title: Medical students writing on death, dying and palliative care: a qualitative analysis of reflective essays.
abstract: BACKGROUND
  Medical students and doctors are becoming better prepared to care for patients with palliative care needs and support patients at the end of life. This preparation needs to start at medical school.
  
  
  OBJECTIVE
  To assess how medical students learn about death, dying and palliative care during a clinical placement using reflective essays and to provide insights to improve medical education about end-of-life care and/or palliative care.
  
  
  METHODS
  Qualitative study in which all reflective essays written by third-year medical students in 1 year from a UK medical school were searched electronically for those that included 'death', 'dying' and 'palliative care'. The anonymised data were managed using QSR NVivo 10 software, and a systematic analysis was conducted in three distinct phases: (1) open coding; (2) axial coding and (3) selective coding. Ethical approval was received.
  
  
  RESULTS
  54 essays met the inclusion criteria from 241 essays screened for the terms 'death', 'dying' or 'palliative'; 22 students gave consent for participation and their 24 essays were included. Saturation of themes was reached. Three overarching themes were identified: emotions, empathy and experiential and reflective learning. Students emphasised trying to develop a balance between showing empathy and their emotional state. Students learnt a lot from clinical encounters and watching doctors manage difficult situations, as well as from their refection during and after the experience.
  
  
  CONCLUSIONS
  Reflective essays give insights into the way students learn about death, dying and palliative care and how it affects them personally as well as the preparation that is needed to be better equipped to deal with these kinds of experiences. Analysis of the essays enabled the proposal of new strategies to help make them more effective learning tools and to optimise students' learning from a palliative care attachment.
authors.affiliation: Hull York Medical School, University of Hull, Hull, UK.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Boland
authors.affiliation: School of Medicine and RI Primary Care & Health Sciences, Keele University, Keele, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dikomitis
authors.affiliation: International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Gadoud
mesh_terms: D001293:Attitude to Death; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004644:Emotions; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D018794:Problem-Based Learning; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology*; D013727:Terminal Care / Q000379:methods*
keywords: Medical students; death; dying; education; palliative care; reflection