Training in End-of-life Care through Interaction with Dying Patients

Binienda, Juliann; Schwartz, Kendra; Gaspar, David L.

doi:10.1097/00001888-200105000-00049

Cited by 16 publications

(16 citation statements)

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“…Medical students show high stress levels early on in their studies [5-8], and the transition from the preclinical to the clinical phase is particularly demanding [6,9,10]. However, the medical profession seems uninterested in its members’ mental health [7].…”

Section: Introductionmentioning

confidence: 99%

“…Other sources of high and more chronic stress are the increasing workload [25], and concerns about academic performance in conjunction with lacking leisure time, particularly during the clinical phase, when professional knowledge and skills are put to the test [6]. Communicating with sick and dying patients and their families can also be a source of stress [9]. …”

Section: Introductionmentioning

confidence: 99%

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Show what you know and deal with stress yourself: a qualitative interview study of medical interns’ perceptions of stress and gender

Verdonk

Räntzsch²,

Vries

et al. 2014

BMC Med Educ

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BackgroundMedical students report high stress levels and in particular, the clinical phase is a demanding one. The field of medicine is still described as having a patriarchal culture which favors aspects like a physicians’ perceived certainty and rationalism. Also, the Effort-Recovery Model explains stress as coming from a discrepancy between job demands, job control, and perceived work potential. Gendered differences in stress are reported, but not much is known about medical interns’ perceptions of how gender plays in relation to stress. The aim of this study is to explore how medical interns experience and cope with stress, as well as how they reflect on the gendered aspects of stress.MethodsIn order to do this, we have performed a qualitative study. In 2010–2011, semi-structured qualitative interviews were conducted with seventeen medical interns across all three years of the Masters programme (6 male, 11 female) at a Dutch medical school. The interview guide is based on gender theory, the Effort-Recovery Model, and empirical literature. Transcribed interviews have been analyzed thematically.ResultsFirst, stress mainly evolves from having to prove one’s self and show off competencies and motivation (“Show What You Know…”). Second, interns seek own solutions for handling stress because it is not open for discussion (… “And Deal With Stress Yourself”). Patient encounters are a source of pride and satisfaction rather than a source of stress. But interns report having to present themselves as ‘professional and self-confident’, remaining silent about experiencing stress. Female students are perceived to have more stress and to study harder in order to live up to expectations.ConclusionsThe implicit message interns hear is to remain silent about insecurities and stress, and, in particular, female students might face disadvantages. Students who feel less able to manifest the ‘masculine protest’ may benefit from a culture that embraces more collaborative styles, such as having open conversation about stress.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Show what you know and deal with stress yourself: a qualitative interview study of medical interns’ perceptions of stress and gender

Verdonk

Räntzsch²,

Vries

et al. 2014

BMC Med Educ

View full text Add to dashboard Cite

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“…[4][5][6][7][8][9][10][11][12] Many schools have published reports of their curricular changes to improve end-of-life care education. [13][14][15][16][17][18][19][20][21][22][23] These changes are well accepted by students, and many have been shown to improve students' confidence, attitudes, and knowledge about end-of-life care. [24][25][26][27][28][29][30] Despite these efforts, significant deficiencies remain.…”

mentioning

confidence: 99%

“…[32][33][34][35][36] Medical schools vary dramatically in the amount and type of end-of-life care instruction students receive. [13][14][15][16][17][18][19][20][21][22][23]31 In particular, there is significant variation in students' clinical exposure to death and dying patients. National Consensus Recommendations underscore the importance of students being exposed to dying patients, 10 and survey studies indicate that students who have clinical end-of-life care experience feel more prepared to discuss end-of-life issues and treat common symptoms.…”

mentioning

confidence: 99%

Exposure to Death is Associated with Positive Attitudes and Higher Knowledge About End-of-Life Care in Graduating Medical Students

Anderson

Williams

Bost

et al. 2008

Journal of Palliative Medicine

109

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Objective: To examine the relationship between exposure to death and attitudes and knowledge about end-oflife care in graduating medical students. Participants and methods: Survey of students graduating from the University of Pittsburgh School of Medicine between 2001 and 2006. Students reported their personal experience with death and their exposure to death and dying patients during medical school. They rated their agreement, on a 4-point Likert scale, with 8 attitude items that were previously used in a national survey. Knowledge about end-of-life care was assessed with a 15-item test about pain and symptom management, ethics, treatment appropriateness, and hospice. Results: Three hundred and eighty students completed the survey; the response rate was 47%. Seventy-six percent of students reported personal experience with death, and 73% reported caring for dying patients or witnessing a patient's death during their third-year clerkships. Students had positive attitudes about physicians' responsibility and ability to help dying patients and their families, but reported negative emotional reactions to end-of-life care. Students who reported personal or professional experience with death had more positive attitudes and higher knowledge scores than those who did not, p Ͻ 0.05. Conclusions: Educational initiatives should maximize the time medical students spend caring for dying patients. Teaching students end-of-life care during the course of their clinical clerkships is an effective way to improve attitudes about end-of-life care. Schools should focus on developing emotionally supportive settings in which to teach students about death and dying.

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“…Em relação à realidade do terceiro e quarto ano, quando se inicia o ciclo clínico começa o grande contato com os pacientes e o inicio das cobranças pelos pacientes e professores com relação aos conhecimentos já adquiridos, além de um aumento da cobrança familiar e pessoal. Nesse período também há maior acúmulo de disciplinas cursadas e o aluno começa a lidar com conflitos éticos como pacientes em estado terminal, dor e sofrimento humano e situações relacionadas ao mau tratamento dos pacientes por parte dos professores e médicos 18,19 . Tudo isso pode corroer a autoestima do aluno de medicina.…”

Section: Medicinaunclassified