Comment on: ‘Medical students do not feel confident in managing palliative care as future doctors’

Abstract

Dear Editor, I read with great interest the article ‘Medical students do not feel confident in managing palliative care as future doctors’ by Melgaard and Neergaard [1] in Progress in Palliative Care. I wanted to offer my perspective on the article as a medical student with an interest in palliative care as well as a student who has faced many interruptions to my undergraduate medical education due to the COVID-19 pandemic. I am not surprised that the results of the study by Melgaard and Neergaard [1] found that medical students do not feel confident in managing palliative care. The literature recognises that medical students are often shielded from seeing really sick patients and undergraduate medical training is centred around fixing people [2]. I have often observed amongst my peers the harmful ideology that a dying patient is a failure. We fail our patients when we cannot see beyond ‘fixing their ailment’ and as a result, neglect to bring comfort and dignity to their lives. I am concerned that the lack of confidence and negative attitudes towards palliative care in medical students may stem from lack of exposure to patients in palliative care. It is interesting that a study by Hammel et al. [3] found that the British palliative care curriculum lead to medical students with ‘more confidence and more supportive attitudes towards PC (palliative care)’ compared to students from the United States. Medical education has had to face huge disruptions, challenges and changes due to the COVID-19 pandemic. I read an article by Boland et al. [4] that highlighted, as junior doctors we will inexorably have to face caring for a dying patient throughout our career. However, by the time I graduate, I will have only encountered palliative care via online teaching. It concerns me that I will not have had first-hand experience with the complex interplay of symptom management, psychological, social and spiritual support seen in palliative care. How I am supposed to forge empathic connections with patients with incurable illnesses, if I have never witnessed the profound difficulties of their experience? I agree with the author’s narrative that it very important to evaluate student confidence and knowledge, in particular when implementing new, elaborate curriculum changes in palliative care. This article is even more pertinent to the undergraduate medical curriculum now. I believe it raises questions as to whether my own medical school and potentially other British medical schools have done enough to evaluate confidence and attitudes towards palliative care. I think it is crucial that more studies are conducted to ascertain the impacts of the COVID-19 pandemic on undergraduate palliative care teaching. Yours sincerely,