Experience‐based learning: junior medical students’ reflections on end‐of‐life care

Abstract

Context Experience‐based learning may contribute to confidence, competence and professional identity; early experiences may be particularly formative. This study explored how pre‐clinical students make sense of their participation in the provision of end‐of‐life care within community settings. Methods We performed dialogic narrative analysis on essays written by junior medical students in New Zealand. Students had reflected on their participation as assistant caregivers in nursing homes, contributing to the personal care of the elderly residents who lived there. Essays had been submitted to a reflective writing competition that was run separately from the students’ medical studies. We analysed five essays about nursing placements, focusing on students’ stories about their engagement with residents who were suffering or were receiving end‐of‐life care. Results In their essays, students wrote about powerful and at times intense learning experiences during these early clinical attachments; their attitudes to death and dying were both highlighted and changed. Allied health professionals (e.g. caregivers) provided important support for student learning, especially in relation to seminal encounters such as those occurring in the course of providing end‐of‐life care. Support increased students’ participation and confidence. Reflective writing helped students make sense of their learning and led them to think about their own professional identities, even in the absence of observing or working with doctors in those settings. Conclusions Students’ reflections revealed that they tend to filter their learning experiences through the lens of future doctoring, especially when involved in challenging clinical situations. Although medical schools have limited influence on interprofessional relationships or mentoring within the environment of community hospitals, support from other staff can help junior students make the most of their engagement in end‐of‐life care. In‐depth reflection may facilitate the links between experience‐based learning and students’ emerging ideas about their own professional identities, but the underlying mechanisms need further exploration.

‘Whispers and shadows’: A critical review of the professional identity literature with respect to minority physicians

“…Articles that focused on values embedded within the profession included a study by Cope et al, 59 which looked at the expectations of surgery trainees who endorsed being driven by ‘perfectionism’, which made them feel ‘neurotic’. Others focused on how our institutions play a role in the construction of a professional identity, 65,113 including through the use of structured training programmes for students, residents and faculty members, 46,60‐62,100,104,114 physical spaces for trainees, 115 call modalities, 74 and opportunities for narrative writing 67,73 …”

“…Grounded theory (n = 17) was cited as the most commonly used methodology, which is appropriate in contexts in which researchers believe divergent epistemologies exist 69 . However, quite a few studies did not mention their choice of methodology (n = 11) and reported vague terms such as ‘inductive analysis’ or ‘open coding’ to describe the analytical work 45,51,52,54,55,58,63‐65,70‐81 . Studies included various contexts previously identified in health education research 82 (eg, longitudinal clerkships, social media, patient care, dual professions, etc.)…”

“…69 However, quite a few studies did not mention their choice of methodology (n = 11) and reported vague terms such as 'inductive analysis' or 'open coding' to describe the analytical work. 45,51,52,54,55,58,[63][64][65][70][71][72][73][74][75][76][77][78][79][80][81] Studies included various contexts previously identified in health education research 82 (eg, longitudinal clerkships, social media, patient care, dual professions, etc.) and only two included the participants' cultural context as an important consideration in their analysis.…”

“…Others focused on how our institutions play a role in the construction of a professional identity, 65,113 including through the use of structured training programmes for students, residents and faculty members, 46,[60][61][62]100,104,114 physical spaces for trainees, 115 call modalities, 74 and opportunities for narrative writing. 67,73 Although the influence of sociocultural values was present in other articles, 65,83…”

Critical reflection in medical training and the biomedical world view

“…Reflection is considered to be a key component of experiential learning, where there is an ongoing cycle of experience, analysis, theoretical review and planning for further action. 7 Reflection in medical education is thus largely focused on improving students' learning and on providing initial appreciation of the complexity and nuances of health professionals' work. Ideally, such reflection leads to 'transformative learning' where students gain insights into their own attitudes, ideas and roles in health care delivery.…”