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Simulation to improve medical student confidence and preparedness to care for the dying: a feasibility study
  1. Geoffrey Wells1,
  2. Julia Montgomery1 and
  3. Andreas Hiersche1,2
  1. 1Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
  2. 2Department of Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Geoffrey Wells, Department of Medical Education, 344a Watson Building, Brighton and Sussex Medical School, Brighton BN1 9PX, UK; g.wells{at}bsms.ac.uk

Abstract

Background Undergraduate teaching currently fails to adequately prepare doctors to deliver ‘end-of-life’ care. Despite much evidence supporting simulation-based teaching, its use in medical undergraduate palliative and ‘end-of-life’ care curricula remain low.

Aim This study assesses whether simulation can improve the confidence and preparedness of medical students to provide holistic care to dying patients and their families, from clinical assessment to symptom management, communication and care after death.

Methods Six fourth-year medical students undertook individual simulations involving a dying patient (high-fidelity simulator) and family member (actor). Intentional patient death occurred in four of the six scenarios (although unexpected by students). Pre-simulation/post-simulation thanatophobia questionnaires measured student attitudes towards providing care to dying patients. Thematic analysis of post-simulation focus group transcripts generated qualitative data regarding student preparedness, confidence and value of the simulations.

Results Thematic analysis revealed that students felt the simulations were realistic, and left them better prepared to care for dying patients. Students coveted the ‘safe’ exposure to dying patient scenarios afforded by the simulations. Observed post-simulation reduction in mean thanatophobia scores was not found to be statistically significant (p=0.07).

Conclusions Results suggest a feasible potential for simulations to influence undergraduate medical student teaching on the care of a dying patient and their family. We believe that this study adds to the limited body of literature exploring the value of simulation in improving the confidence and preparedness of medical students to provide ‘end-of-life’ care. Further research into the cost-effectiveness of simulation is required to further support its application in this setting.

  • terminal care
  • education and training
  • quality of life
  • symptoms and symptom management
  • supportive care
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Footnotes

  • Contributors GW is a research fellow in Medical Education at Brighton and Sussex Medical School. He has completed 2 years of training as a registrar in palliative medicine, and is completing a 2-year MD at the University of Sussex prior to completing registrar training. He is the primary author. JM is an emeritus senior lecturer in Medical Education. She is also a retired Consultant Obstetrician and Gynaecologist. JM undertook and advised on thematic analysis of data, given her expertise in this field from her previously published research. JM also reviewed and edited the final manuscript prior to submission. AH is a Macmillan Consultant in Palliative Medicine and Lead Clinician in Palliative Care at the Royal Sussex County Hospital, Brighton. He is also an honorary senior clinical lecturer at Brighton and Sussex Medical School. AH helped to facilitate the simulations, reviewed the content for accuracy and reviewed/edited the final draft of the manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication This study did not involve patients. Volunteer student participants were made aware this study would be written up for publication, and were informed that any student quotations would be fully anonymised.

  • Ethics approval Ethical approval was granted from the University’s Research Governance and Ethics Committee (RGEC).

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

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