodsSix fourth-year medical students undertook individual simulations involving a dying patient (high-fidelity simulator) and family member (actor). Intentional patient death occurred in four of the six scenarios (although unexpected by students). Pre-simulation/post-simulation thanatophobia questionnaires measured student attitudes towards providing care to dying patients. Thematic analysis of post-simulation focus group transcripts generated qualitative data regarding student preparedness, confidence and value of the simulations.ResultsThematic analysis revealed that students felt the simulations were realistic, and left them better prepared to care for dying patients. Students coveted the ‘safe’ exposure to dying patient scenarios afforded by the simulations. Observed post-simulation reduction in mean thanatophobia scores was not found to be statistically significant (p=0.07).ConclusionsResults suggest a feasible potential for simulations to influence undergraduate medical student teaching on the care of a dying patient and their family. We believe that this study adds to the limited body of literature exploring the value of simulation in improving the confidence and preparedness of medical students to provide ‘end-of-life’ care. Further research into the cost-effectiveness of simulation is required to further support its application in this setting.

ObjectivesOf all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.MethodsA mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.ResultsThirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.ConclusionUsing simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

ObjectivesTo investigate the level of medical student anxiety in caring for a dying patient and their family and identify influencing factors.MethodsWe conducted a cross-sectional survey in a UK medical school to measure medical student anxiety using a validated Thanatophobia Scale questionnaire.ResultsIn total, 332 questionnaires were completed. Mean thanatophobia score was 19.5 (SD 7.78, range 7–49). Most respondents were female (67.4%) and did not have a previous undergraduate degree (56%). Median student age was 22 years (IQR 20–24). Year of study influenced anxiety level, with second year students displaying an increase in mean thanatophobia score of 6.088 (95% CI 3.778 to 8.398, p<0.001). No significant differences were observed between final year and first year thanatophobia scores. For each 1-year increase in student age, mean thanatophobia score reduced by −0.282 (95% CI −0.473 to −0.091, p=0.004). Degree status and gender identity did not significantly affect thanatophobia score.ConclusionA degree of thanatophobia exists among medical students, with no significant improvement observed by completion of training. Recognising this anxiety to care for the dying earlier in undergraduate curricula will give educators the opportunity to address students’ fears and concerns and better prepare our future doctors for their role in caring for our dying patients and their families.

Background One in five patients suffering with terminal cancer is given a blood transfusion. However, given that blood is a finite resource, research is currently lacking on healthcare professional's opinions on blood transfusions in terminally ill cancer patients. Aims To explore the views of healthcare staff regarding the value of blood transfusions for symptom management in patients with advanced cancer in the last months of life, and to compare practices and attitudes in palliative care and oncology staff towards palliative blood transfusions. Methods A web-link to an online questionnaire was distributed to 120 healthcare assistants, nurses and doctors working in either oncology or palliative care. 46 completed the questionnaire, which contained questions about the use and indications of blood transfusions in their specialty. It also asked about their views on the subject of blood transfusions in terminally ill cancer patients. Responses were compared using means, medians and percentages. Results Both groups of healthcare professionals thought that blood transfusions in terminally ill patients were ‘sometimes appropriate’ (3.91(4), 3.90(4)), and no oncology nurses, or doctors in either group thought blood should be withheld from them. However, some nurses in palliative care thought blood transfusions should be withheld (n=2). Less palliative care healthcare professionals than oncology healthcare professionals thought that suffering was an appropriate reason for blood transfusions (74% and 90%, respectively). Conclusions There is a lack of current guidelines outlining when to give terminally ill cancer patients a blood transfusion, due to the fact that every patient needs to be individually assessed. Generally, attitudes towards blood transfusions were positive; most thought that suffering was an appropriate reason for a blood transfusion. The large majority did not think that blood transfusions should be withheld. Attitudes towards blood transfusions with palliative intent were slightly more positive in oncology compared to palliative care healthcare professionals.