Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2015

Open Access 01-12-2015 | Research article

How do junior doctors in the UK learn to provide end of life care: a qualitative evaluation of postgraduate education

Authors: Sophie Price, Susie Schofield

Published in: BMC Palliative Care | Issue 1/2015

Login to get access

Abstract

Background

The fundamental importance of good end of life care has been well documented however recent national publications have high-lighted inadequacies in training in this area. For many patients dying in the UK today care is provided in hospital and the number of inpatient deaths is forecast to climb significantly in future. The demands of providing medical care for these patients by junior doctors will continue to rise. However, there is currently only limited research on training for doctors in this setting.

Methods

A qualitative study using semi-structured interviews of trainees working in general medicine analysed utilising a grounded theory approach.

Results

Eleven medical trainees from nine different medical schools participated. They had worked in fifteen different UK hospitals in the course of their careers. All of the doctors interviewed felt generally confident in managing a dying patient. This had developed at postgraduate level and increased when working in certain key specialties. Emerging themes fell into five main categories: perceived ability in clinical management, different learning opportunities experienced, the impact of variations in approach to end of life care, the role of the specialist palliative care team and suggestions for improvements to training. All participants felt further teaching would be beneficial.

Conclusions

This study identified key areas where training could be improved. This included small changes in everyday practice to shift the emphasis for trainees to education. There also needs to be focus on end of life care in the curriculum, formal teaching programmes and assessment of junior doctors. The specialist palliative care team played a vital role in training as well as service provision. For those working in this specialty, every clinical encounter provides an opportunity for education. Specifically targeting junior doctors will not only improve patient care today but empower the consultants of the future.
Appendix
Available only for authorised users
Literature
1.
2.
Riley J. A strategy for end of life care in the UK. BMJ (Clinical research ed). 2008;337:a943.CrossRef
3.
4.
General Medical Council. Tomorrow’s Doctors. London: General Medical Council; 2009.
5.
Field D, Wee B. Preparation for palliative care: teaching about death, dying and bereavement in UK medical schools 2000-2001. Med Educ. 2002;36(6):561–7.CrossRefPubMed
6.
Walker S, Gibbins J, Barclay S, Barnett M, Adams A, Pees P, et al. Palliative care (pc) education for medical students: has it improved over the last decade? A survey of pc education. BMJ Supp Palliat Care. 2014;4 Suppl 1:A35.
7.
Lloyd-Williams M, MacLeod RD. A systematic review of teaching and learning in palliative care within the medical undergraduate curriculum. Med Teach. 2004;26(8):683–90.CrossRefPubMed
8.
Gibbins J, McCoubrie R, Forbes K. Why are newly qualified doctors unprepared to care for patients at the end of life? Med educ. 2011;45(4):389–99.CrossRefPubMed
9.
Charlton R, Smith G. Perceived skills in palliative medicine of newly qualified doctors in the U.K. J Palliat Care. 2000;16(4):27–32.PubMed
10.
Bowden J, Dempsey K, Boyd K, Fallon M, Murray SA. Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants. J Roy Coll Phys Edin. 2013;43(1):24–8.CrossRef
11.
Wear D. “Face-to-face with It”: medical students’ narratives about their end-of-life education. Acad Med. 2002;77(4):271–7.CrossRefPubMed
12.
Charlton R, Currie A. A UK perspective on worldwide inadequacies in palliative care training: a short postgraduate course is proposed. Am J Hosp Palliat Care. 2008;25(1):63–71.CrossRefPubMed
13.
Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. The Lancet. 2004;363(9405):312–9.CrossRef
14.
15.
16.
17.
Gomes B, Higginson IJ. Where people die (1974--2030): past trends, future projections and implications for care. Palliat Med. 2008;22(1):33–41.CrossRefPubMed
18.
Silverman D. Doing Qualitative Research. 4th ed. London: Sage; 2013.
19.
Glaser BSA. The discovery of grounded theory : strategies for qualitive research. New York: Hawthorne; 1967.
20.
Corbin JSA. Basics of qualitative research : techniques and procedures for developing grounded theory. 3rd ed. Los Angeles: Sage Publications; 2008.CrossRef
21.
Tobaiqy M, McLay J, Ross S. Foundation year 1 doctors and clinical pharmacology and therapeutics teaching. A retrospective view in light of experience. Brit J Clin Pharmaco. 2007;64(3):363–72.CrossRef
22.
Bellman L. A qualitative evaluation of senior house officers’ teaching and learning: towards sharing good practice. Med Teach. 2004;26(4):313–20.CrossRefPubMed
23.
24.
Gott M, Seymour J, Ingleton C, Gardiner C, Bellamy G. ‘That’s part of everybody’s job’: the perspectives of health care staff in England and New Zealand on the meaning and remit of palliative care. Palliat Med. 2012;26(3):232–41.CrossRefPubMed
25.
26.
Schulman-Green D. How do physicians learn to provide palliative care? J Palliat Care. 2003;19(4):246–52.PubMed
27.
Mikhael J, Baker L, Downar J. Using a pocket card to improve end-of-life care on internal medicine clinical teaching units: a cluster-randomized controlled trial. J Gen Int Med. 2008;23(8):1222–7.CrossRef
28.
Wessex and ASWCS Palliative Physicians. The Palliative Care Handbook. Wareham: Hierographics Ltd; 2010.
29.
Kaufman DM. Applying educational theory in practice. BMJ (Clinical research ed). 2003;326(7382):213–6.CrossRef
30.
Kolb DA. Experiential learning : experience as the source of learning and development. Englewood Cliffs, N.J. London: Prentice Hall; 1984.
31.
van der Vleuten CP, Schuwirth LW. Assessing professional competence: from methods to programmes. Med Educ. 2005;39(3):309–17.CrossRefPubMed
Metadata
Title
How do junior doctors in the UK learn to provide end of life care: a qualitative evaluation of postgraduate education
Authors
Sophie Price
Susie Schofield
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2015
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-015-0039-6

Other articles of this Issue 1/2015

BMC Palliative Care 1/2015 Go to the issue

Debate

Minding the gap: access to palliative care and the homeless

Research article

Initial development and psychometric testing of an instrument to measure the quality of children’s end-of-life care

Research article

A mobile hospice nurse teaching team’s experience: training care workers in spiritual and existential care for the dying - a qualitative study

Research article

‘From activating towards caring’: shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians

Research article

Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study

Study protocol

Te Pākeketanga: living and dying in advanced age - a study protocol