Senior Medical Students' Perceptions of the Adequacy of Education on End-of-Life Issues

Abstract

CONTEXT: It is unclear how well prepared U.S. senior medical students are to handle end-of-life issues as they reach the end of medical school. Additionally, the most optimal way of providing medical student end-of-life education has not been adequately defined. OBJECTIVE: This study aims to determine the preparedness of senior medical students at U.S. medical schools regarding end-of-life issues. DESIGN: A self-administered survey. SETTING: Six medical schools throughout the United States, two of which have a formal curriculum on end-of-life issues, and four of which do not. PARTICIPANTS: Fourth-year medical students during November through February of their senior year. MAIN OUTCOME MEASURE: Self-reported preparation on a number of end-of-life competencies. RESULTS: Of the 757 surveys sent out, 262 responses were received (34.6%). Only 22% to 53% of students (varying by topic) felt prepared by their education in the selected end-of-life competencies. Students attending medical schools with a formal end-of-life curriculum were more likely to feel prepared than students with no formal curriculum to address psychosocial issues (21% higher, p = 0.008), cultural/spiritual issues (21% higher, p = 0.005), technical aspects of end-of-life care (18% higher, p = 0.001), and treatment of common symptoms (34% higher, p = 0.001). Students who had more clinical experiences in palliative care were more likely to feel prepared to discuss end-of-life issues with patients (p = 0.013) and to treat common symptoms (p = 0.011). CONCLUSIONS: This study demonstrates support for development of formal curriculum on end-of-life issues, and emphasizes the importance of clinical exposure to terminally ill patients to prepare medical students to provide quality end-of-life care.