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Medical student confidence in care of the dying and their family: a systematic review
  1. Geoffrey Wells1,
  2. Elaney Youssef1,
  3. Rebecca Winter1,
  4. Juliet Wright1 and
  5. Carrie Llewellyn2
  1. 1 Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
  2. 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School Division of Primary Care and Public Health Medicine, Brighton, UK
  1. Correspondence to Dr Geoffrey Wells, Department of Medical Education, Brighton and Sussex Medical School, Brighton BN1 9PH, UK; g.wells{at}


Background The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.

Aim This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.

Design A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.

Data sources MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.

Results Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.

Conclusion This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.

PROSPERO registration number CRD42019119057.

  • terminal care
  • medical students
  • confidence

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  • Contributors GW is the primary author of this work. He has contributed to all aspects of this review, carrying out the initial review, screening all articles for eligibility, full-text review of eligible articles, data extraction, quality assessment, assimilation of results and detailed analysis and discussion of these results. GW has developed this report and has undertaken all aspects of editing for publication. GW takes responsibility for the overall content as guarantor. EY assisted with detailed data extraction of all eligible articles. EY undertook detailed quality assessment as a second reviewer using the MMAT which facilitated the measurement of inter-rater reliability. EY has also been involved in the editing process, and has made recommended changes to the final manuscript. RW undertook initial screening of a random 10% of articles to ensure articles met eligibility criteria, and was involved in the full text review of all studies deemed eligible. RW has also reviewed the final manuscript for any necessary editorial changes. JW has assisted in the development of this manuscript by providing research expertise and support throughout its development. Regular reviews of the manuscript at supervision meetings to recommend edits. JW has reviewed the final manuscript and made changes prior to publication. CL has been the main reviewer for this review, providing her expertise in the field of mixed-methods research, and systematic reviews. CL acted as a third independent reviewer for those articles for which GW and RW could not find a consensus with respect to eligibility. CL has helped with the formation of Cohen’s kappa score, and has made edits to the final document for publication.

  • Funding This review has been conducted as part of a fully funded medical doctorate being undertaken by the primary author at Brighton and Sussex Medical School

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.