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Learning from patient death: One residency program's solution

Patient deaths can trigger challenging emotions and care decisions, yet there are few programs that teach residents how to manage end-of-life care. That’s why one residency program decided to pilot a series of “patient death debriefing sessions” to help residents honestly reflect on patient deaths—and their efforts proved effective. Learn how this unique solution helped residents navigate tough experiences. 

A team of chief residents and educators introduced the “patient death debriefing sessions” to an inpatient medical oncology rotation at Memorial Sloan Kettering Cancer Center. These sessions led by attending physicians were designed as a “real-time, pragmatic” way to address “the emotional impact of patients’ deaths on residents during an oncology rotation,” according to a recent report on the debriefing sessions, which was published in the Journal of Graduate Medical Education.

How the sessions were conducted

In this program, each attending physician was paired with four residents completing a four-week oncology rotation. The patient death debriefing sessions were conducted throughout the four-week rotation period.

Within 24 to 48 hours of a patient’s death, attending physicians hosted discussions with residents for at least 10 minutes. While no formal training for the sessions was required, attending physicians were given a pocket card guide featuring key questions to discuss with residents during the sessions. 

If no patient deaths occurred, attending physicians were encouraged to hold sessions with residents every one to two weeks, according to the report.

“The priority was to create a high-yield, easily integrated program that required minimal faculty and resident preparation and oversight,” authors of the report noted.

Results: How talking about patient death helped residents

Questionnaires on the debriefing sessions were given to residents before and after their four-week rotations, with a 99 percent response rate.

“Overall, residents found debriefing sessions helpful, educational and appreciated attending physician leadership,” the report said. “The number of debriefing sessions positively influenced residents’ perception of received support.”

Residents also provided open-ended written responses about their experiences in the sessions. When asked to describe the most helpful aspect of having conversations about patient death, some residents wrote:

  • ‘‘Explor[ing] the emotional aspects of a patient’s death instead of just the medical ones.’’
  • ‘‘Hearing other residents’ reactions and getting instruction from attendings on how they deal with these issues.’’

Residents also noted valuable lessons they gleaned from conversations. For instance, one resident wrote that he learned ‘‘Deaths affect attendings even into a long career.”

Another resident remarked on a simple yet helpful lesson for physicians in any phase of their careers: “Grief after the death of a patient is normal ... not something we should be ashamed of … we can have some comfort knowing that we did the best we could.”

“Patient death debriefing sessions improved residents’ perception of support and coping, which we believe is a critical first step to effectively dealing with emotional reactions,” authors of the report concluded. “Debriefing frequently and consistently on every patient death may foster a more open forum that normalizes sharing one’s emotions, which we believe is an important, potentially culture-changing aspect of the program.”

Review the report for additional observations about the sessions and the pocket card residents used to discuss questions about patient death during their sessions. Also, read this honest reflection from a first-year resident on the valuable lessons she has learned while grappling with patient death in training.

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