Experiences of medical students and nursing trainees from unexpected death through simulation training.

BACKGROUND: Dying in simulation training is controversially discussed. On the one hand, the danger of an emotional overload of the learners is pointed out. On the other hand, dying in simulation settings is addressed as an opportunity to prepare future health professionals to deal with patient death. The present study investigates how medical students and nursing trainees experience the sudden death of a simulated patient and how and under which conditions it can be valuable to simulate the patient's death. METHODS: At the TUM School of Medicine in Munich, Germany, we developed an interprofessional, simulation-based course in which participants were unexpectedly confronted with a cardiac arrest scenario within which resuscitation had to be discontinued due to an advanced directive. After the course, focus groups were conducted with nine medical students and six nursing trainees. Data were analysed using Grounded Theory techniques. RESULTS: The participants reported low to high emotional involvement. The active renunciation of life-sustaining measures was felt to be particularly formative and caused a strange feeling and helplessness. Questions of what could have been done differently determined interviewees' thoughts. The participants appreciated the opportunity to experience what it feels like to lose a patient. The course experience encouraged interviewees to reflect on dying and the interviewees explained that they feel better prepared to face death after the course. The unexpected character of the confrontation, presence of the advanced directive and debriefing positively affected the impact of the simulation. CONCLUSIONS: The study recognises simulation training as a promising approach for preparing future health care professionals to encounter a patient's death.

Changes in medical students´ and anesthesia technician trainees´ attitudes towards interprofessionality - experience from an interprofessional simulation-based course.

BACKGROUND: Interprofessional simulation based education (IPSBE) programs positively impact participants' attitudes towards interprofessional collaboration and learning. However, the extent to which students in different health professions benefit and the underlying reasons for this are subject of ongoing debate. METHODS: We developed a 14-h IPSBE course with scenarios of critical incidents or emergency cases. Participants were final year medical students (FYMS) and final year anesthesia technician trainees (FYATT). To assess attitudes towards interprofessionalism, the University of the West of England Interprofessional Questionnaire was administrated before and after the course. Using focus group illustration maps, qualitative data were obtained from a subcohort of the participants (n = 15). RESULTS: After the course, self-assessment of communication and teamwork skills, attitudes towards interprofessional interactions and relationships showed comparative improvement in both professions. Attitudes towards interprofessional learning improved only in FYMS. Qualitative data revealed teamwork, communication, hierarchy and the perception of one's own and other health profession as main topics that might underlie the changes in participants' attitudes. An important factor was that participants got to know each other during the course and understood each other's tasks. CONCLUSIONS: Since adequate communication and teamwork skills and positive attitudes towards interprofessionality account to effective interprofessional collaboration, our data support intensifying IPSBE in undergraduate health care education.

Medical Trainees' Experiences With Dying and Death.

This study investigates medical trainees' experiences with dying and death, by means of semistructured interviews. Nine medical students and nine residents reported a total of 114 experiences. The great majority of these experiences took place during the final year of medical school. The authors identified the latent characteristics, which illustrate an in-depth understanding of the significance of the described experiences. Three main themes emerged: circumstances of death, personal relationship, and one's own role. The age of the dying person, the extent of suffering, time frame and setting, and the patients' behaviors were factors that influence the perceptions of the experiences. The interviewees reported powerful emotional consternation by the patients' deaths with whom they had developed a close relationship. Failure, helplessness, and guilt were negatively associated perceptions of one's own role. This study illustrates the tension between emotional concern and professional detachment. It highlights the continuing existence of a physician image, in which control represents the key issue.

Insights into the meaning of medical students' studies. An online survey at two medical faculties.

Objective: The aim of the study was to investigate how medical students' deal with their own questions of meaning during their studies, how they cope with patients' questions of meaning or crises of meaning, to what extent their experience of meaning changes during their studies, and what role medical studies play in this. Methods: In 2022, we conducted an exploratory cross-sectional study in the form of an online survey at two German universities with students in the clinical part of their studies. Quantitative data were analyzed descriptively, and group differences were analyzed using Mann-Whitney U tests. Free-text comments were analyzed using thematic analysis. Results: Of the 111 participants (response rate 12%), 92% had addressed questions of meaning. 64% of the students felt that their studies were meaningful, and 45% felt that their clinical internships were meaningful. 59% reported that they had been confronted with questions of meaning in their contact with patients, although many of them felt that they had been inadequately prepared for this (56%). This impression was stronger among respondents at the beginning of the clinical phase compared to respondents at the end (U(56,34)=660, p=0.012). According to the students, strategies for dealing with questions of meaning were active engagement with topics of meaning, tolerance of uncertainties, or avoidance. In addition to the basic requirement of openness to all topics of meaning, students expressed the wish to be better prepared for professional questions of meaning and for follow-up work on stressful events. A wide range of critical experiences with training and the healthcare system had an inhibiting effect on the experience of meaning. Conclusion: Since a higher sense of purpose can be associated with improved health and motivation, university programs might have the potential to support students' sense of purpose and, in the long term, improve their capacities to support patients who grapple with questions of meaning.

'You Also Have to Let People Go'-Effects of Formative Experiences with Dying and Death on Medical Trainees' Attitudes.

This study investigates the effects of medical students' and residents' formative patient death experiences on their understanding of the role of the physician in dealing with dying patients. Analyses revealed a change in attitude, an acceptance of death as 'part of life'. Thoughtful and comprehensive care, allowing patients to die and enabling them to have a beautiful death, were identified as the physician's duty. Honesty, well timing and completeness were determined as the guiding principles of communication. The importance of distancing and keeping in control to practice the medical profession was stressed. The burdensome nature of making therapeutic decisions was emphasized.

Design and Transition of an Emergency E-Learning Pathology Course for Medical Students-Evaluation of a Novel Course Concept.

BACKGROUND: Around the world, the emergency brought about by the COVID-19 pandemic forced medical schools to create numerous e-learning supplements to provide instruction during this crisis. The question now is to determine a way in which to capitalize on this momentum of digitization and harness the medical e-learning content created for the future. We have analyzed the transition of a pathology course to an emergency remote education online course and, in the second step, applied a flipped classroom approach including research skills training. METHODS: In the summer semester of 2020, the pathology course at the Technical University of Munich was completely converted to an asynchronous online course. Its content was adapted in winter 2021 and incorporated into a flipped classroom concept in which research skills were taught at the same time. RESULTS: Screencasts and lecture recordings were the most popular asynchronous teaching formats. Students reported developing a higher interest in pathology and research through group work. The amount of content was very challenging for some students. CONCLUSION: Flipped classroom formats are a viable option when using pre-existing content. We recommend checking such content for technical and didactic quality and optimizing it if necessary. Content on research skills can be combined very well with clinical teaching content.