“It is not a disease we treat, but a person”: Medical students’ reflections on their first rotations to an oncology and palliative care unit

The vast array of technologic advances in medicine has transformed traditional medical practice and education. However, these advances are not without their critics (1-7). Some medical educators and students suggest that the “final product” of medical education has many of the characteristics of the applied scientist (2) rather than those of the humane physician-healer (8). Many medical students bring to their studies an idealism and an empathy that, for many, is quickly eroded over time. According to Bellini and Shea (4), they may never fully recover their empathy. Several studies have concluded that a significant decline in empathy occurs during the third year of medical school, a time when empathy is most important because students are having their initial interactions with patients (6, 9). Shapiro has written extensively on current limitations in medical education (7, 10, 11). These include: an overemphasis on logico-scientific thinking, problem solving, and control; a devaluation of personal identity; a discounting of personal experience; and the practice of encouraging medical students to create a distance between themselves and patients. Such factors have significant implications for the way trained physicians will see their patients, for the quality of vocational satisfaction they will experience, and for their sustainability within the healthcare system (12). In 2009, the undergraduate medical curriculum at the University of New South Wales in Sydney, Australia, was expanded to include (inter alia) a significant component of reflective practice in students’ clinical activities. As a result of this curricular change, undergraduate medical students are now required to submit written reflections on their learning experiences. This compulsory report documents students’ impressions of their first four-week rotation and their exposure to patients in an oncology and palliative care setting. The aims of the current study were to analyze students’ reflections in order to determine the personal/professional impact of the rotation, to report on student responses to the new teaching curriculum, and to identify additional steps that could be taken to support students’ learning activities