Medical students’ first clinical experiences of death

Medical Education 2010: 44 : 421–428 Objectives Many medical students feel inadequately prepared to address end‐of‐life issues, including patient death. This study aimed to examine medical students’ first experiences of the deaths of patients in their care. Methods Final‐year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e‐mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results Twenty‐nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e‐mail. The issues that emerged were organised under the overlying themes of ‘young’, ‘old’ or ‘unexpected’ deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five‐stage cyclical model of students’ experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ‘Preparation’ touches on personal experience and pre‐clinical instruction. ‘The event itself’ could be categorised as referring to a ‘young’ patient, an ‘old’ patient or a patient in whom death was ‘unexpected’. In the ‘resolution’ phase, coping mechanisms included rationalisation, contemplation and learning. The ‘lessons learned’ shape medical students’ experiences of future patient deaths and their professional identity. Conclusions A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient’s clinical circumstances, supervisor role‐modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student’s first experience of patient death and be educated regarding sympathetic debriefing.     

Medical students’ attitudes towards women: a sex-linked variable?

Two hundred and ten (95%) second-year clinical students at the London Hospital Medical College answered a questionnaire before and after their 2-month attachment in obstetrics and gynaecology, in an attempt to measure their attitudes to women and the subject being studied.
In only six of the thirty-two questions were there significant changes in the pre- and post-course responses, and these related to abortion, sterilization and obstetric practice. Students did not often answer 'don't know' to the questions, and the most striking finding was that the responses of male and female students differed, with statistical significance at the 1% level in twenty-six of the thirty-two questions. The male students were more likely to agree with statements which stereotyped women in a negative way and this suggests that, unless active steps are taken by medical teachers to help students to question their attitudes, women will continue to complain about the way they are treated by the medical profession, and women doctors will not fulfil their potential.     

Dietetic students’ performance of activities in an objective structured clinical examination

Background: Objective structured clinical examinations (OSCEs) have been used to assess the key clinical skills of many health professions; however, this form of assessment is not reported to have been used extensively for dietetic students. The present study explored which key dietetic skills could be assessed by an OSCE and which activity students performed best. Methods: An OSCE of six activities, two involving simulated patients, was developed to assess key dietetic clinical skills. Thirty‐five level two dietetic students undertook the OSCE, which was marked using structured marking tools. A self‐administered questionnaire was also used to obtain data concerning student’s opinion on the OSCE process and the time allowed for each activity. Results: Six activities were incorporated into the OSCE, involving communication, discriminatory and interpretation and food knowledge skills. The OSCE activity students performed least well involved knowledge of portion sizes and the carbohydrate content of specific foods. The activities that students performed best were the two activities in which mainly communication skills were assessed in simulated dietetic consultations using actors as standardised patients. Conclusions: A dietetic OSCE was generally positively accepted by the students and offers a very effect form of assessment of key dietetic skills. Students performed better at activities requiring communication skills than those requiring greater discriminatory and interpretation and food knowledge skills. Students’ food knowledge skills require reinforcing to ensure that they acquire the knowledge and skills that are unique to dietitians.     

Occupational therapy students’ perceptions of occupational therapy

Background/aims: An understanding of students’ perceptions of occupational therapy on entry is required to recognise how professional socialisation occurs through curriculum. Findings pertain to a qualitative study investigating students’ perceptions of occupational therapy upon entry to two occupational therapy programmes in Australia. Methods: Students commencing Bachelor of Occupational Therapy and Masters of Occupational Therapy Studies programmes participated in the study (n = 462). A purpose‐designed questionnaire was distributed to students in the first lecture of each programme. Preliminary analysis comprised identification of keywords/phrases and coding categories were generated from patterns of keywords. Frequency counts and percentages of keywords/phrases within categories were completed. Results: Students’ responses were categorised as ‘what’ occupational therapists do; ‘how’ they do it; ‘why’ they do it; and ‘who’ they work with. In ‘what’ occupational therapists do students frequently described ‘helping’ people. Both undergraduate and graduate entry masters students used the term ‘rehabilitation’ to describe how occupational therapy is done, with graduate entry students occasionally responding with ‘through occupation’ and ‘modifying the environment’. Students perceived the ‘why’ of occupational therapy as getting back to ‘everyday activities’, with some students emphasising returning to ‘normal’ activities or life. Regarding the ‘who’ category, students also thought occupational therapists worked with people with an ‘injury’ or ‘disability’. Conclusions: Students entered their occupational therapy programmes with perceptions consistent with the general public’s views of occupational therapy. However, graduate entry students exposed to a pre‐reading package prior to entry had more advanced occupational therapy concepts than undergraduate students.     

High school students’ attitudes about firearms policies

PURPOSE: To examine high school students' attitudes about firearm policies and to compare their attitudes with those of adults. METHODS: The Hamilton Youth and Guns Poll is the first national survey of high school students about their attitudes concerning firearm policies. Questions were asked of 1005 sophomores, juniors, and seniors about their actual (i.e., direct) exposure (e.g., presence of a gun in the home) and about their social (i.e., indirect) exposure (e.g., whether the student could get a gun) to firearms and related violence. Population weights were applied, and multivariate logistic regression was used to examine the relationship between demographic and exposure variables and opinions about firearm policies. RESULTS: Most high school students supported more restrictive firearm policies. Opinions varied little by demographic variables with the exception of gender. Females were significantly more supportive of most firearm policies. Actual exposure was a more consistent predictor than social exposure. Students living in a home with a gun, particularly a handgun, were less likely to support most restrictive gun policies. CONCLUSIONS: Most high school students in the United States favor stringent policies governing firearms. Adolescents' attitudes about firearm policies parallel those of adults.