P3D193: Coping with Death: Medical Student Curriculum on Discussions Around Death and Dying

Background: Death and dying is a topic that is inevitably encountered once a student starts clinical rotations in medical school. Having preemptive discussions about the experiences they will encounter is important to equip students with important resources and skills to navigate and cope with these experiences in all rotations. Experiences with death and dying can be particularly traumatic and challenging for students on pediatric rotations, where the experience involves children. There are workshops to equip resident physicians with this level of responsibility, but there is little data on preparation for medical students. Courses outlining these principles are not widely implemented on a medical school level, due to limited curricular time and lack of a standardized curriculum. McGovern Medical School (MMS) has a Transition to Clerkship course, where material is taught to prepare students for their clinical rotations, which is an optimal time to introduce student reflection on coping with death and dying. We aimed to assess the need for this type of training experience among medical students.

Methods: In this cross-sectional study, anonymous optional surveys were sent to preclinical and clinical MMS students via listservs in mid academic year of 2022. Data were collected for 1 month. Primary outcome of interest was potential utility of a curriculum on this coping with death and dying. Secondary outcomes were (1) whether medical students have witnessed a death and (2) what material they feel would be beneficial in a curriculum. This study was approved by UT Houston IRB.

Results: Response rates were 21% for preclerkship students (103/487) and 20% for clerkship students (99/491). Ninety-one percent of pre-clerkship and 75% of clerkship students responded “probably yes” or “definitely yes” that a workshop on this topic would be helpful. Sixty-six percent of pre-clerkship students had not witnessed a death before the wards, and 63% of clerkship students did witness a death on the wards. Overall, students wanted information on ways to handle emotions associated with death and dying and discussing death with families and loved ones.

Conclusion: Medical students experience major adjustments during clinical rotations. Curricula on coping with death during the wards is not standardized, and it is especially important during the pediatrics clerkship to be able to discuss this difficult topic with families who experience it. Future directions include creating a workshop in response to student needs and evaluating the effectiveness of the curriculum, which might include understanding the medical student role in end-of-life conversations, identifying resources available for students to cope, and increasing comfort in reflecting on these situations.