Background End of life care (EOLC) is a large part of junior doctors’ workload. Negative attitudes may impact on care provided and may be shaped during undergraduate medical training.

Aims We investigated:

• whether medical students expect EOLC to have a negative emotional impact on themselves

• demographic and psychological factors associated with such expectations.

Methods Multicentre cross-sectional online study of 1520 first and 954 final year medical students from 18 universities, (16 UK, 1 New Zealand, 1 Ireland). We assessed attitudes towards EOLC (Sullivan’s statements), age, gender, course year, course type (standard or graduate), spirituality and experience of bereavement as well as psychological variables: death anxiety (Collett Lester Fear of Death Scale, COLFD), empathy (Davis’s Interpersonal Reactivity Index, IRI) and depression (Hospital Depression Scale HADS-D). Factor analysis suggested 3 Sullivan statements formed a ‘negative personal emotional impact score’ (Impact Score, −6 to +6). Students with low/neutral (−6 to +3) and high (+3 to+6) Impact Score were compared (χ2-tests and ANOVA) and regression analyses undertaken.

Results Respondents were neutral overall (mean Impact Score=0.3), although with substantial variations. Participants with high Impact Score were likely to be younger, standard course, first-year students, and to have higher depression and distress scores (HADS-D and IRI-Personal-Distress-scale), lower cognitive empathy scores (IRI-Perspective-Taking) and to score more highly on all COLFD sub-scales. Regression analysis showed psychological factors were strongly associated with the Impact Score: COLFD others-dying (1.29;CI: 1.08 to 1.50;p=0.001), IRI-Personal-Distress-scale (0.97;CI: 0.77 to 1.17;p=0.001), HADS-D (0.45;CI: 0.17 to 0.74;p=0.002), and COLFD others-death (0.31;CI: 0.09 to 0.54;p=0.006) scales were the strongest predictors.

Conclusions Medical students worry about the possible negative personal emotional impact of EOLC when doctors. While medical education may mitigate such concerns, negative expectations appear related to distress, death anxiety and depression. Measures to improve and support psychological well-being may have a positive impact on medical students’ attitudes toward EOLC.