New Material and a New Way to Learn: Students as Teachers on Grief.

Recently in a second year meds class, we were debriefing the experience our 2015 meds students had with their “First Patient Project.” During that debriefing class, we had relatively unique and very engaging learning experience about a serious and under-reported topic. My thanks to Dan Corazolla, Soniya Sharma, Lindsay Bowman, Aaron Wynn, Heather Johnston, and Mason Curtis, all Meds 2015 for their help with this article.

The First Patient Project is an 18 month project which begins right in September of medical students’ first year and continues until after December of their second year. Students in pairs follow a chronically ill patient, attending health care appointments and visiting with them in their home. The students also interact with community and faculty physicians and complete critical analysis reports about their learning.

This day, on April 30, we heard from six “student teachers.” Having students teach a formal session is reasonably unique in our medical school and the topic of their teaching was also reasonably unique in medical literature: How do physicians deal with grief, on the loss of a patient? How do they recover and go on…down the hall to the next ward room with another patient in it, to another clinic room, to home?

Six of our students encountered death over the program…two of our “Patient Teachers” sadly have died over the past two years. And another pair of students lost their patient as she was the spouse of one of the patients who passed away and could not continue with the program.

The six students met with a clinical faculty member to discuss the experience, and individual discussion/counseling was made available to them. But they also continued with the project by doing research on three areas: 1. How physicians help families when a family member dies 2. How physicians can help themselves when a patient dies, and 3. How medical literature and medical education literature give insight on how to bring this up in medical education.

Their research and presentations were excellent! I thought I’d share, with their permission, some of their findings:

From Soniya Sharma and Dan Corazolla, came these concepts in how physicians can help their patients deal with grief: the differences between “normal grief” and “abnormal grief”, the tasks of grieving, the family as a resource, and the role of the physician. They consulted nine current references to expand upon these concepts to their classmates and to link up with previous sessions on this topic in their first year classes.

The title of Lindsay Bowman’s and Aaron Wynn’s talk was “Wearing your heart on your jacket: Patient death and the importance of physician grief. “ They pulled from fifteen diverse sources from Military Medicine (great article on resilience-building) to Vasalius, (How to cope with disaster loss and mourning: Galen’s paper which was lost for centuries) to more traditional medical and medical education journals. One particular source I found intriguing was J. Shapiro’s article in Perspective: Does Medical Education Promote Professional Alexithymia? A Call for Attending to the Emotions of Patients and Self in Medical Training. Acad Med 2011;86:326-332.

Lindsay and Aaron taught convincingly about the factors that make patient death difficult to deal for physicians, why grief education is important and relevant to physicians and medical trainees, the current state of grief education in our curriculum and that of other medical schools and where it could and should be represented in undergraduate and postgraduate medicine.

The third partnership to teach about this topic consisted of Heather Johnson and Mason Curtis. Their teaching centred around healthy strategies for physicians in dealing with grief. Both Heather and Mason conducted surveys or interviews. Heather’s survey inquired into when and how we should teach about physician loss and grief in our curriculum. She gave practical strategies and a model on how to move through loss and grief and created a “grief curriculum” whose components could be shared with faculty as well as students.

Interestingly both Heather and Lindsey focused on an article that, in their words, “if you had to read only article on this topic,” this would be it: The inner life of physicians and the care of the seriously ill by Meier, D.E. et al in JAMA 2001, 286(23): 3007-14. I’ve just read it too and let me chime in—a very thorough and insightful article on this topic.

Mason had interviewed physicians and created a model of grief approaches from three perspectives. He also spoke movingly about how he had responded to his grandfather’s death at a time when in medical school he was learning about oncology, palliative care and the elderly.

Students in the class afterward said that it was really positive to learn this material from their classmates. The work was solid, the literature review broad, and the points very clearly and thoroughly presented with good handouts.

The students who taught were positive too…tho’ some had not been initially  Some were hesitant to teach their classmates, and concerned that it would not be well received. They were really buoyed up by the great feedback from their peers and from faculty Dr. Sanfilippo and Dr. Leslie Flynn, Kathy Bowes, Program Coordinator, Erin Matthias, Program Assistant, and patients in the room.

What’s the next step? Well, the students and I can see a need for further exploration of this subject in clerkship and residency. As well, I hope the students will put together a poster about this for CCME.

My take on this aspect of the project is this: our six student teachers were excellent teachers! They were well-prepared, and had done a thorough job in finding out in different modes and in some cases ferretting out literature on a topic that seems to be localized in only a few aspects of medicine and medical education. They were clear speakers, and had great teaching points. Their slides were excellent and they had a good beginning, middle and end to their talks. They were convincing, authoritative, and had much to share. Turning some of the teaching over to students teaches those who teach, and their classmates. We already do student small group teaching in our Community Based Projects and our Nutrition Projects—maybe some large group teaching is in order?

Beyond the teaching method, the students taught us all about a part of medicine that appears to be kept somewhat quiet. About the culture of a “stiff upper lip” that could pervade in some medical cultures. About how may physicians act differently about their own grief than they would advise a patient to act. They gave us all a lesson in how to cope in a healthy way, when you have to move on…to the next patient, the next room, the next door and all the way home.

Are you interested in the reference lists from the students? Or would you like to contact them to find out more about their talk and what surprised them? Write back here, or write to them via email addresses on MEdTech.

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