Perceptions of a required hospice experience: a comparison of first- and fourth-year medical students

As more attention is focused on the need to improve end-of-life care, medical schools are expanding curricula in this area. This paper presents information about a 12-week, 60-hour hospice unit required for first-year medical students between 1989 and 2001, along with a comparison of first- and fourth-year students' perceptions of this unit. Surveyed in summer of 2001 were 111 individuals who had completed the unit: 59 students who had completed the hospice unit in the 2000-01 academic year and 52 graduating students who had completed the hospice unit in the 1997-98 academic year. The survey tapped perceptions of usefulness of the unit, comfort with end-of-life-care knowledge and skills, and suggestions for improvement. Ninety percent of graduating students rated the hospice experience as personally valuable and 81% aceeded its important for medical education, compared to 69% and 65% of first-year students, respectively. Almost all felt that the hospice unit was a useful experience for them as future clinicians. However, there were few differences in comfort with end-of-life skills between the two classes, e.g., almost 90% felt comfortable listening to patients; about 50% felt comfortable with their knowledge of grief/bereavement, symptom control, physical needs and psychosocial needs; and only 25% felt comfortable discussing a patient's terminal illness with the patient and family. The majority of students felt the unit should remain a first-year requirement, but wanted more opportunities to attend dying patients, work with physician role models, and reflect on their experience with death and its meaning.