Documentary Effects on Medical Student Attitudes & Skills Regarding Nutrition at the End of Life

Scott De La Cruz, Francesca Nicosia, Eva Aagaard

Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, USA.
Department of General Internal Medicine, University of Colorado Denver, Denver, USA.

DOI: 10.4236/ce.2014.52015                

Abstract

Medical trainees rarely have the opportunity to provide comprehensive end of life care or see the physical transformation of the dying process. Studies suggest that the use of film in medical education is an effective means of exposing students to aspects of medicine they might not otherwise receive. Dying Wish is a visual instrumental case study of a patient with end-stage cancer who chose to stop eating and drinking at the end of his life. In this randomized, controlled study, we assessed the impact of Dying Wish on medical students’ attitudes, knowledge, and confidence in patient/family discussions surrounding nutrition at the end of life using student surveys and independently validated standardized patient assessments. By the middle of the first clinical year, about 58% of students witnessed and 38.6% actively participated in a discussion regarding nutrition at the end of life with a patient and/or their family. Although there was no significant difference in students’ self-perceived knowledge or skills, a significantly higher percentage of students who viewed “Dying Wish” prior to standardized patient visits clearly explained the biological consequences of stopping eating and drinking compared to those who had not viewed the film. Students agreed that “Dying Wish” improved their knowledge of the physical effects of stopping eating and drinking and effectively introduced the ethical and psychosocial issues associated with nutrition at the end of life. Documentaries are considered by students to be effective teaching tools and “Dying Wish” represents a feasible way to deliver instruction regarding nutrition at the end of life. Visual depictions and documentary films that portray the natural courses of illnesses may prove to be helpful, efficient teaching tools and their role in the educational process for healthcare providers should continue to be studied.

Keywords

Medical Education; Documentary Film; Visual Instrumental Case Study; End of Life; Nutrition

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Alexander, M., Lenahan, P., & Pavlov, A. (2005). Cinemeducation: A comprehensive guide to using film in medical education. Singapore: Radcliffe Publishing.
[2]	Billings, J. A., & Block, S. (1997). Palliative care in undergraduate medical education: Status report and future directions. JAMA, 278, 733-738. http://dx.doi.org/10.1001/jama.1997.03550090057033
[3]	Block, S. D., Bernier, G. M., & Crawley, L. M. (1998). Incorporating palliative care into primary care education. National Consensus Conference on Medical Education for Care Near the End-of-life. Journal of General Internal Medicine, 13, 768-773. http://dx.doi.org/10.1046/j.1525-1497.1998.00230.x
[4]	Buss, M. K., Marx, E. S., & Sulmasy, D. P. (1998). The preparedness of students to discuss end-of-life issues with patients. Academic Medicine, 73, 418-422. http://dx.doi.org/10.1097/00001888-199804000-00015
[5]	Davis, D., Thomson O’Brien, M. A., Freemantle, N., Wolf, F., Mazmanian, P., & Taylor-Vaisey, A. (1999). Impact of formal continuing medical education—Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA, 282, 867-874. http://dx.doi.org/10.1001/jama.282.9.867
[6]	Field, M. J., & Cassel, C K. (1997). Approaching death: Improving care at the end of life. Washington DC: National Academy Press.
[7]	Fraser, H. C., Kutner, J. S., & Pfeifer, M. P. (2001). Senior medical students’ perceptions of the adequacy of education on end-of-life issues. Journal of Palliative Medicine, 4, 337-343. http://dx.doi.org/10.1089/109662101753123959
[8]	Gibbins, J., McCoubrie, R., Alexander, N., Kinzel, C., & Forbes, K. (2009). Diagnosing dying in the acute hospital setting—Are we too late? Clinical Medicine, 9, 16-19. http://dx.doi.org/10.7861/clinmedicine.9-2-116
[9]	Gibbins, J., McCourbrie, R., & Forbes, K. (2011). Why are newly qualified doctors unprepared to care for patients at the end of life? Medical Education, 45, 389-399. http://dx.doi.org/10.1111/j.1365-2923.2010.03873.x
[10]	Kahn, M. J., Sherer, K., Alper, A. B., Lazarus, C., Ledoux, E., Anderson, D., & Szerlip, H. (2001). Using standardized patients to teach end-of-life skills to clinical clerks. Journal of Cancer Education, 16, 163-165.
[11]	Kumagai, A. K. (2008). A conceptual framework for the use of illness narratives in medical education. Academic Medicine, 83, 653-658. http://dx.doi.org/10.1097/ACM.0b013e3181782e17
[12]	Lorenz, K. A., Steckart, M. J., & Rosenfeld, K. E. (2004). End-of-life education using the dramatic arts: The Wit educational initiative. Academic Medicine, 79, 481-486. http://dx.doi.org/10.1097/00001888-200405000-00020
[13]	Nelson, W., Angoff, N., & Binder, E. (2000). Goals and strategies for teaching death and dying in medical schools. Journal of Palliative Medicine, 3, 7-16. http://dx.doi.org/10.1089/jpm.2000.3.7
[14]	Schmidt, T. A., Norton, R. L., & Tolle, S. W. (1992). Sudden death in the ED: Educating residents to compassionately inform families. The Journal of Emergency Medicine, 10, 643-647. http://dx.doi.org/10.1016/0736-4679(92)90155-M
[15]	Self, D., DeWitt, C., & Baldwin, J. (1990). Teaching medical humanities through film discussions. Journal of Medical Humanities, 11, 2329. http://dx.doi.org/10.1007/BF01142236
[16]	Serwint, J. R., & Simpson, D. E. (2002). The use of standardized patients in pediatric residency training in palliative care: Anatomy of a standardized patient case scenario. Journal of Palliative Medicine, 5, 146-153. http://dx.doi.org/10.1089/10966210252785123
[17]	Van der Riet, P., Good, P., Higgins, I., & Sneesby, L. (2008). Palliative care professionals’ perceptions of nutrition and hydration at the end of life. International Journal of Palliative Nursing, 14, 145-151.
[18]	Weber, C. M., & Silk, H. (2007). Movies and medicine: An elective using film to reflect on the patient, family, and illness. Family Medicine, 39, 317-319.