Dealing With Patient Death on International Health Electives: A Qualitative Study of Residents’ Experiences

PURPOSEInternational health electives (IHEs) provide numerous educational benefits; potential harms are less well understood. One potential harm is trainee distress associated with increased patient death during IHEs. The purpose of this study was to explore residents’ and fellows’ IHE experiences with patient death. METHODThe authors used applied thematic analysis to explore residents’ and fellows’ IHE experiences with patient death. The Mayo International Health Program supports IHEs from all specialties across three Mayo Clinic sites. Data were collected and analyzed in two steps. First the authors collected, coded, and analyzed narrative reflections from 43 postrotation reports gathered in 2001–2017 and identified themes relating to experiences with patient death. Second, in 2016–2017 the authors conducted semistructured interviews with six previous participants to refine thematic analysis. RESULTSParticipants described impacts of experiencing increased patient death and identified themes in two domainsdifficult experiences with patient death and potential interventions to help residents process their experiences. They identified four themes illustrating why these experiences were difficultlack of preparation for increased exposure to death, lack of closure, consequences of limited resources, and differences in cultural beliefs regarding death. While pretrip preparation for dealing with death was viewed as important, trainees identified support during and debriefing after IHEs as additional important interventions. CONCLUSIONSGiven the popularity of IHEs, residency programs should consider the effect on trainees of increased exposure to patient death. Study findings can inform IHE preparation, support, and debriefing to minimize distress associated with witnessing patient deaths on IHEs.