Using reflection activities to enhance teaching about end-of-life care

While reflection on experiences and attitudes related to death can be an important component of learning to care for the dying, opportunities within the medical school curriculum to promote learner reflection are often limited.

To describe implementation and evaluation of activities in an end-of-life curriculum to promote self-reflection and student concerns and thoughts revealed through reflection exercises.

Within a lecture-based course on end-of-life care, second-year medical students participated in four activities to promote self-reflection, including: (1) visualizing their own deaths; (2) documenting their experiences with death; (3) writing essays reacting to course content; and (4) participating in physician-led small group sessions.

Student reaction essays and small group evaluations.

Qualitative analysis of student reaction essays (2002-2004; total, n = 522) revealed nine major themes in student concerns and thoughts related to caring for the dying. These included: (1) expressing emotions; (2) personal grief and emotional detachment; (3) communicating effectively; (4) spending enough time; (5) feeling ill-prepared to deal with death; (6) losing a loved one; (7) shifting emphasis from curing to caring; (8) listening to patients and respecting their decisions and (9) previous negative end-of-life experiences. Analysis of essays and evaluations assessed the impact of the various reflection activities and demonstrated that these activities allowed students to critically examine and discuss their experiences and concerns regarding providing end-of-life care.

A variety of activities can be incorporated successfully into a largely didactic curriculum to promote student reflection on their attitudes and concerns related to end-of-life care, thereby laying an important foundation for their future practice in caring for the dying. In addition, analysis of student reflection essays can serve as an important curriculum evaluation tool.