How Internal Medicine Residents Deal with Death and Dying: a Qualitative Study of Transformational Learning and Growth

Abstract

Background: Dealing with death and dying is one of the most common sources of work-related stress for medical trainees. Research suggests that the degree of psychological distress that students and residents feel around providing care for terminally ill patients generally decreases as training progresses. However, there is a dearth of literature that directly addresses how trainees learn to manage emotions and process grief when patients die. Objective: To gain insight into medical resident experiences in caring for the dying, including the role of training level and use of support networks and coping strategies to manage personal reactions to patient death. Design: A thematic analysis of focus group interviews was conducted, and patterns that reflected resident coping and managing experiences with patient death were identified. Participants: Internal medicine residents from all year levels and recent graduates from two large academic medical centers in the United Arab Emirates. Approach: Qualitative study using a phenomenologic approach. Results: Residents undergo transformational learning and growth in their experiences with death and dying. Five major themes emerged: emotions, support, education and experience, coping strategies, and finding meaning. As residents progress through their training, they seek and receive support from others, improve their end-of-life patient care and communication skills, and develop effective coping strategies. This transformational growth can enable them to find meaning and purpose in providing effective care to dying patients and their families. Positive role modeling, faith and spirituality, and certain innate personality traits can further facilitate this process. Conclusion: Understanding the complex emotions inherent in caring for dying patients from the perspective of medical residents is a critical step in creating evidence-based educational innovations and policies that support trainees. Residency programs should work to foster reflective practice and self-care in their trainees and teaching faculty.