Abstract
Dear Editor:
The COVID-19 pandemic has forced all of us in medicine to face larger questions about our own mortality. Although confronting death is a part of health care, COVID-19 has made it a daily consideration for us, our families, and our patients. As of this writing, almost 200,000 Americans have died from COVID-19, with most deaths occurring in older patients and about half in nursing homes or similar institutions. Discussions with patients and families about difficult decisions at the end of life are increasingly commonplace. Restrictions on visitors that many hospitals have implemented have also escalated the role that providers have in addressing patient distress. In addition, health care workers report emotional exhaustion, depersonalization, and fear related to the care of COVID-19 patients. Some have lost their lives, forcing all providers to ask the question: Will I survive this?
Even before the pandemic, we discerned that most medical school curricula do not devote enough time to domains of geriatrics, palliative care, and end-of-life care. This skills gap is exacerbated by COVID-19, with providers inadequately prepared to respond emotionally to the high volume of critically ill patients. As medical students, we designed, implemented, and since 2018 have led an elective curriculum in our medical school that teaches important skills for end-of-life care, called “Being Mortal.” Medical and physician assistant students are given opportunities to learn and practice tools for engaging in difficult conversations with patients experiencing serious or life-threatening illnesses. For most of our students, this course was their first and only formal instruction in topics such as grief, death, hospice, advance directives, geriatric mental health, and goals of care conversations. In directing the course, we realized the importance of reflective practice and compassionate communication in promoting strong physician–patient relationships. Student feedback affirmed the need for more time allotted in medical school to develop and refine these skills, and to foster professional identities as caring providers.
We, therefore, call on the Liaison Committee for Medical Education to establish standards for its accredited medical schools in providing early comprehensive training in topics related to geriatrics, palliative care, and mortality in the COVID-19 era. There is a pressing need for such training as students return to clinical rotations and face a pandemic that will not resolve quickly. Moreover, don't we all want to be cared for by compassionate and courageous physicians who can more effectively connect with their patients and loved ones? By allocating time for the aforementioned topics, we will be able to graduate more caring physicians equipped with faculties for compassion and resilience—who will be able to use these important and sustaining skills to help patients long after COVID-19 passes.