Does simulated experience of caring for a dying patient and their family improve the confidence and preparedness of medical students?

Abstract

Background: Of all doctors, Foundation Year 1 (FY1) trainees spend the most time with dying patients and report feeling poorly prepared and lacking in confidence with respect to providing care to the dying. Despite documented effectiveness of simulation in teaching end of life care to undergraduate nurses, undergraduate medicine continues to teach this subject using a more theoretical, classroom-based approach. By increasing undergraduate exposure to interactive dying patient scenarios, simulation presents a potential opportunity to improve the confidence and preparedness of medical students to care for dying patients. Primary aims: To explore whether simulated experience of caring for a dying patient and their family can improve the confidence and preparedness of medical students to provide such care.Methods: Three studies were undertaken: a systematic review of the literature to ascertain what is known about the confidence of medical students to care for dying patients; a cross-sectional survey of medical student attitudes at Brighton and Sussex Medical School (BSMS) towards caring for a dying patient (Thanatophobia); and a mixed-methods interventional study simulating the care of a dying patient with pre/post measures of confidence (Self Efficacy in Palliative Care (SEPC) tool) and preparedness (Thematic Analysis (TA) of Focus Group data).Results: The systematic review found medical students experience low baseline confidence to care for dying patients, with evidence that additional teaching interventions can statistically improve their confidence. Lack of exposure to dying patients and inadequate education at undergraduate level were cited as main factors affecting confidence. 332 (46.4%) students returned the cross-sectional study. A higher degree of thanatophobia was observed in younger students (p=0.004, CI -0.473 – -0.091) and those in their second year of study (p<0.001, CI 3.778 – 8.398). Gender identity and degree status had no effect on thanatophobia. Thirty-eight fourth-year students participated in the simulation study. Low presimulation confidence echoed systematic review findings. A statistically significant post-simulation increase in confidence was seen for all three SEPC domains, with sustained confidence observed at six-months. Six themes were identified from focus group data: current preparedness, simulated learning environment, learning complex skills, patient centeredness, preparation for the future and curriculum change. Students reported feeling better prepared to care for the dying and felt the simulations would be a worthy addition to the current curriculum at BSMS.Conclusion: Using simulation to teach medical students how to care for a dying patient and their family increases student confidence and preparedness to provide such care.

Date of Award	Oct 2020
Original language	English
Awarding Institution	University of Brighton
Supervisor	Juliet Wright (Supervisor), Carrie Llewellyn (Supervisor), Andreas Hiersche (Supervisor) & Ollie Minton (Supervisor)