Emotional Responses and Learning in Early Encounters With Seriously Ill and Dying Patients: A Qualitative Study of Preclinical Students

Purpose

Early exposure to hospice and palliative medicine (HPM) introduces preclinical students to serious illness and end-of-life care. This study explored students’ emotional responses to early HPM encounters and examined how these experiences shaped learning and professional development.

Methods

Preclinical medical and dental students participated in a required half-day HPM mentored clinical shadowing experience between May and July 2023. Students completed brief written reflections following participation. Reflections describing emotions the students had experienced were identified and analyzed using qualitative content analysis. Student volunteers also participated in focus groups in September 2023 and transcripts were analyzed using qualitative techniques.

Results

Forty-nine of 150 reflections (33%) described emotions the students had experienced. Emotional responses arose from two primary sources: personal connections (e.g., prior experiences with illness, reflections on mortality, awareness of personal limitations) and reactions to patients or their families (e.g., distress, challenging clinical circumstances, physical deterioration).

Twelve students participated in focus groups. Four themes emerged: (1) emotional intensity and vulnerability as catalysts for learning, (2) uncertainty in early clinical encounters, (3) structural supports that transformed emotional intensity into learning (including preparation, role clarification, interdisciplinary collaboration, and debriefing), and (4) meaning-making in confronting the limits of medicine.

Conclusions

Early encounters with serious illness have important implications for learning and professional development. In this study, students described emotional intensity and uncertainty as central parts of the experience and identified preparation, role clarification and debriefing as helpful supports. Structuring early HPM experiences to include these supports may foster professional identity formation.