Pre-Clerkiship Medical Student Preparedness for Patient Loss: A Qualitative Study
Poster #: 022
Session/Time: A
Author:
Remy Claire Lloyd, BS
Mentor:
Kelly A. Thomson, MD
Research Type: Educational
Abstract
INTRODUCTION:
Often, medical students experience the death of a patient they've cared for during clinical rotations. Students may lack the time and/or tools to process these events and emotions in the context of a heavy academic load and clinical expectations, juggling extra-curricular activities, and maintaining good work-life balance. This study aims to proactively assess pre-clerkship medical students' attitudes towards patient loss and adverse outcomes to better understand their preparedness.
METHODS:
An anonymous survey was distributed to the EVMS MD Class of 2027. Responses were collected from the end of the pre-clerkship period until the end of the first clerkship rotation. Likert scale and free-text responses were analyzed for perceived confidence in ability to cope, anticipated coping skills to be used, concerns, perceived emotional effect, and emotions anticipated experiencing as a result of patient loss or adverse outcomes.
RESULTS:
A total of 21 students participated in the survey. More than half of respondents reported being pretty confident in their ability to cope with patient loss (52%) and 4.8% were completely confident. A wide variety of concerns regarding patient loss and adverse outcomes were expressed. These ranged from fear of crying in front of attending physicians or patient family members (9.5%) to not knowing how to care for the patient's family afterwards (9.5%). Respondents also reported fear of its effect on their ability to care for others and inability to let go of situations (9.5% each). Further, 47.5% of respondents expect that experiencing patient loss will moderately or significantly emotionally affect them. Students most commonly expected to experience sadness/sorrow (57.1%), guilt, regret, or liability (38.1%), grief (33.3%), and anger (14.3%). Other responses included intellectualization, bewilderment, a feeling of being lost, sympathy, depression, and heaviness. Taking this into consideration, respondents suggested a varied spectrum of coping tools to employ during their clerkship year. The most common responses included talking with loved ones, mentors, counselors, or physicians (33%), journaling (19.0%), meditation/reflection (19.0%), physical activity (14.3%), and sleeping (14.3%).
CONCLUSION:
Evolving clinical responsibilities coupled with high academic demands create a unique environment during the clerkship year. Most students are likely to encounter the loss of patients they've cared for while adapting to this new environment. Despite most respondents feeling confident in their abilities to cope with patient loss and adverse outcomes, our findings suggest that pre-clerkship students still expect to be heavily impacted emotionally. Responses demonstrated a wide range of coping skills capable of bolstering resilience, with a network of loved ones or colleagues to talk to being predicted as the most important tool. Yet, most respondents still expect to feel sadness, guilt, or grief. Though the clerkship year is already heavily supported by clinical curricula, introducing and addressing the emotionally demanding aspects of medicine could increase preparedness and confidence in pre-clerkship students' ability to handle adverse patient outcomes. Thus, we suggest that proactive institutional support of patient loss could be an important pillar in student well-being.
Often, medical students experience the death of a patient they've cared for during clinical rotations. Students may lack the time and/or tools to process these events and emotions in the context of a heavy academic load and clinical expectations, juggling extra-curricular activities, and maintaining good work-life balance. This study aims to proactively assess pre-clerkship medical students' attitudes towards patient loss and adverse outcomes to better understand their preparedness.
METHODS:
An anonymous survey was distributed to the EVMS MD Class of 2027. Responses were collected from the end of the pre-clerkship period until the end of the first clerkship rotation. Likert scale and free-text responses were analyzed for perceived confidence in ability to cope, anticipated coping skills to be used, concerns, perceived emotional effect, and emotions anticipated experiencing as a result of patient loss or adverse outcomes.
RESULTS:
A total of 21 students participated in the survey. More than half of respondents reported being pretty confident in their ability to cope with patient loss (52%) and 4.8% were completely confident. A wide variety of concerns regarding patient loss and adverse outcomes were expressed. These ranged from fear of crying in front of attending physicians or patient family members (9.5%) to not knowing how to care for the patient's family afterwards (9.5%). Respondents also reported fear of its effect on their ability to care for others and inability to let go of situations (9.5% each). Further, 47.5% of respondents expect that experiencing patient loss will moderately or significantly emotionally affect them. Students most commonly expected to experience sadness/sorrow (57.1%), guilt, regret, or liability (38.1%), grief (33.3%), and anger (14.3%). Other responses included intellectualization, bewilderment, a feeling of being lost, sympathy, depression, and heaviness. Taking this into consideration, respondents suggested a varied spectrum of coping tools to employ during their clerkship year. The most common responses included talking with loved ones, mentors, counselors, or physicians (33%), journaling (19.0%), meditation/reflection (19.0%), physical activity (14.3%), and sleeping (14.3%).
CONCLUSION:
Evolving clinical responsibilities coupled with high academic demands create a unique environment during the clerkship year. Most students are likely to encounter the loss of patients they've cared for while adapting to this new environment. Despite most respondents feeling confident in their abilities to cope with patient loss and adverse outcomes, our findings suggest that pre-clerkship students still expect to be heavily impacted emotionally. Responses demonstrated a wide range of coping skills capable of bolstering resilience, with a network of loved ones or colleagues to talk to being predicted as the most important tool. Yet, most respondents still expect to feel sadness, guilt, or grief. Though the clerkship year is already heavily supported by clinical curricula, introducing and addressing the emotionally demanding aspects of medicine could increase preparedness and confidence in pre-clerkship students' ability to handle adverse patient outcomes. Thus, we suggest that proactive institutional support of patient loss could be an important pillar in student well-being.