Background: Dying in simulation training is controversially discussed. On the one hand, the danger of an emotional overload of the learners is pointed out. On the other hand, dying in simulation settings is addressed as an opportunity to prepare future health professionals to deal with patient death. The present study investigates how medical students and nursing trainees experience the sudden death of a simulated patient and how and under which conditions it can be valuable to simulate the patient’s death. Methods: At the TUM School of Medicine in Munich, Germany, we developed an interprofessional, simulation-based course in which participants were unexpectedly confronted with a cardiac arrest scenario within which resuscitation had to be discontinued due to an advanced directive. After the course, focus groups were conducted with nine medical students and six nursing trainees. Data were analysed using Grounded Theory techniques. Results: The participants reported low to high emotional involvement. The active renunciation of life-sustaining measures was felt to be particularly formative and caused a strange feeling and helplessness. Questions of what could have been done differently determined interviewees’ thoughts. The participants appreciated the opportunity to experience what it feels like to lose a patient. The course experience encouraged interviewees to reflect on dying and the interviewees explained that they feel better prepared to face death after the course. The unexpected character of the confrontation, presence of the advanced directive and debriefing positively affected the impact of the simulation. Conclusions: The study recognises simulation training as a promising approach for preparing future health care professionals to encounter a patient’s death.

This study investigates medical trainees’ experiences with dying and death, by means of semistructured interviews. Nine medical students and nine residents reported a total of 114 experiences. The great majority of these experiences took place during the final year of medical school. The authors identified the latent characteristics, which illustrate an in-depth understanding of the significance of the described experiences. Three main themes emerged: circumstances of death, personal relationship, and one’s own role. The age of the dying person, the extent of suffering, time frame and setting, and the patients’ behaviors were factors that influence the perceptions of the experiences. The interviewees reported powerful emotional consternation by the patients’ deaths with whom they had developed a close relationship. Failure, helplessness, and guilt were negatively associated perceptions of one’s own role. This study illustrates the tension between emotional concern and professional detachment. It highlights the continuing existence of a physician image, in which control represents the key issue.

Background: Around the world, the emergency brought about by the COVID-19 pandemic forced medical schools to create numerous e-learning supplements to provide instruction during this crisis. The question now is to determine a way in which to capitalize on this momentum of digitization and harness the medical e-learning content created for the future. We have analyzed the transition of a pathology course to an emergency remote education online course and, in the second step, applied a flipped classroom approach including research skills training. Methods: In the summer semester of 2020, the pathology course at the Technical University of Munich was completely converted to an asynchronous online course. Its content was adapted in winter 2021 and incorporated into a flipped classroom concept in which research skills were taught at the same time. Results: Screencasts and lecture recordings were the most popular asynchronous teaching formats. Students reported developing a higher interest in pathology and research through group work. The amount of content was very challenging for some students. Conclusion: Flipped classroom formats are a viable option when using pre-existing content. We recommend checking such content for technical and didactic quality and optimizing it if necessary. Content on research skills can be combined very well with clinical teaching content.

This study investigates the effects of medical students’ and residents’ formative patient death experiences on their understanding of the role of the physician in dealing with dying patients. Analyses revealed a change in attitude, an acceptance of death as ‘part of life’. Thoughtful and comprehensive care, allowing patients to die and enabling them to have a beautiful death, were identified as the physician’s duty. Honesty, well timing and completeness were determined as the guiding principles of communication. The importance of distancing and keeping in control to practice the medical profession was stressed. The burdensome nature of making therapeutic decisions was emphasized.

Background: With growing recognition of uncertainty tolerance (UT) and reflection ability (RA) as core competencies for healthcare professionals, targeted promotion of these skills has become increasingly important in medical education. However, research on the associations between UT and RA and students’ individual characteristics, such as age and gender, remains limited, and existing findings are inconsistent. Addressing this gap, the present study assesses UT and RA among medical students at entry to medical school, examines their associations with age and gender, and explores implications for the tailored design of educational interventions. Methods: All first-year medical students at Ludwig Maximilian University and the Technical University of Munich were invited to participate in the survey during a compulsory joint course, Introduction to Clinical Medicine . The questionnaire, administered via EvaSys, included the Groningen Reflection Ability Scale, the Uncertainty Tolerance Scale, and demographic data. Results: A total of 761 participants were included in the analysis. The age could be determined for 384 participants, and the gender for 493 participants. Measuring UT resulted in a mixed picture: while students reported openness toward novel experiences, they simultaneously expressed a preference for predictability and routine. Linear regression analysis revealed no significant association between overall UT scores and age or gender (all p > 0.05). However, statistically significant gender differences emerged at the item level, with female students reporting lower tolerance of uncertainty. Regarding RA, linear regression analysis similarly revealed no significant association between overall GRAS scores and age or gender (R² = 0.002; all p > 0.05). However, statistically significant gender differences were identified at the item level, with female students reporting a higher level of self-underestimation and self-doubt. Conclusions: Although overall UT and RA scores were not significantly associated with gender or age, exploratory item-level analysis suggested gender-specific differences in certain aspects of both constructs. Given the high proportion of female students, these differences may warrant further investigation and consideration in curriculum development to promote equitable opportunities and optimally prepare all students for clinical practice.