Preparing Medical Students for End-of-Life Care

Every medical student receives training in the scientific causes of death, but few are prepared for the emotional challenge of caring for dying patients. Ready or Not, a new video and EDC Study Guide, gives medical schools a powerful tool to introduce students to high-quality end-of-life care.

“Preparing doctors for end-of-life care is notoriously difficult,” says EDC’s Anna Romer, lead author of the new Study Guide. “Many physicians teaching medical students may want to address this topic, especially the feelings raised for doctors when a patient is dying, but they don’t have the tools, and often don’t feel they know how to do so effectively.” The Ready or Not package gives medical educators an informative, yet inexpensive tool that can take as little as a few hours of class time.

The video, produced by Emmy-Award winning filmmakers Pierre Valette and Bill Jersey, follows Harvard Medical School students in a ground-breaking course that pairs first year students with patients who are dying. Through these relationships and interviews with palliative care experts, the video creates a clear picture of the difficulties and the rewards that come with caring for a dying patient. The course, “Living with Life-Threatening Illness,” was developed by palliative care experts Dr. Susan D. Block and Dr. J. Andrew Billings.

“The video provides images that will stay with the students,” says Romer. In one scene, for example, cancer patient Lila Lieberman talks to the medical student working with her about the typical care she receives from one doctor. “I often feel like a paper doll,” says Lieberman. “My doctor hangs this gown on me and sees if it would fit…[and then tries] another.” Lieberman looks directly at the student, someone she has clearly grown to trust. “I would like you not to practice medicine like that,” she says.

EDC’s study guide draws on the situations portrayed in the video as vehicles for self-exploration and content for talking about doctor-patient relations. “The study guide gives teachers and students ways to address many of the complicated issues that arise in physician-patient relations,” explains Romer. These issues include degrees of intimacy with patients; self-disclosure; how much, in fact, doctors can do even when there are no further curative treatments; and the ways doctors can learn from patients. “We hope to enhance students’ comfort and skill in caring for dying patients and, more generally, to enhance their ability to forge meaningful relationships with patients.”

Together, the video and study guide provide content, structure and a formal place for students to grapple with the emotional side of caring for patients. “If there isn’t a formal place for medical students to learn about death and dying,” explains Romer, “those same students, once doctors, probably won’t feel competent when they confront the needs of dying patients and their families.”

In addition to funding by The Robert Wood Johnson Foundation, The Open Society Institute’s Project on Death in America, and The Nathan Cummings Foundation, this product came to fruition because of the deep commitment of video producers Pierre Valette and Bill Jersey as well as EDC’s Anna Romer and Mildred Solomon. “End-of-Life care is something that needs to be experienced. You need to be introduced to characters who are going through it.” says Valette. “What really moved us was to see how the caregivers clearly got something from their patients. It wasn’t the sad story we had anticipated—it was a life-affirming one.”