Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the...

Varied meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death.

An 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with paired t tests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings.

A total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration ( $$ = -0.64, 95% CI -0.15 to -1.15), greater likelihood of accommodating ventilator removal ( $$ = 0.60, 95% CI 0.41-0.85), and greater acceptance ( $$ = 0.63, 95% CI 0.28-0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture ( $$ = 0.63, 95% CI 0.28-0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death ( $$ = 0.19, 95% CI -0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient ( $$ = -0.61, 95% CI -0.91 to -0.30) despite no change in frustration toward the surrogate ( $$ = -0.26, 95% CI 0.20 to -0.70).

Changes in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.