THE PREPAREDNESS OF STUDENTS TO DISCUSS END-OF-LIFE ISSUES WITH PATIENTS

Purpose. To explore how well medical schools prepare students to addre ss end-of-life issues with their patients. Method. In 1997, the author s surveyed 226 fourth year students at Georgetown University School of Medicine and Mayo Medical School, assessing relevant knowledge, exper iences, and attitudes, and the students' sense of preparedness to addr ess end-of-life issues. R Results. Seventy-two percent (162) of the el igible students responded. Almost all (99%) recognized the importance of advance directives and anticipated discussing end-of-life issues wi th patients in their practices (84%). However, only 41% thought their education regarding end-of-life issues had been adequate, only 27% had ever discussed end-of-life issues with a patient themselves, and only 35% thought they had had adequate exposure and education regarding ad vance directives. Eighty percent favored more education about end-of-l ife issues. Educational exposure to end-of-life issues and to role mod els, ability to correctly define an advance directive, number of end-o f-life discussions witnessed, and age all were associated the students ' sense of preparedness to discuss advance directives with patients. C onclusion. Most of the students felt unprepared to discuss end-of-life issues with their patients, but wanted to learn more. The factors ass ociated with a sense of preparedness suggest several possible, easily made, educational interventions, but further research is required to u nderstand the scope of the problem and to implement curricular modific ations.