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Original research
Care of the dying – medical student confidence and preparedness: mixed-methods simulation study
  1. Geoffrey Wells1,
  2. Carrie Llewellyn2,
  3. Andreas Hiersche1,
  4. Ollie Minton3,
  5. David Barclay4 and
  6. Juliet Wright1
  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, Brighton, UK
  3. 3 Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
  4. 4 St Wilfrid's Hospice, Eastbourne, UK
  1. Correspondence to Dr Geoffrey Wells; g.wells{at}bsms.ac.uk

Abstract

Objectives Of all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of simulation in teaching end-of-life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation has the potential to improve confidence and preparedness of medical students to care for dying patients. The main study objective was to explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.

Methods A mixed-methods interventional study simulating the care of a dying patient was undertaken with serial measures of confidence using the Self Efficacy in Palliative Care (SEPC) tool. Significance testing of SEPC scores was undertaken using paired t-tests and analysis of variance. Post-simulation focus groups gathered qualitative data on student preparedness. Data were transcribed using NVivo software and interpreted using Thematic Analysis.

Results Thirty-eight 4th-year students participated. A statistically significant post-simulation increase in confidence was seen for all SEPC domains, with sustained confidence observed at 6 months. Focus group data identified six major themes: current preparedness, simulated learning environment, learning complex skills, patient centredness, future preparation and curriculum change.

Conclusion Using simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

  • Clinical assessment
  • Terminal care
  • Symptoms and symptom management
  • Education and training
  • Clinical decisions

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/spcare-2022-003698

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors GW is the main researcher and guarantor for this study and has been involved in every aspect of the study from initial conception through to completion and write up. CL has provided academic support throughout the study, including statistical advice and guidance particularly with data interpretation and analysis. They have been actively involved in the revision and review of all aspects of the study. They have reviewed the manuscript prior to submission. AH has provided clinical support for the simulations, in capacity as a palliative medicine specialist and educationalist. They have helped with the development and facilitation of simulation scenarios. They have reviewed the manuscript prior to submission. OM has provided clinical support for the simulations in capacity as a palliative medicine specialist. They have provided academic support to the study and has acted as facilitator for the simulations. They have reviewed the manuscript prior to submission. DB has provided clinical support as facilitator for the simulations in their capacity as a palliative medicine specialist. They have reviewed the manuscript prior to submission. JW has provided overarching support for this study and has provided the resources and expertise in its development from conception. They have reviewed all aspects of the study at every stage with expertise as both a clinician and educationalist. They have reviewed the manuscript prior to submission.

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

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.