Medical students' palliative care education in a Latin American university: a three-year experience at Austral University in Buenos Aires, Argentina.

BACKGROUND: The School of Medicine of Austral University incorporated palliative care as an elective in undergraduate medicine curriculum during 2010. OBJECTIVE: We analyzed the experience and results after 3 years of teaching palliative care. We compared students who chose palliative care as an elective subject (PC Group) with students who did not (Non-PC Group). We focused on the experience of contact with palliative care patients and self-perceived attitudes. Additionally, the impact produced by palliative care education in knowledge, self-perceived attitudes, and comfort was evaluated. METHODS: All the students tested completed a questionnaire on their attitude when exposed to dying patients. Students in the PC Group completed an additional questionnaire to assess their level of knowledge and their self-perceived comfort when interacting with patients. RESULTS: We tested 146 students. All students in the PC Group and 95.2% in the Non-PC Group considered that specific death issues ought to be part of the curriculum. Some students indicated that they could be present in a mandatory course. Before taking their elective, students in the PC Group confirmed a lack of technical training to understand palliative care patients, as did those students in the Non-PC Group. After taking a palliative care elective students expressed an improvement in self-perceived attitudes toward suffering and there was a significant increase (p<0.0001-0.0045) in knowledge. They also expressed an improvement in comfort levels in evaluation and treatment of pain. More than 95% of the students in the PC Group rated the experience as valuable and perceived the content as not available elsewhere in their training. DISCUSSION/CONCLUSION: Our results show that palliative care education provides opportunities to improve attitudes not specific to this discipline: interprofessional collaboration, holistic care, patient-centered care, self-awareness, and humanism. We conclude that an exposure to palliative care improved student's perception about the complexities of dying patients and their care.

A perspective of end-of-life care education in undergraduate medical and nursing students in Buenos Aires, Argentina.

BACKGROUND: The goals of this study were to evaluate: (1) the experiences and attitudes after exposure to dying patients in undergraduate medicine and nursing students with lack of training in end-of-life care issues; (2) whether or not exposure to terminally ill patients (TIPs) influences attitudes in students who had no training in end-of-life care; (3) students wishes regarding their future care of TIPs; and (4) if medicine and nursing students are indeed interested in receiving training in end-of-life care. MATERIALS AND METHODS: A survey was administered to students in the first and last year in schools of medicine and nursing, comprising seven universities in the city of Buenos Aires, Argentina, and surrounding areas. Data were collected during the 2005 to 2010 time period. Data from 730 students were analyzed. DISCUSSION AND CONCLUSION: We found that nursing and medical undergraduate students at nursing and medicine schools in the city of Buenos Aires and surrounding areas: (a) come in direct contact with TIPs and perceive their suffering; and (b) have a highly positive attitude toward these patients, even though some of them referred to that relationship as arduous and in some cases they tended to avoid emotional involvement because they did not feel well trained. We also found that (c) this wish for avoidance was increased in final-year medical and nursing students who had been exposed to a higher number of TIPs; and (d) students unanimously manifested the opinion that the teaching about caring of TIPs should be included in the curricula and they would be well disposed to receive it. For all these reasons, we consider that the teaching of caregiving to TIPs in the academic degree programs of nursing and medicine should not be presented as a marginal issue.

Nursing education: the experience, attitudes, and impact of caring for dying patients by undergraduate Argentinian nursing students.

BACKGROUND: There is extensive research documenting serious deficiencies in undergraduate nursing education related to end-of-life care. Many nurses and nursing students have difficulties in dealing with death and report feeling anxious and unprepared to be with patients who are dying. In Argentina, education on palliative care, death, and dying has not been made part of the undergraduate nursing curriculum. METHODS: We performed a multicenter survey on undergraduate nursing education regarding the care of dying patients at eight schools of nursing in Buenos Aires, Argentina. We enrolled 680 students from first to fifth year. RESULTS: Students acknowledged interacting directly with dying patients. Attitudes toward dying patients were highly positive. Students of the fifth year expressed a less satisfying relationship with their patients than those from the first year; considered it as a less gratifying occupation, and also showed a greater preference for avoiding emotional involvement with those patients. DISCUSSION: Many of them described in short and very expressive phrases the emotional impact of their encounters with patients facing a life-threatening illness. Students perceived that this issue received more attention in humanistic rather than clinical subjects. Ninety-eight percent of students spontaneously demanded more training in end-of-life care. The interest and desire of undergraduate students to enhance their knowledge and experience in palliative care, demands more specific teaching contents. CONCLUSION: This suggests that in Argentina, improvements in undergraduate nursing training are urgently needed and would be well received by the students. It could be very useful to consider this topic as part of accreditation standards for nursing programs.

Teaching dying patient care in three universities in Argentina, Spain, and Italy.

We performed a multicenter comparative survey on undergraduate medical education regarding the care of dying patients at medical schools in three countries. We enrolled 380 first- and sixth-year medical students from Universidad Austral (Argentina), Universidad de Navarra (Spain), and Università Campus Biomedico di Roma (Italy). Answers to the questions were similar among the three universities. Students acknowledged interacting directly with dying patients in all cases. Attitudes toward dying patients were highly positive. Students spontaneously requested more training in end-of-life care. Some attitudes and wishes varied significantly from course to course. Students perceived that this issue received more attention in humanistic rather than in clinical subjects. Ninety-eight percent of students considered that death and helping patients to have a good death should be included in their training. Students' attitudes revealed high interest and poor training in end-of-life issues. Medical curricula should be improved to adequately address these issues.