Aims To investigate medical students international elective experience of end of life care.
Methods An anonymous online questionnaire was distributed to all final year medical students at University of Bristol. Study was approved by the Faculty of Medicine and Dentistry Committee for Ethics.
Results 220 students were contacted, 60% responded. 72% students saw a patient die and 24% had witnessed a paediatric death abroad. 77% of students who saw a child die were in Africa; 1/3 resuscitated patients on their own—“the hospital had no doctors”. One poignant quote was one student commenting on how many patients had died “I’d never thought I’d say this but I honestly lost count”. For half the students it was their first experience of patient’s dying. Students reported being out of their depth signing death certificates, performing neonatal resuscitation and intubating children. There was a lack of equipment “nothing available to resuscitate with”, “no fluids, oxygen or drugs”. Students reported local staff underperforming “neonatal resuscitation was not performed anywhere near correctly, despite a poster with the right procedure on the wall”. Many students were angry or frustrated after their patient died: “angry at myself, worried that I didn’t do enough”; they also reported feeling patient death was an “injustice”. On elective students sought support from friends first, using social network sites and email, looking globally rather than from the local team—“didn’t want to burden people”. Students needed confirmation that others would have “done the same” helping them cope with the death. Only 13% thought their medical course had prepared them sufficiently to deal with death. Those who felt prepared had often gained this knowledge elsewhere for example, working as healthcare assistant rather than from formal medical teaching. Students commented that they would benefit most from a lecture “dealing with death” before their elective combined with a lecture “medicine in resource poor settings” in order to prepare for scenarios they might experience.
Conclusion Students on elective abroad often have to confront patient death. Many feel inadequately prepared or supported. These issues need to be addressed within the university curricula prior to sending students abroad.
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