title: Preclinical Medical Students' Diverse Educational and Emotional Responses to a Required Hospice Experience.
abstract: BACKGROUND
  Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care.
  
  
  OBJECTIVE
  To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE).
  
  
  METHODS
  Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts.
  
  
  METHODS
  Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites.
  
  
  METHODS
  Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded.
  
  
  RESULTS
  Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions."
  
  
  CONCLUSIONS
  In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
authors.affiliation: 1 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Chung Sang
authors.initials: CS
authors.lastname: Tse
authors.affiliation: 2 Yale Palliative Care Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Morrison
authors.affiliation: 3 Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Ellman
mesh_terms: D001291:Attitude of Health Personnel; D004504:Education, Medical, Undergraduate; D004644:Emotions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*
keywords: emotional response; hospice care; medical education; preclinical students; reflective writing