Lack of exposure to dying patients is resulting in low confidence among graduate doctors when caring for patients at the very end of life and for their families.
That is the conclusion of a systematic review recently published in the BMJ Supportive and Palliative Care journal, conducted by Dr Geoffrey Wells, Research Fellow in Medical Education at Brighton and Sussex Medical School (BSMS).
With support from colleagues and his supervisory group, Dr Wells looked at what is known about medical student confidence worldwide and to see which tools were being used to measure their confidence.
He discovered 15 articles from eight countries across a 26-year publication period (1993-2019). A diversity of assessment tools were being used, and student confidence was found to be low in the areas of symptom management, family support, and psycho-spiritual care.
Dr Wells said: “A general lack of exposure of medical undergraduates to actively dying patients, and lack of structure in undergraduate palliative care curricula were cited as factors responsible for the low confidence observed.”
This review is part of a larger study being led by Dr Wells at BSMS who is working towards his Medical Doctorate (MD).
Dr Wells undertook a series of simulations, measuring student confidence pre, post and six-months post simulation. In addition focus groups were conducted to ascertain how prepared students felt with respect to caring for the dying.
He recruited 38 students and ran simulations between March and May 2019: “During each simulation individual students had to care for a dying patient, using a mannequin, and a patient relative, played by an actor.
“Scenarios included dealing with symptom control, angry and distressed relatives, assessing appropriateness for clinically-assisted hydration and nutrition, as well as addressing the spiritual and religious needs of the dying patient.
“In some of the scenarios the patient died mid-scenario irrespective of the student’s actions – and part of this study was to see how students managed this situation.”
Dr Wells is continuing to analyse results but said: “What we are seeing in the data is a statistically significant post-simulation improvement in confidence, which appears to be sustained over a six-month period.”
Read the journal article here >