Third-year medical students' experiences with dying patients during the internal medicine clerkship: a qualitative study of the informal curriculum.
OBJECTIVE
To explore third-year medical students' experiences with death and dying patients during the first internal medicine clerkship.


METHODS
In August 2002, through purposeful sampling, the authors targeted for open-ended interviews 32 third-year medical students at the University of California, San Francisco in the first core internal medicine clerkship. Interviews averaged 45 minutes in length and were audiotaped, transcribed, and analyzed using a grounded theory approach.


RESULTS
Twenty-eight (87.5%) students participated in interviews. All students encountered death or dying patients, and most cared directly for at least one dying patient. Students' relationships with patients were characterized by attachment, empathy, and advocacy. Students valued preparation by preclinical end-of-life (EOL) courses, but assigned greater value to patient care experiences guided by teams that acknowledged deaths, role-modeled EOL care, and respected students' participation in patient care. Clerkship experiences in EOL care affected students' developing professional identities by affording opportunities to manage strong emotions, understand the challenges of transitioning to residency, and gain a sense of self-efficacy as future physicians providing EOL care.


CONCLUSIONS
Third-year medical students' experiences with dying patients affect their skills and attitudes in EOL care, as well as the emergence of their professional identities. The behaviors and attitudes modeled by residents and attendings during the clerkships can strongly influence students' perceptions of and self-efficacy in EOL care. Further research and interventions into how residents and attendings model responses to death in the clinical clerkship may suggest strategies not only for EOL training, but also for mentoring professional development.
Ratanawongsa
Neda
N
University of California, San Francisco, School of Medicine, USA. neda@jhmi.edu
Teherani
Arianne
A
Hauer
Karen E
KE
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002982:Clinical Clerkship; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007407:Interviews as Topic; D008297:Male; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012495:San Francisco; D013337:Students, Medical / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*