Two-Dimensional Deaths? A Discourse Analysis of Patient Death in Preclinical Tutorial Cases at a Canadian Medical...

Area of Science:

• Medical Education
• Thanatology
• Curriculum Development

Background:

• Undergraduate medical education (UGME) often neglects the social and emotional aspects of death and dying.
• Existing curricula typically focus on biomedical, legal, or logistical elements, or confine these topics to palliative care or simulations.
• There is a need to explore how death and dying are represented within text-based learning materials.

Purpose of the Study:

• To investigate the discursive construction of death and dying in text-based cases within Case-Informed-Learning (CIL).
• To identify how the format, content, and purpose of these cases shape the representation of death.
• To highlight missed opportunities in undergraduate medical education for discussing death and dying.

Main Methods:

• Critical discourse analysis of 127 pre-clerkship tutorial cases used in undergraduate medical education.
• Document analysis using a developed template to examine the portrayal of death and dying.
• Longitudinal semi-structured interviews with 12 medical students throughout their program (92 interviews total).

Main Results:

• Death was featured in only 5% of cases, often as a predictable plot device, epilogue, or absence, rather than a central theme.
• Learning objectives and case titles rarely highlighted death and dying; when present, it was framed as a biomedical outcome.
• Students perceived the limited and poorly timed discussion of death as a missed educational opportunity.

Conclusions:

• The current Case-Informed-Learning curriculum often marginalizes the complexities of death and dying.
• Medical educators should carefully consider the design, content, and timing of cases to better represent patient death.
• Nuanced cases with ample time for discussion and reflection can help address gaps in preclinical death education.