A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective

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.

Curricular Reform in Serious Illness Communication and Palliative Care: Using Medical Students’ Voices to Guide Change

“…6 However, medical school curricula vary in their content, timing, and integration of palliative care concepts, which are mostly elective. [7][8][9][10][11][12][13] Studies show that students' early and direct experiences in caring for people with serious illnesses improve their knowledge of and attitudes toward palliative care principles. 10,14,15 At 2 medical schools with nationally recognized longitudinal curricula in palliative care (University of Rochester School of Medicine and Dentistry and Yale School of Medicine), graduating students have reported feeling well prepared to communicate with seriously ill patients as interns.…”

“…Over recent decades, students in U.S. medical schools have had increasing access to educational experiences in palliative care, 1–5 coinciding with the growth of palliative medicine as a subspecialty 6 . However, medical school curricula vary in their content, timing, and integration of palliative care concepts, which are mostly elective 7–13 . Studies show that students’ early and direct experiences in caring for people with serious illnesses improve their knowledge of and attitudes toward palliative care principles 10,14,15 .…”

Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice

“…[8][9][10][11][12][13][14][15][16][17][18] Another 17 studies evaluated student-related outcomes immediately following the course, such as knowledge, confidence, attitude, and perceptions related to the content. 4,5,12,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] Two other studies did not evaluate student outcomes. 3,6 Only 3 studies evaluated how many students actually accepted positions in the specialty taught in the clinical elective on graduation.…”

“…Of the 30 articles, 11 provided evaluation data on the course itself, including the quality of the course, satisfaction with the course, how well the course met the objectives, and the student's intent in going into the specialty field after graduation 8-18. Another 17 studies evaluated student-related outcomes immediately following the course, such as knowledge, confidence, attitude, and perceptions related to the content 4,5,12,19-32. Two other studies did not evaluate student outcomes 3,6…”

A Week in the Life: Pediatric Palliative Care through the Eyes of a Medical Student

“…Written reflections by medical students after a palliative care rotation have demonstrated learnings in medical knowledge and patient care, such as pain and symptom management and assessing patient and family coping; communication; systems-based practice, such as understanding the patient experience; and personal and professional development, such as understanding the mission of medicine and personal growth [4][5][6].…”