Zohouri Mahshid, Amini Mitra, Sagheb Mohammad Mehdi
Faculty of medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Quality Improvement in Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Adv Med Educ Prof. 2017 Apr;5(2):73-77.
Medical students should be familiar with the end of life ethical issues and its considerations. For teaching end of life care to medical students, literature is a source of excellent narratives of patients with experiences of terminally ill condition in their journey through suffering and one of the most favourite bioethics literature readings has been the death of Ivan Ilych by Tolstoy. We used this novel to show medical students end of life events and suffering and asked them to write a reflective essay on it. We aimed to find what students think about terminally ill patients and their journey to death.
In an inductive qualitative content analysis model, 350 essays, collected by homogenous sampling, were analyzed. The fourth year medical students were provided with the novel to read. They were asked to write a reflection essay based on the reflective stages defined by Sandars. These essays served as the unit of analysis, each being read several times and a coding model was formed according to main topics. The related concepts in each unit were named as themes and each theme was abstracted to a code and the related codes were compared and developed as categories.
Qualitative content analysis of 350 essays of fourth year medical students revealed three major categories in students' reflection on reading as an end of life human body. These included: 1) Emotional experience, 2) Empathy and effective communication, 3) Spirituality and dignity. Analysis of essays showed that this reflection activity may help medical students have a deeper idea of the end of life situation and feelings.
This project suggests that literature can be used as an example to introduce new ethical concepts to less experienced medical trainees. The students acquired the concept of the story and reflected the major aspects of the suffering of a human being in their essays. Having used and evaluated the effect of literature on facilitating ethical insight in the teaching end of life care, we strongly recommend this method and specially the novella, .
医学生应熟悉临终伦理问题及其考量因素。在向医学生传授临终关怀知识时，文学作品是讲述绝症患者在痛苦历程中经历的绝佳素材，而托尔斯泰的《伊凡·伊里奇之死》一直是最受欢迎的生命伦理学文学读物之一。我们用这部小说向医学生展示临终事件与痛苦，并要求他们就此撰写一篇反思性文章。我们旨在了解学生对绝症患者及其死亡历程的看法。
采用归纳性定性内容分析模型，对通过同质抽样收集的350篇文章进行分析。向四年级医学生提供这部小说供其阅读。要求他们根据桑德斯定义的反思阶段撰写一篇反思文章。这些文章作为分析单位，每篇都被阅读多次，并根据主要主题形成了一个编码模型。每个单元中的相关概念被命名为主题，每个主题被提炼为一个代码，相关代码进行比较并发展为类别。
对四年级医学生的350篇文章进行定性内容分析，揭示了学生在将阅读视为临终人体体验时的反思中的三大类别。这些类别包括：1）情感体验，2）同理心与有效沟通，3）精神性与尊严。文章分析表明，这种反思活动可能有助于医学生更深入地理解临终状况和感受。
该项目表明，文学作品可作为向经验不足的医学实习生引入新伦理概念的范例。学生理解了故事的概念，并在文章中反映了人类痛苦的主要方面。在使用并评估了文学作品在促进临终关怀教学中的伦理洞察力方面的效果后，我们强烈推荐这种方法，特别是这部中篇小说。
