caring for special groups
Why are newly qualified doctors unprepared to care for patients at the end of life?
Article first published online: 15 MAR 2011
© Blackwell Publishing Ltd 2011
Volume 45, Issue 4, pages 389–399, April 2011
How to Cite
Gibbins, J., McCoubrie, R. and Forbes, K. (2011), Why are newly qualified doctors unprepared to care for patients at the end of life?. Medical Education, 45: 389–399. doi: 10.1111/j.1365-2923.2010.03873.x
- Issue published online: 15 MAR 2011
- Article first published online: 15 MAR 2011
- Received 1 February 2010; editorial comments to authors 23 February 2010, 27 July 2010; accepted for publication 14 September 2010
Medical Education 2011: 45: 389–399
Context Death and dying occur in almost all areas of medicine; it is essential to equip doctors with the knowledge, skills and attitudes they need to care for patients at the end of life. Little is known about what doctors learn about end-of-life care while at medical school and how they learn to care for dying patients in their first year as doctors.
Methods We carried out a qualitative study using face-to-face interviews with a purposive sample of 21 newly qualified doctors who trained in different medical schools.
Results Data were analysed using a constant comparative approach. Two main groups of themes emerged. The first pertained to medical school experiences of end-of-life care, including: lack of exposure; a culture of ‘clerking and signs’; being kept and keeping away from dying patients; lack of examinations; variable experiences, and theoretical awareness. The second group of themes pertained to the experiences of recently qualified doctors and included: realising that patients really do die; learning by doing; the role of seniors; death and dying within the hospital culture; the role of nursing staff, and the role of the palliative care team.
Conclusions Undergraduate medical education is currently failing to prepare junior doctors for their role in caring for dying patients by omitting to provide meaningful contact with these patients during medical school. This lack of exposure prevents trainee doctors from realising their own learning needs, which only become evident when they step onto the wards as doctors and are expected to care for these patients. Newly qualified doctors perceive that they receive little formal teaching about palliative or end-of-life care in their new role and the culture within the hospital setting does not encourage learning about this subject. They also report that they learn from ‘trial and error’ while ‘doing the job’, but that their skills and knowledge are limited and they therefore seek advice from those outside their usual medical team, mainly from nursing staff and members of palliative care teams.