Date of Award


Degree Type


Degree Name

Master of Science


Health and Rehabilitation Sciences


Dr. Jeff Nisker


Title: Medical Students’ First Clinical Experiences of Death Research Objective: To elucidate medical students’ first experiences with patient death

using grounded theory and autoethnographic reflection.

Methods: Final-year medical students at the Schulich School of Medicine & Dentistry were invited by email to share their experience of the death of a patient in their care, either in an interview or focus group, or through email. The interviews and focus group were recorded and transcribed verbatim, which, along with the email responses, underwent qualitative analysis using grounded theory (Strauss and Corbin 1994) supported by Nudist N6TM software. Ethics approval was obtained from University of Western Ontario Research Ethics Board #10351E. In the final section, the author reflects on her own experiences of patient death and the research process in an autoethnographic piece.

Findings: Twenty-nine students had experienced the death of a patient and chose to participate (20 interviews, 5 in a focus group, 4 through email). Beginning with the open code stage that classified deaths as “old”, “young”, or “unexpected”, an axial stage of coding revealed seven major themes prevalent in students’ death experiences: (i) “preparation”; (ii) “death event”; (iii)”feelings”; (iv) “role of clinical clerk”; (v) “differential factors between death”; (vi) “closure”; and (vii) “relationships”. These themes in turn allow a cyclical model of student experience to be generated, proceeding in five stages; (i) “preparation”; (ii) “the event itself’; (iii) “the crisis”; (iv) “the resolution”; and (v) “the lessons learned”. In “preparation” students begin with their personal experience and preclinical instruction. During “the event itself’, students may encounter old, young or unexpected deaths, that may precipitate some degree of “crisis”. In the “resolution” phase, coping mechanisms included rationalization, contemplation, or learning. The “lessons learned” not only shape medical students’ understanding the death experience of future patients and their own experience of such deaths, but of their professional identity. In the final piece, the author reveals some of her own experience with patient death



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