Course on Death and Dying for Medical Students / 의학교육논단

The aim of modern medicine is to prolong life by fighting death. Doctors have traditionally believed that this was an ethical good deed. The negative connotation surrounding death has led to the avoidance of terminally ill patients. But in a modern society where death is medicalized, doctors have to see dying patients every day and are in a state of guilt from implementing meaningless life-sustaining treatments. Therefore, medical schools should allow medical students to embrace a new perspective through death education.Yonsei University Medical College has implemented death education since 2017 as an optional class for first and second year medical students. Students watch videos related to death once a week for 6 weeks and submit their reflections by e-mail. The professor reads the students’ reflections and gives them weekly feedback. Through this coursework, students realize that death is not a medical event, but rather a part of life and completion. The ultimate purpose of death education is to transform blind life-absolutist identity into narrative identity.

The Influence of Death Education on Medical Students' Attitudes towards End-of-Life Care: A Preliminary Study / 의학교육논단

End-of-life care competencies have been perceived as important and essential, so it has been suggested that end-of-life care be studied in undergraduate medical education. However, end-of-life care curriculum has mostly focused on acquisition of knowledge and skills rather than attitudes. Therefore, we aimed to explore whether education about death affects medical students' attitudes towards care for dying patients and perception of death anxiety, meaning in life, and self-esteem. A total of 15 first- or second-year medical students were surveyed with questionnaires before and after completing a 6-week death education course. Paired data analysis showed that participants' attitudes towards caring for terminally ill patients and their caregivers improved significantly (t=−2.84, p=0.013) with an effect size of 0.73. In contrast, no significant changes were found in death anxiety, meaning in life, or self-esteem. All participants agreed that formal teaching about death and dying must be encouraged in medical schools. Our results suggest that death education may positively influence attitudes towards end-of-life care. Although replication with larger samples is necessary, this preliminary finding may support the importance of developmentally appropriate end-of-life care education in medical schools.

Current pharmacological management of chronic pain

Chronic pain is associated with disabling physical and emotional symptoms. Patients with chronic pain utilize more health services, have an impaired sense of well-being and frequently experience anxiety or depression. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life. Treatment of chronic pain involves a comprehensive approach using medication and functional rehabilitation. The usual approach for mild to moderate pain is to start with nonopioid analgesics. Also, trying antidepressant drugs for sleep loss and gabapentin for neuropathic pain or fibromyalgia is appropriate. For moderate to severe chronic pain, opioid analgesics can be used without any serious side effects if adequately used at the right dosage. It is important to provide guidance on the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Mechanisms of analgesia, drug selection, and recommendations for clinical usage for the management of chronic pain are reviewed in this paper.