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How do we train doctors to deal with death?

Author: Toby Scott, Head of Communications & Campaigns at Hospice UK
07 February 2018
  • Delegates at the conference organised by the General Medical Council and Hospice UK, focusing on how doctors are trained to deal with end of life issues.

A recent conference in Manchester, organised by the General Medical Council and Hospice UK, looked at how we train doctors to deal with end of life issues. The day was jointly opened by Dr Colin Melville, Director of Education and Standards for the GMC, and Claire Henry, Director for Improvement and Transformation at Hospice UK. Toby Scott, Head of Communications & Campaigns at Hospice UK ran a workshop about Dying Matters and public attitudes to dying, death and bereavement at the event and shares its key points with ehospice.

The sold-out event attracted a range of people from across medical education, from the heads of university undergraduate programmes to people from teaching hospitals. The speakers ranged from professors of medicine to medical students, as well as people like the always incredible Lesley Goodburn sharing her experience of her husband’s death in hospital.

The day was structured to discuss a series of questions. Where are we now? Where do we want to be? How do we get there? The short answer is that things are better than they used to be, but still not what we’d like to see.

Compared to a couple of decades ago, the amount of time medical undergraduate students spend on end of life issues has increased, but still varies widely depending on which university people are studying at. The basis of end of life teaching has changed as well. For earlier generations of doctors, end of life and palliative care was largely seen as a matter for the oncology department, whereas now it is both a specialism in its own right and also a matter of interest to a much wider range of other specialisms.

The role of hospices in medical education was discussed repeatedly. Many undergraduate programmes include a day in a hospice, which was found to raise more issues when we dig deeper into it. The first point is that spending a day in a hospice building doesn’t give a complete picture of the full range of hospice services and leaves medical students with many unanswered questions.

The second point came from some research carried out by Cambridge University. The undergraduate course split its students at random and gave one group the usual single day in a local hospice and the other group four days. Each was asked how prepared they felt to deal with end of life issues, and patients nearing death. The single day group actually felt less prepared than they had before: they’d seen enough to get a sense of the topic, but left feeling overwhelmed by it. The four day group, on the other hand, had enough time to pass through the sense of being incapable, and saw and heard enough to feel confident about tackling the issue.

This gets to the heart of the problem: time. Everyone would like undergraduate and trainee doctors to spend more time on end of life and palliative care, no matter what area of medicine they eventually intend to practice. But there is only so much time in the curriculum, and anything to be added to end of life issues has to be taken from somewhere else. Paediatrics? Geriatric care? Surgery? Public health education? Every area of medicine has a strong argument for retaining if not expanding the amount of time given to it in the training timetable.

Speakers from the British Medical Association presented results of a series of roadshow events held last year. These found that many doctors remember clearly the first patient who died in their care, and many see patient deaths as a failure. This prompted a vigorous discussion about how we care for doctors as human beings, who often are upset by the deaths of patients in their care, but lack a means to show this and the time to process these emotions.

The final session started to look at how we can improve the end of life part of medical education without requiring more time to be given to it. Here there were more questions than answers, more suggestions than firm policies. But everyone present agreed that the day had been a success in raising the questions, and left determined to seek ways to address it. Whatever the outcome, hospices will continue to have a vital role in helping educate the next generation of doctors. 
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