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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 1  |  Page : 18-21

Medical students' perception on ethics and communication module: How to deal with death?


1 Department of Forensic Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Anatomy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission27-Nov-2020
Date of Decision20-Jun-2021
Date of Acceptance23-Nov-2021
Date of Web Publication02-Sep-2022

Correspondence Address:
Dr. Chandni Gupta
Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_117_20

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  Abstract 


Background: For the overall development of medical professionals, the affective domain compromising attitude, communication, and ethics needs to be taught. Hence, the aim was to analyze the perception of the students regarding the ethics and communication module “How to deal with Death?”
Materials and Methods: A study was conducted on 81 undergraduate students of the 9th semester who attended the module. They were told to fill the questionnaire based on Likert scale regarding the module after the module was over. Later, the results were analyzed.
Results: More than half of the respondents felt that role-play was the best method of teaching this module. This module had a positive impact on more than 90% of the students. More than 90% felt that empathy and compassion are required while dealing with death. Half of the students felt that empathy and compassion while dealing with death can be taught to medical students. More than 80% felt that this module helps them in developing patient-centered care. More than 75% felt that such modules help them to become good doctors. More than 95% of the students felt that medical students should know about euthanasia and end-of-life issues.
Conclusion: Students feel that such a module on ethics and communication should be taught in their regular MBBS curriculum.

Keywords: Curriculum, empathy, euthanasia, students


How to cite this article:
Palimar V, Gupta C. Medical students' perception on ethics and communication module: How to deal with death?. J Med Soc 2022;36:18-21

How to cite this URL:
Palimar V, Gupta C. Medical students' perception on ethics and communication module: How to deal with death?. J Med Soc [serial online] 2022 [cited 2022 Sep 30];36:18-21. Available from: https://www.jmedsoc.org/text.asp?2022/36/1/18/355575




  Introduction Top


Most of the medical students want to become a physician as they want to cure patients and medical training prepares the physicians in the same way.[1] Their curriculum has no topics on death and matters correlated to it like communicating bad news, grief, and euthanasia. And when these young students graduate, they feel themselves unprepared for such end-of-life issues. This is all because of the fact that the training in the medical curriculum is mainly based on curing instead of being compassionate. The student is educated that illness can be cured and they can gain victory over the death. Moreover, they are taught to work against death and not with it.[2]

For such students, it can be very tough to admit that all diseases are not remediable and death is occasionally unavoidable, and it is very difficult to communicate it to patients or to patients' families. This type of condition has altered the doctor–patient bond, and there is a need to talk about these concerns recently.[3] Nowadays, a lot of consideration has been focused toward death associated matters which include the role of a doctor in taking care of terminally ill patients and interacting with patients and their family members about death and dying.[4] All specialty doctors sometime have to communicate some bad news to their patients and their family members, and therefore, they need to be qualified for this during their medical curriculum.[5]

Due to all these reasons, Medical Council of India has projected a new systematized longitudinal program on attitude, ethics, and communication, which is known as the AETCOM. It has a framework of competency-based learning in the attitude, ethics, and communication fields that a medical expert should have at the time of graduation so that they should successfully fulfill the criteria of Indian medical graduate as an outstanding clinician, a perfect leader, and a competent fellow of health-care team and organization. Such medical graduates will also become outstanding communicators, lifelong learners, and well-developed experts.[6]

Hence, keeping these points in mind in our college, we taught the ethics and communication module “How to deal with Death?” to 9th-semester MBBS students. After conducting the module, we took their perception regarding the module.


  Materials and Methods Top


An observational study was conducted on 81 undergraduate students. Students of the 9th semester who attended the module “How to deal with death?” were included in the study. Those who did not attend the module and other semester students were excluded from the study. The module was conducted as a part of AETCOM program. It is taken as a 2 h session. In that 2 h, one video was shown to students, a debate was done on a topic regarding the module, a case was given followed by discussion, and students were told to do a role-play regarding the module. Later after the module was over, they were told to fill the questionnaire based on Likert scale regarding the module. Later, all the questions of the questionnaire were analyzed and the results were calculated in percentage.


  Results Top


Response of students regarding various teaching modalities of the module is shown in [Chart 1]. About 52% of the respondents felt that role-play was the best method of teaching this module.



Percentage of students answering each question regarding the module is shown in [Table 1].
Table 1: Percentage of students answering each question

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This module had a positive impact on 93% of the students. Almost 96% of students felt that empathy and compassion are required while dealing with death. About 50% of the students felt that empathy and compassion while dealing with death can be taught to medical students. About 81% of students felt that this module helps them in developing patient-centered care. About 81% of students felt that such modules help them to become good doctors. Almost 97% of the students felt that medical students should know about euthanasia and end-of-life issues.


  Discussion Top


Nowadays because of aging and associated chronic illness, doctors are seeing patients who are having diseases in their terminal stages, and patients who are not curable and they are having life-limiting sicknesses. Doctors whose aim was to save lives are feeling distress by seeing dying patients, and they are feeling that they are not prepared to deliver good care for the dying.[7] Why all these things are happening? This is because of inadequate information and skills concerning to death and its communication to the patient's families.

Many authors mentioned in their study that medical students feel that they are not well prepared for facing the dying patient. Although they might have “theoretical knowledge,” compassion is still missing in them.[8],[9] Some told that medical colleges should include training related to these types of topics in their courses so that students should be aware of the probable experiences and sentiments which they might face while dealing with the dying patient, and they should be given guidance on whom they can ask for support.[8],[9],[10] In our study, 97% of the students felt that medical students should know about euthanasia and end-of-life issues.

Sullivan et al. told in their study that educational practices in U. S. medical schools do not support satisfactory end-of-life care, and there is a need to change the curriculum to improve end-of-life care education.[7] Even from our study, it is clear that there is a need of such type of training in the medical school curriculum.

In Buss et al. study, almost 99% of students accepted the significance of advance directives and 84% of students expected that they might have to discuss end-of-life issues with patients while doing their practices. About 80% of students mentioned that they need more education regarding end-of-life issues.[11] In our study also, 96% of students felt that empathy and compassion are required while dealing with death and 97% of the students felt that medical students should know about euthanasia and end-of-life issues.

Billngs and Block mentioned in their study that students are in favor of teaching about palliative care, and it definitely influences student attitudes and improves their communication skills. However, the curriculum is not well integrated; most of the time, it is taught in the form of lectures and that also in the preclinical phase.[12] In our study, 50% of the students felt that empathy and compassion while dealing with death can be taught to medical students. Almost 93% of students mentioned that the module had a positive impact on them. About 81% of students felt that this module helps them in developing patient-centered care. About 81% of students felt that such modules help them to become good doctors. In our study, 52% of the respondents felt that role-play was the best method of teaching this module.

Marques et al. found that 80% of the students had not received any guidance in dealing with death situations. They also mentioned that training about death and dying is mainly theoretical, and real experiences can be used for training and educating about the end-of-life issues.[13]

Souza et al. mentioned that there should be a discussion on the topic of death and dying, which should begin in the first semesters in undergraduate courses so that students should develop a compassionate behavior while dealing with dying patients.[14] Duarte et al. and wear D in their study mentioned that the undergraduate curriculum should include such training so that such competencies can be improved, based on scientific, ethical, and legal knowledge.[15],[16]

Billings et al. mentioned in their study that medical students who are trained for end-of-life care are better prepared to deal with such matters. They also suggested that planned training has a substantial influence on students' professional development. Hence, there should be a place for such type of training in the medical curriculum to provide the best end-of-life care to all dying patients.[17] In our study also, 93% of students mentioned that this module had a positive impact them. About 81% of students felt that this module helps them in developing patient-centered care and help them to become good doctors. Almost 97% of the students felt that medical students should know about euthanasia and end-of-life issues.

Fraser et al., in their study, found that only 22% to 53% of students felt that they are prepared in dealing with end-of-life care issues. Students who underwent the training felt prepared than students who had no training. They also mentioned that there is a need for improvement in the curriculum on end-of-life issues, and they also highlighted the significance of exposing the students to terminally ill patients so that they are prepared in dealing with such issues.[18] In our study also, 93% of students mentioned that this module had a positive impact them. About 81% of students felt this module helps them in developing patient-centered care and help them to become good doctors. Almost 97% of the students felt that medical students should know about euthanasia and end-of-life issues.

Sullivan et al. mentioned in their study that even associate deans of medical education in the US support that training about end-of-life care issues should be incorporated in the existing undergraduate medical curriculum.[19]

Porter-Williamson et al. conducted a 32-h training session in palliative medicine for 3rd-year medical students who showed improvement in their knowledge.[20] In our study also, 93% of students mentioned that the module had a positive impact on them.

Anderson et al. mentioned in their study that medical students during their medical training should be trained more in caring for dying patients. This will improve their attitude while dealing with dying patients.[21] In our study also, 81% of students felt this module helps them in developing patient-centered care and help them to become good doctors.

Rappaport and Witzke in their study they mentioned that 54% of medical students feel that they were not well trained in dealing with terminally ill patients, and 91% agreed that they want to be trained in this area during their clinical years.[22] Even in our study also, 97% of the students felt that medical students should know about euthanasia and end-of-life issues.

From our research also, it is clear that even students feel that this module is essential in their profession. Hence, it is vital to implement these types of modules in their regular curriculum.

Acknowledgment

The author wishes to acknowledge the faculty members involved in teaching ethics and communication module-How to deal with death? for the students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lloyd-Williams M, Dogra N. Caring for dying patients – What are the attitudes of medical students? Support Care Cancer 2003;11:696-9.  Back to cited text no. 1
    
2.
Starzewski Júnior A, Rolim LC, Marrone LC. The preparation of the doctor and communication with family members about death. Rev Assoc Med Bras 2005;51:11-6.  Back to cited text no. 2
    
3.
Rakel RE, Storey P. Care of the dying patients. In: Rakel RE, editor. Textbook of Family Medicine. 5th ed. Philadephia: W.B. Saunders Company; 1995. p. 134-51.  Back to cited text no. 3
    
4.
Curtis KK, Mcgee MG. An overview of physician attitudes toward death and dying: History, factors, and implications for medical education. Illn Crisis Loss 2000;8:341-9.  Back to cited text no. 4
    
5.
Buckman R. Breaking bad news: Why is it still so difficult? Br Med J (Clin Res Ed) 1984;288:1597-9.  Back to cited text no. 5
    
6.
Attitude, Ethics and Communication (AETCOM) Competencies for the Indian Medical Graduate. Reconciliation Board. Academic Committee of Medical Council of India; 2018. Available from: https://www.mciindia.org.  Back to cited text no. 6
    
7.
Sullivan AM, Lakoma MD, Block SD. The status of medical education in end-of-life care: A national report. J Gen Intern Med 2003;18:685-95.  Back to cited text no. 7
    
8.
Jones R, Finlay F. Medical students' experiences and perception of support following the death of a patient in the UK, and while overseas during their elective period. Postgrad Med J 2014;90:69-74.  Back to cited text no. 8
    
9.
Ghodke BV, Ray-Mohanty I, Wagh AR, Deshmukh YA. Perception and attitudes of medical students toward communication, chronic disease and death. Int J Basic Clin Pharmacol 2014;3:854-9.  Back to cited text no. 9
    
10.
Royak-Schaler R, Gadalla S, Lemkau J, Ross D, Alexander C, Scott D. Family perspectives on communication with healthcare providers during end-of-life cancer care. Oncol Nurs Forum 2006;33:753-60.  Back to cited text no. 10
    
11.
Buss MK, Marx ES, Sulmasy DP. The preparedness of students to discuss end-of-life issues with patients. Acad Med 1998;73:418-22.  Back to cited text no. 11
    
12.
Billings JA, Block S. Palliative care in undergraduate medical education. Status report and future directions. JAMA 1997;278:733-8.  Back to cited text no. 12
    
13.
Marques DT, Oliveira MX, Santos ML, Silveira RP, Silva RP. Perceptions, attitudes, and teaching about death and dying in the medical school of the federal university of acre, Brazil. Rev Bras Educ Méd 2019;43:123-33.  Back to cited text no. 13
    
14.
Souza MC, Sousa JM, Lago DM, Borges MS, Ribeiro LM, Guilhem DB. Evaluation of the death attitude profile-revised: A study with health science undergraduate students. Texto Contexto Enferm 2017;26:e3640016.  Back to cited text no. 14
    
15.
Duarte AC, Almeida DV, Popim RC. Death within the medical undergraduate routine: Students' views. Interface (Botucatu) 2015;19:1207-19.  Back to cited text no. 15
    
16.
Wear D. “Face-to-face with it”: Medical students' narratives about their end-of-life education. Acad Med 2002;77:271-7.  Back to cited text no. 16
    
17.
Billings ME, Engelberg R, Curtis JR, Block S, Sullivan AM. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med 2010;13:319-26.  Back to cited text no. 17
    
18.
Fraser HC, Kutner JS, Pfeifer MP. Senior medical students' perceptions of the adequacy of education on end-of-life issues. J Palliat Med 2001;4:337-43.  Back to cited text no. 18
    
19.
Sullivan AM, Warren AG, Lakoma MD, Liaw KR, Hwang D, Block SD. End-of-life care in the curriculum: A national study of medical education deans. Acad Med 2004;79:760-8.  Back to cited text no. 19
    
20.
Porter-Williamson K, von Gunten CF, Garman K, Herbst L, Bluestein HG, Evans W. Improving knowledge in palliative medicine with a required hospice rotation for third-year medical students. Acad Med 2004;79:777-82.  Back to cited text no. 20
    
21.
Anderson WG, Williams JE, Bost JE, Barnard D. Exposure to death is associated with positive attitudes and higher knowledge about end-of-life care in graduating medical students. J Palliat Med 2008;11:1227-33.  Back to cited text no. 21
    
22.
Rappaport W, Witzke D. Education about death and dying during the clinical years of medical school. Surgery 1993;113:163-5.  Back to cited text no. 22
    



 
 
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