What Medical Students Learn About Death and Dying.

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Abstract

Death and dying remain taboo in modern societies. Care at the end-of-life is limited, even in advanced countries with an efficient public health system like Spain. In this paper I demonstrate that the knowledge acquired by the medical students in the textbooks they use during their studies in the medical school about end-of-life care and better dying is minimal. The majority of those textbooks is in English, and/or published by international publishing houses. I analyze both, national and international textbooks, as far as they are actually included in the reading lists of the 44 courses of the six years of the Medical School at the University of Barcelona (Spain) . I work with 2,868 textbooks used by the students and recommended by teachers. I analyze all those books classified as textbooks at the library of the Medical School and Hospital Clínico (teaching hospital funded in 1906) in the heart of Barcelona. It is the best medical school and the best medical library in the region. I review the textbooks by courses and medical specialties. Some of those courses —like public health, and medical psychology— do not deal adequately with the care at the end-of-life. The transitions to death of terminal patients are absent. I only found relevant information in some textbooks (like oncology, family and community Medicine). But even in those cases the information is biased and not original. The terminal patient care —i.e. the transition to a better dying— is neglected in the medical schools. A modern model of death (MMD) is still absent in the medical textbooks researched. The case of Spain is probably similar to other countries, as it uses practically the same textbooks, but that needs to be demonstrated using further data.

Author

• Jesus M. De Miguel, Mont Saint Aignan