Background: While reflection on experiences and attitudes related to death can be an important
component of learning to care for the dying, opportunities within the medical school curriculum
to promote learner reflection are often limited.
Objective: To describe implementation and evaluation of activities in an end-of-life curriculum
to promote self-reflection and student concerns and thoughts revealed through reflection
exercises.
Design: Within a lecture-based course on end-of-life care, second-year medical students participated
in four activities to promote self-reflection, including: (1) visualizing their own
deaths; (2) documenting their experiences with death; (3) writing essays reacting to course
content; and (4) participating in physician-led small group sessions.
Measurements: Student reaction essays and small group evaluations.
Results: Qualitative analysis of student reaction essays (2002–2004; total, n = 522) revealed
nine major themes in student concerns and thoughts related to caring for the dying. These
included: (1) expressing emotions; (2) personal grief and emotional detachment; (3) communicating
effectively; (4) spending enough time; (5) feeling ill-prepared to deal with death; (6)
losing a loved one; (7) shifting emphasis from curing to caring; (8) listening to patients and
respecting their decisions and (9) previous negative end-of-life experiences. Analysis of essays
and evaluations assessed the impact of the various reflection activities and demonstrated
that these activities allowed students to critically examine and discuss their experiences and
concerns regarding providing end-of-life care.
Conclusions: A variety of activities can be incorporated successfully into a largely didactic
curriculum to promote student reflection on their attitudes and concerns related to end-oflife
care, thereby laying an important foundation for their future practice in caring for the dying.
In addition, analysis of student reflection essays can serve as an important curriculum
evaluation tool.
