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Revista Brasileira de Educação Médica

Print version ISSN 0100-5502On-line version ISSN 1981-5271

Rev. Bras. Educ. Med. vol.46 no.4 Rio de Janeiro  2022  Epub Dec 13, 2022

https://doi.org/10.1590/1981-5271v46.4-20210459 

ORIGINAL ARTICLE

Attitude to death and opinion of medical students on the top training

Maria Eduarda Cavalcanti de Siqueira1  , study conception, planning, analysis, interpretation of data, drafting of the manuscript, critical review of the content, approval of the final version of the manuscript
http://orcid.org/0000-0003-1459-1449

Larissa Menelau Rapela Mergulhão1  , study conception, planning, analysis, interpretation of data, drafting of the manuscript, critical review of the content, approval of the final version of the manuscript
http://orcid.org/0000-0003-4240-4399

Rebeca Fernandes Sant’Anna Pires1  , study conception, planning, analysis, interpretation of data, drafting of the manuscript, critical review of the content, approval of the final version of the manuscript
http://orcid.org/0000-0003-2342-4458

Arturo de Pádua Walfrido Jordán1  , study conception, planning, analysis, interpretation of data, drafting of the manuscript, critical review of the content, approval of the final version of the manuscript
http://orcid.org/0000-0002-2955-8302

Leopoldo Nelson Fernandes Barbosa1  , study conception, planning, analysis, interpretation of data, drafting of the manuscript, critical review of the content, approval of the final version of the manuscript
http://orcid.org/0000-0002-0856-8915

1Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil.


Abstract:

Introduction:

Currently, most people are inserted in a sociohistorical context of denial of death, including physicians who deal with dying daily who consider themselves unprepared in the face of the death of a patient. The discomfort of these professionals in the face of the death process is due in part to the lack of the training that occurred during graduation.

Objective:

This study aimed to analyze the opinion of medical students at the Faculdade Pernambucana de Saúde (FPS) about teaching and perceptions on death and dying during graduation, verify the importance in medical education and describe this approach through the students’ perspective. It is also objective to find aspects that influence the belief of undergraduates about the theme.

Method:

This is an exploratory cross-sectional study with quantitative method, conducted between August 2020 and July 2021. Data collection was carried out through online questionnaires, with a sample of 365 subjects, after acceptance and marking on the free and informed consent form, sent to students by e-mail. For analysis, epi-info software was used using relative and absolute frequencies to describe qualitative variables and position and dispersion measures to describe quantitative variables. The chi-square test was used to verify the chi-square test, considering a significance level of 5%. The study followed all the precepts of Resolution nº 510/2016 of the National Council of Ethics in Research and received approval from the ethics committee of the college under opinion number 4,228,016.

Result:

Most students associate anguish, fear, and sadness with the process of death and agree that the discussion of this process in graduation impacts on the practice of medicine and on the psychosocial well-being of the physician. The students agree that the approach to the death process happened in rare moments during graduation and consider it necessary to include more disciplines that address it.

Conclusion:

The discussion about the process of death and dying process during medical graduation is necessary, and the insertion of modules that approach it is recommended in the medical course of FPS to contribute to the students’ understanding of this process and in the psychological preparation of these students to deal with death in the exercise of the profession.

Keywords: Attitude to Death; Education Medical; Education Medical Undergraduate

Resumo:

Introdução:

Atualmente, a maioria das pessoas está inserida num contexto sócio-histórico de negação da morte, incluindo médicos que lidam com o morrer diariamente que se consideram despreparados perante a morte de um paciente. O desconforto desses profissionais nesse processo de morte deve-se em parte à deficiência da formação ocorrida durante a graduação.

Objetivo:

Este estudo teve como objetivos analisar a opinião dos alunos de Medicina da Faculdade Pernambucana de Saúde (FPS) acerca da abordagem referente à morte e ao morrer durante a graduação, verificar a importância disso na formação médica e descrever esse tema por meio da perspectiva dos estudantes. Também se objetifica identificar aspectos que influenciam a percepção dos graduandos acerca do tema.

Método:

É um estudo exploratório, de corte transversal, com metodologia quantitativa, realizado entre agosto de 2020 e julho de 2021. A coleta de dados foi realizada por meio de questionários on-line, com amostra de 365 sujeitos, após aceite e marcação no Termo de Consentimento Livre e Esclarecido, enviados aos alunos por e-mail. Para análise, adotou-se o software Epi-Info, em que se utilizaram frequências relativas e absolutas para descrever as variáveis qualitativas e medidas de posição e dispersão para descrever variáveis quantitativas. Para verificação de relações, foi utilizado o teste de qui-quadrado, considerando um nível de significância de 5%. O estudo seguiu todos os preceitos da Resolução nº 510/2016 do Conselho Nacional de Ética em Pesquisa e teve aprovação do Comitê de Ética da FPS - Parecer nº 4.228.016.

Resultado:

A maioria dos alunos associa angústia, medo e tristeza ao processo de morte e concorda que a discussão desse processo na graduação impacta o exercício da medicina e o bem-estar psicossocial do médico. Os estudantes concordam que a abordagem do processo de morte aconteceu em raros momentos durante a graduação e julgam necessária a inclusão de mais disciplinas que tratem do tema.

Conclusão:

A discussão acerca do processo de morte e morrer durante a graduação em Medicina é necessária, e recomenda-se a inserção de módulos que abordem o tema no curso da FPS, a fim de contribuir para a compreensão dos estudantes acerca desse processo e o preparo psicológico deles para lidar com a morte no exercício da profissão.

Palavras-chave: Atitude Frente a Morte; Educação Médica; Educação de Graduação em Medicina

INTRODUCTION

“Total cessation of life, of existence” and “definitive interruption of the life of an organism”, are examples of the meanings attributed to death1. This meaning, however, is much more complex than these simplified definitions, being for many “a relative concept, which will depend on other variables”2.

Death represents the end of a cycle and is a natural biological phenomenon that all individuals will someday experience. It is as natural a process as birth. And, although it is a certainty that everyone has, it is always accompanied by insecurities and fears, feelings that have a lot of influence on how people see the process of death. The conception about death and the individual’s attitude towards it tends to change according to several factors, such as the historical, social and cultural context in which it is inserted. In Mexico, for example, the ‘Day of the Dead’ is celebrated every year. It is a tradition that, for them, represents the moment of meeting again those who have passed away. It is believed that the dead return from another spiritual plane for a visit on this day, when they are welcomed with food, drink and dance. “It is a culture where death is celebrated and not feared”2),(3.

The Mexican belief, however, is different from that of most countries, including Brazil. The reality is that most people are inserted in a socio-historical context of the denial of death2. It is valid to say that death in some cultures is even considered a taboo, a subject that people avoid. For most people, talking or even thinking about death is uncomfortable, it arouses fear and anguish2.

The process of dying is difficult to accept even for doctors and other health professionals, who often have to deal with this process on a daily basis, due to the profession they have chosen. Many physicians, even technically trained to fight against diseases, find themselves unprepared to face the death of their patients. Since undergraduate school, these professionals are oriented to diligently seek the healing process, and when death is inevitable, they face it with feelings of impotence, guilt and failure4)-(6. The emotional impacts caused by the feeling of powerlessness in the face of death, added to the desire to avoid it at any cost, can result in serious psychological damage and professional exhaustion, directly affecting the quality of life and, consequently, the work of these professionals7.

This discomfort of physicians towards the death process is largely due to the deficiency in the training of these professionals on death and dying during undergraduate school6. Medical students have their first contact with death right at the beginning of the course, in classes with anatomical parts and corpses. The contact with the death process, that is, the entire complexity of the process and its variables, comes a few years later, during practical activities7. Medical universities in Brazil usually do not have many moments reserved for the discussion of issues related to the death process during undergraduate school6. Some have disciplines that address mainly the social aspects of thanatology, which is the scientific study of death. However, most medical courses in the country do not have a mandatory workload focused on the discussion of the death process, which makes their students unprepared to deal with these events and that can cause significant emotional impacts on these students8)-(10.

At Faculdade Pernambucana de Saúde (FPS), death is approached at certain times, such as in exhibitions on spirituality and during some classes of the communication discipline, where discussions about palliative care, euthanasia and death in contemporary society are held, as well as debates between students about their conceptions and perspectives regarding death, dying and mourning11),(12. The students also discuss ways to communicate bad news and are advised on the correct way to inform the family of a patient’s death. However, despite being important, these issues are not addressed constantly during the six years of the medical course, happening in specific periods of undergraduate school13.

Therefore, it is relevant to know the opinion of FPS medical students about the approach to the death process and to understand whether it is sufficiently addressed during undergraduate school to prepare them as future physicians. It is also important to understand how these students perceive the approach to the subject of death and dying during college meetings, since an insufficient approach to this subject can cause so many negative personal and professional impacts.

METHOD

This is an exploratory, cross-sectional study with a quantitative methodology. The study was carried out from August 2020 to July 2021. Data collection started only after approval by the Ethics Committee for Research with Human Beings of the FPS under Opinion number 4,228,016. The principles of Resolution 510/16 of the National Council for Ethics in Research (CONEP) were followed. The study was carried out in the population of 1,024 students of the FPS medical course, from the first to the twelfth semesters, and from these, 365 full responses and 360 partial responses were obtained. The 365 completed questionnaires were used for the analysis.

Data were obtained through structured and self-administered questionnaires prepared by the authors of the research, based on forms used in the study: “The process of death and dying according to the point of view of nursing students”14, carried out at Faculdade de Anhanguera, in Brasília, in 2010. The questionnaires were answered after reading the Free and Informed Consent Term (FICT) and accepting to participate in the research. The form encompassed three axes to be evaluated: sociodemographic data of the students; data about academic training; data on the topic of death and dying; and were sent through emails and social networks as the study was carried out during the COVID-19 pandemic period.

After data collection, they were entered into a database built in Excel for Windows, version 2016 and later analyzed in Epi-Info for Windows, version 7.2. Relative and absolute frequencies were used to describe qualitative variables, and measures of position (mean) and dispersion (standard deviation) were used to describe quantitative variables. The chi-square test was used to verify associations, considering a significance level of 5%.

RESULTS

The 365 students who answered the questionnaires in full correspond to 35.64% of the total number of medical students at the FPS. Of these, 72 (19.72%) were attending the fourth semester, 65 (17.80%) the third, 62 (16.98%) the eighth and 41 (11.23%) the first. Regarding the sociodemographic profile, 238 (65.21%) of the responses were from female students, 274 (75.07%) consider themselves white, 174 (44.77%) are Catholic, and 194 (53.20%) have a family income of more than 12 minimum wages. In terms of age, the youngest student to answer the questionnaire is 18 years old, and the oldest 46, with a mean age of approximately 22.11 years (Table 1).

Table 1 Sociodemographic and academic profile of medical students at Faculdade Pernambucana de Saúde. Recife, Pernambuco, Brazil, 2021 

Characteristic N %
Total number of students in the sample 365 100
Period
Basic cycle 196 53.7
Clinical cycle 131 35.89
Internship 38 10.41
Gender
Male 124 33.97
Female 238 65.21
Ethnicity
White 274 75.07
Brown 81 22.19
Black 5 1.37
Others 5 1.37
Family income
One to three minimum wages 27 7.40
Four to seven minimum wages 59 16.16
Eight to twelve minimum wages 85 23.29
More than twelve minimum wages 194 53.20
Religion
None 120 32.88
Catholic 174 47.67
Others 71 19.45

Source: prepared by the authors.

Of the total number of interviewed students, 279 (76.44%) considered death something possible to conceptualize and 348 (95.34%) said they had already thought about their feelings on death. The most frequent feelings found in the answers were anguish, fear, sadness, followed by resignation. Regarding the death of a patient, 300 (82.20%) students disagreed or partially agreed with the statement “the death of a patient is considered a failure” (Table 2).

Table 2 Opinion of medical students from Faculdade Pernambucana de Saúde about the importance of discussion and aspects related with the process of death and dying and their impacts during graduation for the exercise of the medical profession in the future. Recife, Pernambuco, Brazil, 2021 

Characteristic N %
Total number of students in the sample 365 100
Feelings regarding death
Fear 209 57.26
Anguish 211 57.80
Terror 62 16.98
Sadness 205 56.16
Resignation 141 38.63
Indifference 18 4.93
Anger 20 5.47
Depression 45 12.32
None 0 0
Opinion of students about the following statement: “The death of a patient is considered a failure”.
Totally agree 4 1.09
Partially agree or disagree 300 82.20
Indifferent 10 2.74
Totally disagree 51 13.97

Source: prepared by the authors.

Regarding the students' opinion on the importance of discussing the process of death and dying during undergraduate school for the medical profession in the future, 331 (90.68%) of the students answered that they consider it very important, 33 (9.04%) consider it reasonably important. None of the students said they did not consider it important, and only 1 considered it not very important. Moreover, 295 (80.82%) of the students fully agreed that the discussion about the process of dying during undergraduate school has an impact during the practice of medicine.

In addition, 285 (70.08%) students answered that they believed that the delay in approaching death and dying during undergraduate school negatively impacts both the psychosocial well-being of the physician and the practice of medicine. Twenty (5.48%) students did not believe that this negative impact exists, while 18 (4.93%) students believed that it only impacts the exercise of medicine, while 42 (11.51%) answered that it only impacts the professional’s psychosocial well-being. It was also observed that 88.76% of the students considered that the approach to the process of death and dying during medical education interferes a lot or too much with the mental health of medical professionals (Table 3).

Table 3 Feelings about death and the opinion of medical students at Faculdade Pernambucana de Saúde about the importance of discussing death and dying during undergraduate school. Recife, Pernambuco, Brazil, 2021 

Characteristic N %
Total number of students in the sample 365 100
Importance of discussing the process of death and dying during undergraduate school for the medical profession in the future
Don’t think it is important 0 0
Little important 1 0.27
Reasonably important 33 9.04
Very important 331 90.68
Students’ opinion about the following statement: “The discussion about the process of death and dying during undergraduate school has an impact on the exercise of the medical profession”.
Totally agree 295 80.82
Partially agree or disagree 51 13.98
Neither agree, nor disagree 11 3.01
Totally disagree 8 2.19
Aspects that are negatively impacted by the deficient approach to the process of death and dying during undergraduate school according to the student’s point of view
On the psychosocial well-being of the physician 42 11.51
On the exercise of medicine 18 4.93
On both 285 78.08
On neither 20 5.48
Degree of interference of the approach to the death and dying process during medical education on the mental health of medical professionals
Interferes very little 1 0,27
Interferes little 6 1,64
Interferes to some extent 34 9,32
Interfere a lot 185 50,68
Interfere too much 139 38,08

Source: prepared by the authors.

As for the question related to the perspective of FPS medical students about the approach to the process of death and dying during the undergraduate medical course, it was verified that: In relation to the frequency that the topic is addressed, 282 (77.26%) stated that the subject is rarely or sometimes addressed, while 45 (12.33%) believed that the subject is never addressed, and only 38 (10.34%) said that the subject is addressed frequently or always. For 192 (52.60%) students this approach took place only during theoretical activities, while 34 (9.32%) thought that this approach took place during practical activities. Eighty-seven (23.84%) students thought that this issue was addressed both in theoretical activities and in practical activities, and 52 (14.25%) students stated that the topic was not addressed in either of these activities.

Regarding the need to include more disciplines that address the process of death and dying during undergraduate medical school, 310 (84.93%) students considered it necessary, while only 55 (15.07%) thought that this inclusion is little needed or that there is no such need. The students who answered the optional question about which disciplines should address the process of death and dying during the undergraduate medical course mentioned mostly the modules on elderly health and ethics, in addition to the communication laboratory and outpatient clinics.

Of the total number of respondents, 238 (65.21%) students said they felt psychologically unprepared or little prepared to deal with the death of a patient, while only 10 (2.74%) felt very prepared to deal with such a situation, whereas only 46 (12.60%) students fully agreed that the FPS medical course prepares the student to face the process of death and dying (Table 4).

Table 4 Students’ perspective regarding the approach to the process of death and dying during undergraduate medical school at Faculdade Pernambucana de Saúde. Recife, Pernambuco, Brazil, 2021 

Characteristic N %
Total number of students in the sample 365 100
Perspective about the frequency that the topics related to death and dying are addressed during curricular activities
Never addressed 45 12.33
Rarely addressed 92 25.21
Sometimes addressed 190 52.05
Frequently addressed 35 9.52
Always addressed 3 0.82
For the student, the abovementioned topic was addressed
In theoretical activities 192 52.60
In practical activities 34 9.32
In both 87 23.84
In neither 52 14.25
Students’ view of the need to include more disciplines that address the process of death and dying during undergraduate medical school at Faculdade Pernambucana de Saúde
Not necessary 20 5.48
Little necessary 35 9.59
Reasonably necessary 118 32.33
Very necessary 192 52.60
Students’ perspective about the following statement: “The undergraduate medical course at Faculdade Pernambucana de Saúde prepares the student to face the process of death and dying”.
Totally agree 46 12.60
Partially agree or disagree 191 52.33
Neither agree, nor disagree 116 31.78
Totally disagree 12 3.29
Feelings of medical students at Faculdade Pernambucana de Saúde in relation to psychological preparation to deal with the death of a patient
Feel unprepared 80 21.92
Feel little prepared 158 43.29
Feel moderately prepared 117 32.05
Feel very prepared 10 2.74

Source: prepared by the authors.

Regarding the aspects that can influence the students’ perception of the understanding of the process of death and dying, 298 (70.67%) students believed that religion greatly influences it, while 271 (74.24%) believed that the experiences acquired through from the death of a relative, friend or acquaintance have a great influence on this understanding. The 12 (3.28%) students who chose to cite other aspects, mentioned spirituality, books, movies, arts, science, reflections and the reading of the book “Death is a day worth living” as influencing the process of understanding the death process.

Of those interviewed, 348 (95.34%) stated that students in the health area must be well prepared during their training to address the process of death with the patient. While 248 (64.94%) students said they were unprepared or little prepared to address this topic, 110 (30.13%) said they were moderately prepared and 7 (1.91%) believed they were very prepared to address this topic. For 119 (32.60%) students, the lack of practical knowledge is a feeling that hinders approaching the death process with these patients, while 131 (35.89%) said that it is their discomfort with the topic and 119 (32.60%) said the feeling that discourages them is the lack of theoretical knowledge (Table 5).

Table 5 Feelings about the death process and aspects that can influence the perception of medical students at Faculdade Pernambucana de Saúde about the process of death and dying. Recife, Pernambuco, Brazil, 2021 

Characteristic N %
Total number of students in the sample 365 100
Aspects that can influence the understanding of the process of death and dying
Culture 237 64.93
Religion 298 70.68
Information 196 53.69
Experiences acquired from the death of a relative, friend, acquaintance, etc. 271 74.24
Others 12 3.28
Student’s feelings about being prepared to address the death process with their patients
Unprepared 65 17.81
Little prepared 183 50.14
Moderately prepared 110 30.14
Very prepared 7 1.92
Feelings that, from the students’ point of view, discourage them from addressing the death process with their patients
Lack of theoretical knowledge 119 32.60
Lack of practical knowledge 289 79.17
Lack of time 7 1.91
Discomfort about the topic 131 35.89
Others 16 4.38

Source: created by the authors.

DISCUSSION

When analyzing the sociodemographic data of the present study, it was observed that they are in agreement with the scientific literature. A study carried out in 2007 on the profile of medical students at Universidade Federal do Espírito Santo, published in Revista Brasileira de Educação Médica, shows a prevalence of female (50.2%), white (68.6%) students with high family income (77.7%), similarly to the current study15. It is worth noting that the FPS is a private school, thus requiring greater purchasing power from the families. On the other hand, the study by UFES, a public university, found the same epidemiological data, showing that, even in tuition-free universities, most students have a high family income. This is probably due to the fact that medical school is, essentially, an expensive one. Additionally, the prevalence of white students with high monthly income in public universities is due to the fact that the quota system for having access to public universities based on the dependence of the race/skin color category to social class failed to include non-whites and low-income students in the medical course, as indicated by the study ‘Socioeconomic and Racial Profile of Medical Students at a Public University in Rio de Janeiro’16.

The present study also showed that the students had already thought about their feelings in relation to death and considered it something possible to conceptualize. The feelings most frequently associated with death by the students are fear, sadness, anguish and resignation. These data show it is possible to infer that, even though death is a natural process that all individuals will go through, it is still seen in a negative way by most medical students from FPS. In a literature review on “Feelings of medical students and physicians towards death” published in 2020 in Revista de Educação Médica, it was verified that, in most of the 18 analyzed studies, fear, insecurity, sadness, anger and guilt were mentioned as feelings experienced in the face of death situations on the part of medical students and resident physicians17. Another study found negative feelings experienced by students in relation to dying, reporting that death brings to them a sense of frustration and a feeling of incapacity, as they report a situation of unpreparedness to deal with death “with dignity”7.

Regarding the importance of discussing the process of death and dying during undergraduate school for the medical profession in the future, the present study showed that students consider it very important and believe this discussion has an impact during the practice of medicine. These data can be reinforced by the article published in 2020 in Revista Brasileira de Educação Médica on the perception and experience of death by medical students during undergraduate school, which showed that students changed their views on death after experiencing it during the course and consider that it is necessary to expand the discussion on this topic during undergraduate school18. This expansion is necessary for students to be able to reflect on the end-of-life process. Through this change, these future physicians will be able to develop the learning to deal with death in a more humanized way, reducing the discomfort that exists when dealing with this topic19.

In a systematic review of the literature with an exploratory nature on the teaching of death and dying in Brazilian undergraduate medical schools published in 2015, it was evidenced how much the non-discussion of death and dying makes medicine more mechanistic, where the disease outweighs the patient and brings harm not only to the practice of medicine, but also to the psychological aspects20. This statement can be reinforced by the students’ perception in the present study about the approach to the death and dying processes, since they believe that addressing this process interferes with the mental health of medical professionals. Moreover, students also demonstrated that they believe that the delay in this approach negatively impacts both the psychosocial well-being of the physician and the practice of medicine20. An article published in 2018 demonstrates that the lack of support during undergraduate school to deal with the topic of death can impair the student’s mental health and have an impact on care, making professionals feel unable to deal with death, and intensifying feelings such as pain and anguish19.

Another important factor to be highlighted is how the death process is addressed with the students. Some medical schools have adopted the PBL (problem-based learning) model, also used in FPS and thus, many of the disciplines that address this topic have become extinct. This emphasizes what was pointed out in the study by Marta et al., which states that tutoring activities should address not only technical-scientific knowledge, but also take into account the tutors’ reflections and experiences that promote discussions on this topic with the students. In another study, when asked about the PBL method and the traditional model, students stated that they felt more prepared to deal with uncertainties, with their limits and to make decisions with PBL teaching; however, as a negative point, they identified the difficulty in communicating, to have an emotional involvement, and to understand the disease process21. The study evidence reinforces how the PBL model correctly addresses the Brazilian guidelines on medical training; however, further research is still needed21. This can be supported by the present study, which showed that students consider it necessary to include more disciplines that address the process of death and dying during the undergraduate course.

As for the psychological preparation to deal with the death of a patient, most students reported being unprepared or little prepared to deal with this situation. These data is similar to that found by A. Vianna and H. Piccelli in their study published in the journal of the Brazilian Medical Association, in which 47.4% of the interviewees answered that they would be afraid to deal with the subject when asked about their possible reaction to being placed in the presence of an individual with a terminal illness22. For FPS students, the feelings that most prevent this approach are the lack of practical knowledge, discomfort with the topic and lack of theoretical knowledge. This lack of theoretical knowledge may be due to the focus that universities have on addressing diseases, their pathophysiology, causes, symptoms and treatments, and superficially discussing topics such as death, as important and commonplace as diseases during the exercise of the profession. This lack of knowledge generates discomfort in relation to the subject, and unpreparedness in the face of a patient’s death.

Regarding the aspects that can influence the students’ perception of the process of death and dying, the students demonstrated they believe that religion, experiences acquired when facing the death of a close person and cultural issues are the ones that have the most influence, and this point is evidenced by the study of T. Santos and V. Pintarelli (2019), which showed that 54% of students and 44.2% of resident physicians in the research stated that religion influences their perception of death23. The cultural influence on the perception of death occurs because different societies have different specific ways of dealing with death. Although most cultures are inserted in a context of denial of death, Mexicans, for instance, even have a date to celebrate it. The Day of the Dead is part of the festive calendar of popular culture in Mexico and, in this festival, death is celebrated in a joyful and unique way on November 2nd, based on the idea that the dead did not die completely, they just passed to the other side of life24. On this same date, the Day of the Dead is also celebrated in Brazil and, very differently from the Mexican party, this holiday is characterized by sadness, nostalgia and mourning for loved ones who have passed away.

Study limitations

Data collection was negatively affected by the COVID-19 pandemic, being carried out remotely, making it difficult for students to have access to an explanation about the importance of the research in person. This fact compromised the number of students who answered the questionnaire in full and, considering this, it is not possible to generalize the opinion of all FPS medical students, since incomplete and absent answers from a considerable number of individuals could bring different results, other than those found by the present study.

CONCLUSIONS

Most of the investigated FPS medical students reported negative feelings towards the death process and feel psychologically unprepared to deal with the death of a patient, as they do not consider that the undergraduate medical course prepares them to face the death and dying process. Moreover, the students agree that the discussion about this process is important both in the practice of medicine and in the psychosocial well-being of the physician, in addition to interfering with the mental health of these professionals.

For students, the death and dying process is rarely addressed during the undergraduate medical course at FPS and there is a consensus among students that it is necessary to include more disciplines to discuss this subject in the undergraduate medical course at the institution, since most of them feel unprepared to approach the death process with a patient, a common situation in the life of medical professionals.

Therefore, the present study suggests the inclusion of modules that address death and dying during the undergraduate medical course at FPS, aiming to contribute to the understanding of its students about this process, in addition to psychologically preparing these future physicians to deal more effectively with the death of patients during the exercise of their profession.

REFERENCES

1. Ferreira ABH. Dicionário Aurélio básico da língua portuguesa. Rio de Janeiro: Nova Fronteira; 1988. [ Links ]

2. Hohendorff JV, Melo WV. Compreensão da morte e desenvolvimento humano: contribuições à psicologia hospitalar. Estud Pesqui Psicol. 2009;9(2):480-92. [ Links ]

3. Freitas Neto JA. O México e a festa dos mortos. 2020. [acesso em 2 abr 2020]. Disponível em: Disponível em: https://www.unicamp.br/unicamp/ju/artigos/jose-alves-de-freitas-neto/o-mexico-e-festa-dos-mortos . [ Links ]

4. Melo AAM, Silva LC. A estranheza do médico frente à morte: lidando com a angústia da condição humana. Revista da Abordagem Gestáltica. 2012;18(1):52-60. [ Links ]

5. Blasco PG. O médico perante a morte. Sociedade Brasileira de Medicina de Família (São Paulo). 2009;2(4):7-12. [ Links ]

6. Bifulco VA, Lochida LC. A formação na graduação dos profissionais de saúde e a educação para o cuidado de pacientes fora de recursos terapêuticos de cura. Rev Bras Educ Med. 2009; 33(1):92-100. [ Links ]

7. Azeredo NSG, Rocha CF, Carvalho PRA. O enfrentamento da morte e do morrer na formação de acadêmicos de Medicina. Rev Bras Educ Med . 2011;35(1):37-43. [ Links ]

8. Meireles MAC, Feitosa RB, Oliveira LA, Souza HJ, Lobão LM. Percepção da morte para médicos e alunos de medicina. Rev Bioét. 2019;27(3):500-9. [ Links ]

9. Batista GFM, Freire GCL. Análise do ensino da morte e do morrer na graduação médica brasileira. Revista Brasileira de Bioética. 2019;15(3):1-13. [ Links ]

10. Kovács MJ. Desenvolvimento da tanatologia: estudos sobre a morte e o morrer. Paidéia. 2008; 18(41):457-68. [ Links ]

11. Faculdade Pernambucana de Saúde. Curso: Medicina. Matriz Curricular 2. Disponível em: Disponível em: https://www.fps.edu.br/cursos/download/b9f66226a746c7d20aed613387d0fe56_medicina_matriz_curricular_2_2021.pdf . Acesso em: 9 ago 2021. [ Links ]

12. Viana OS, Jordan APW, Melo J, de Medeiros FPM. Curadoria para o grupo de estudo em saúde e espiritualidade. In: Curadoria de Conteúdo dos Projetos de Extensão e Responsabilidade Social da FPS. Recife; 2021. p. 250-59. [ Links ]

13. Araújo CAFL, Lima EJF, Maia PFCMD, Souza E, Leal C. Manual do estudante 2020. Medicina 3° período: Planos de ensino e programação dos módulos. Recife; 2020. p. 1-33. [ Links ]

14. Custódio MRM. O processo de morte e morrer no enfoque dos acadêmicos de enfermagem. Encontro: Revista de Psicologia. 2010; 13(18). [ Links ]

15. Fiorotti KP, Rossoni RR, Miranda AE. Perfil do estudante de Medicina da Universidade Federal do Espírito Santo. Rev Bras Educ Med . 2010;34(3):355-62. [ Links ]

16. Souza, PGA de et al. Socio-Economic and Racial profile of Medical Students from a Public University in Rio de Janeiro, Brazil. Revista Brasileira de Educação Médica [online]. 2020, v. 44, n. 03 [Acessado 2 out 2022], e090. Disponível em: <Disponível em: https://doi.org/10.1590/1981-5271v44.3-20190111.ING Disponível em: https://doi.org/10.1590/1981-5271v44.3-20190111 >. Epub 08 jul 2020. ISSN 1981-5271. https://doi.org/10.1590/1981-5271v44.3-20190111.ING. [ Links ]

17. Souza TIM, Assis LC, Silva LO, Souza THOM, Tadeu HAC, Campos MEC, et al. Sentimentos dos estudantes de Medicina e médicos residentes ante a morte: uma revisão sistemática. Rev Bras Educ Med . 2020;44(4):e178. [ Links ]

18. Correia DS, Taveira MGMM, Marques AMVFA, Chagas RRS, Castro CF, Cavalcanti SL. Percepção e vivência da morte de estudante de Medicina durante a graduação. Rev Bras Educ Med . 2020;44(1):e013. [ Links ]

19. Siqueira J, Zilli F, Griebeler S. Profissionais de saúde e o processo de morte e morrer dos pacientes: uma revisão integrativa. Pers Bioét. 2018;22(2):288-302. [ Links ]

20. Camargo AP, Nunes LMF, Reis VKR, Breschiliare MFP, Morimoto FJ, Mares WAS. O ensino da morte e do morrer na graduação médica brasileira: artigo de revisão. Revista Uningá. 2015; 45(1):44-51. [ Links ]

21. Gomes R, Brino RF, Aquilante AG, Avó LRS. Aprendizagem baseada em problemas na formação médica e o currículo tradicional de Medicina: uma revisão bibliográfica. Rev Bras Educ Med . 2009;33(3):433-40. [ Links ]

22. Vianna A, Piccelli H. O estudante, o médico e o professor de medicina perante a morte e o paciente terminal. Rev Assoc Med Bras. 1998;44(1):21-7. [ Links ]

23. Santos TF, Pintarelli VL. Educação para o processo do morrer e da morte pelos estudantes de Medicina e médicos residentes. Rev Bras Educ Med . 2019;43(2):5-14. [ Links ]

24. Villaseñor RL, Concone MHVB. A celebração da morte no imaginário popular mexicano. Revista Temática Kairós Gerontologia. 2012;15(4):37-47. [ Links ]

6Evaluated by double blind review process.

SOURCES OF FUNDING The authors declare no sources of funding related to this research.

Received: November 30, 2021; Accepted: September 20, 2022

Chief Editor: Rosiane Viana Zuza Diniz. Associate editor: Izabel Coelho.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest related to this study.

Creative Commons License Este é um artigo publicado em acesso aberto sob uma licença Creative Commons