We have previously reported work which examined the inclusion of the physiology of death within the medical curriculum (Brown et al., 2022). Our previous focus had mainly examined educational recommendations and resources for doctors, but we were keen to expand this work to other medical and allied healthcare professionals. We aimed to explore whether training recommendations and education on this important but often ignored topic was better for some professions. We hoped that we could identify best practise and use this to make recommendations for other professions when learning about this topic.
A literature review was conducted of 59 educational and professional guidance documents for 14 allied health professions and other conventional medical professionals. Further analysis of the selected terms/keywords within 45 academic textbooks for three advanced clinical practitioner types was undertaken, as well as 15 general, non-profession-aimed medical science textbooks.
Results showed that paramedics had the highest frequency of selected terms, with ’death’ being the most common term across both reviews and ’apoptosis’ being the most frequent term within the general medical science textbook analysis. More scientific and technical terms, such as ’brain stem death’, were found more frequently in the textbooks than in the guidance documents. Nurses had a more holistic approach to care and dying, as reflected in their selected terms, such as ’palliative’ and ’end of life’ being more common. Physician associates scored the lowest compared to advanced nurse practitioners and paramedic practitioners, likely due to their newness as a profession and use of selected terms that focused more on cellular processes, rather than death or dying of the actual person.
The study concludes that paramedics may have the most significant understanding of the physiology of death, followed by doctors, if the recommendations made in their clinical guidance documents are taught fully and effectively. Paramedics are also very likely to be exposed to a broader range of patient deaths and trauma given the nature of their clinical role. It was also clear that, despite the recommendations regarding a full understanding of lifespan physiology for many healthcare professions, there is a lack of specific learning material available for educators and learners to use when trying to expand their understanding. Developing educational material or learning activities on such a sensitive topic may also be challenging for specific professions (e.g. midwives) where such experiences may potentially be very distressing and hard to simulate. It may be that curriculum guidance documents should be reviewed in light of the recent experiences of some healthcare professionals (e.g. physiotherapists) who dealt more closely and frequently with dying patients during the pandemic than was previously typical.
We conclude that there are elements of good practice relating to death and the dying process in materials for healthcare professionals such as paramedics. Lessons could be learned from their education and resources to enhance the training of other clinical staff. These findings have implications for the enhancement of healthcare education and highlight the need for more open and honest discussions about death.