Interventions to support medical trainee well-being after patient death: A scoping review

Abstract

Background: Medical trainees are at the forefront of end-of-life care provision in the hospital setting but often feel unprepared to manage the complex emotions after patient death.

Objectives: To systematically identify and synthesize the published literature on interventions to support medical trainees dealing with patient death.

Methods: Searches were conducted in MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL, and ERIC from inception to June 30, 2023. English language peer-reviewed publications of interventions to support medical students and residents/fellows dealing with patient death. Studies of practicing clinicians and nonphysician healthcare trainees were excluded. Two reviewers independently determined study eligibility. Discrepancies were resolved through consensus and a third reviewer served as a tiebreaker if needed.

Results: Of the 9107 articles retrieved, 973 underwent full-text review, and 50 studies met inclusion criteria. Most interventions targeted residents (n = 32; 64%) and were conducted in North America (n = 45, 90%). Types of interventions included preventive measures involving educational lectures and workshops (n = 19; 38%), clinical placements (n = 10; 20%), and postventions (n = 16; 32%), including debriefing and memorial services. Several interventions incorporated the arts (n = 5; 10%), including movies, drama, and artwork, and most incorporated reflective narratives (n = 16; 32%). Most interventions were limited in frequency and duration.

Conclusions: This review identified several interventions to support trainees through the experience of patient death but also highlighted areas for improvement. Strengthening support for medical trainees will foster emotionally resilient physicians who are better equipped to deliver high-quality, empathetic care to dying patients and their families.