ABSTRACT
Introduction: Medical students should be familiar with the end of life ethical issues and its considerations. For teaching end of life care to medical students, literature is a source of excellent narratives of patients with experiences of terminally ill condition in their journey through suffering and one of the most favourite bioethics literature readings has been the death of Ivan Ilych by Tolstoy. We used this novel to show medical students end of life events and suffering and asked them to write a reflective essay on it. We aimed to find what students think about terminally ill patients and their journey to death.
Methods: In an inductive qualitative content analysis model, 350 essays, collected by homogenous sampling, were analyzed. The fourth year medical students were provided with the Death of Ivan Ilych novel to read. They were asked to write a reflection essay based on the reflective stages defined by Sandars. These essays served as the unit of analysis, each being read several times and a coding model was formed according to main topics. The related concepts in each unit were named as themes and each theme was abstracted to a code and the related codes were compared and developed as categories
Results: Qualitative content analysis of 350 essays of fourth year medical students revealed three major categories in students' reflection on reading Death of Ivan Ilych as an end of life human body. These included: 1] Emotional experience, 2] Empathy and effective communication, 3] Spirituality and dignity. Analysis of essays showed that this reflection activity may help medical students have a deeper idea of the end of life situation and feelings
Conclusion: This project suggests that literature can be used as an example to introduce new ethical concepts to less experienced medical trainees. The students acquired the concept of the story and reflected the major aspects of the suffering of a human being in their essays. Having used and evaluated the effect of literature on facilitating ethical insight in the teaching end of life care, we strongly recommend this method and specially the novella, Death of Ivan Ilych
Subject(s)
Female , Humans , Male , Students, Medical , Education, Medical , Writing , Death , Terminally IllABSTRACT
This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus [SLE] and a matched control group of non-SLE kidney recipients. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. In each group, 12 patients [36.4%] received a kidney from a deceased donor, 15 [45.4%] from a living unrelated donor, and 6 [18.2%] from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 +/- 18.1 days in the SLE group, while it was 13.0 +/- 7.3 days in the controls [P = .006]. One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients [P = .17]. One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls [P = .26]. Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications [P = .59]. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys