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“It’s Not that Easy”—Medical Students’ Fears and Barriers in End-of-Life Communication

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Abstract

This study aims to assess and improve communication education for medical students in palliative care (PC) with the use of simulated patients (SP) in Germany. More specifically, to explore how students evaluate the use of SP for end-of-life communication training and which fears and barriers arise. A pilot course was implemented. Qualitative content analysis was used to analyse transcribed recordings of the course. Pre- and post-course questionnaires containing open-ended questions ascertained students’ motivation for participating, their preparation within their degree programme and whether they felt they had learned something important within the course. Seventeen medical students in their third to fourth year of education (age 22–31) participated in the five-session course and answered the questionnaires (pre n = 17, post n = 12). Students felt insufficiently prepared and insecure. Discussing end-of-life issues was experienced as challenging and emotionally moving. Within the conversations, although students sometimes showed blocking behaviour in reaction to emotional impact, they valued the consideration of emotional aspects as very important. The course was overall highly appreciated and valued as being helpful. The communication situation with the SP was perceived as authentic. Ten out of 12 students confirmed to have learned something important (post course). Our results indicate an urgent need for better communication training for medical students. Due to the fact that bedside teaching in PC is not feasible for all students, training with standardized SP can be a way to generate an authentic learning situation. Techniques to address fears and blocking behaviour should, however, also be considered.

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Notes

  1. Medical training principles in Germany base upon the Licensing Regulations for Physicians (Approbationsordnung) (http://www.bundesaerztekammer.de/downloads/Approbationsordnung2010.pdf). Undergraduate medical studies in Germany are divided into a pre-clinical part of 2 years and a clinical part of 4 years, including one practical year at the end. The first medical examination takes place after the pre-clinical part and the second examination after four following years of study. In consideration of examinations and revision time, the regular length of study covers a period of 6 years and 3 months.

    (http://www.bundesaerztekammer.de/page.asp?his=1.101.169. Accessed 2 May 2014)

  2. http://www.bmg.bund.de/fileadmin/dateien/Publikationen/Praevention/Broschueren/Broschuere_Nationaler_Krebsplan_-_Handlungsfelder__Ziele_und_Umsetzungsempfehlungen.pdf; p. 60–61

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Acknowledgements

The authors would like to thank the Offices of the Dean of Student Affairs of the University Hospital of Cologne for funding this project. Furthermore, we thank Anne Düsterdiek and Beatrice Beck for their observation and making field notes, Dr. Jan Schildmann for consultation on design and instruments, Dr. Julia Strupp and PD Dr. Christine Schiessl for helpful advice, Marianne Henry for transcription, Heather Graham for proof reading and especially, all participating simulated patients and students for their valuable engagement. Our department is supported for clinical studies by the Federal Ministry of Education and Research (BMBF01KN0706).

Ethical Standards

The manuscript does not contain clinical studies or patient data. All participants gave informed written consent.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Palliative Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    V. Romotzky, M. Galushko, A. Düsterdiek, C. Ostgathe & R. Voltz

  2. Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    R. Obliers & C. Albus

  3. Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen – EMN, University Hospital of Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany

    C. Ostgathe

  4. Center for Integrated Oncology Cologne/Bonn, Kerpener Str. 62, 50937, Cologne, Germany

    C. Albus & R. Voltz

  5. Center for Clinical Trials, Herder Str. 52-54, 50931, Cologne, Germany

    C. Albus & R. Voltz

  6. Department of Pediatric Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    A. Düsterdiek

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  1. V. Romotzky
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  2. M. Galushko
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  3. A. Düsterdiek
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  4. R. Obliers
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  5. C. Albus
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  6. C. Ostgathe
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  7. R. Voltz
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Correspondence to V. Romotzky.

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Romotzky, V., Galushko, M., Düsterdiek, A. et al. “It’s Not that Easy”—Medical Students’ Fears and Barriers in End-of-Life Communication. J Canc Educ 30, 333–339 (2015). https://doi.org/10.1007/s13187-014-0712-0

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  • DOI: https://doi.org/10.1007/s13187-014-0712-0

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