Abstract
Patient death is a complex and formative experience for medical students. Debriefing can be a powerful support for students during clerkship, when most students encounter patient death for the first time. However, medical educators require better understanding of student debriefing experiences amid patient death, to inform debriefing as a support. We conducted a focused secondary Reflexive Thematic Analysis (RTA) of longitudinal semi-structured interviews with twelve medical students during the clinical phase of a four-year Canadian undergraduate medical program (n = 48 interviews). Our iterative interpretive analysis explored student experiences of debriefing about patient death. Students described highly variable access to debriefing, with many encounters with patient death occurring without acknowledgement or support. When debriefing was absent, students expressed feelings of loneliness, emotional turmoil, and even disillusionment. However, when debriefing was practiced or even just offered, students described feeling connected, accepted, and safe. Student-identified barriers to debriefing included existing expectations, attitudes, and practices around patient death. Students emphasized the value of debriefing informally with preceptors and near peers. Participants desired skills and practices to help them to emotionally process the death of a patient during clinical placements. They perceived offers for debriefing as indications of a safe learning environment, whether students accepted or declined these offers. Missed opportunities for debriefing about death reinforced professional norms that diminish death and devalue emotional experiences in medicine. By introducing and normalizing debriefing as a practice early in medical education and encouraging its use during clinical placements, we can better prepare students to face the deeply impactful experience of patient death.