We need to talk about death
Professor Derek Scott, School of Medicine, Medical Science & Nutrition
Describe the context of your / the project team’s approach to enhance teaching and learning.
All healthcare professionals and medical scientists are expected to have an understanding of physiology across the continuum of life – but this expectation does not apparently extend to the mechanisms underlying death, an irreversible physiological process akin to that of labour. The implications of a lack of understanding and discussion about death are widespread and hugely detrimental, particularly to the standard of care of the dying. It was proposed that this void of understanding about death amongst healthcare professionals and science students was the consequence of an absence of teaching about death – and the physiology underlying the process – in current educational programmes. The topic is also completely absent from most textbooks. Students also told us that they didn’t always understand why friends or loved ones had died during the pandemic. We aimed to develop a range of teaching activities to teach about how people die in a sensitive but evidence-based manner.
Provide a description of the project and either briefly describe your role as an individual, and if applicable, the role of others; or briefly describe the roles of all named above.
A review was undertaken of all core healthcare/medical science texts held by our library to assess what they actually said about how we die. Curriculum guidance for various healthcare/science professions was also reviewed. Using this as a basis, I conceived of the idea of using various fictional texts/TV programmes as a platform for discussing how and why people die in a way that would be less distressing for students to talk about in class. The texts/media could be chosen to suit any different learner group. A variety of problem-solving tutorials were developed and integrated into existing teaching in Levels 1 and 3. The same tutorials delivered in Aberdeen were also delivered at University of East Anglia to compare responses/effectiveness. Following a short introduction, students focus on selected examples from media e.g. James Bond movies. They reflect on their understanding and unpack true causes of why people die in different circumstances.
Give a rationale for your / the project team’s teaching approach or new initiative.
These tutorials were designed to provide a safe environment for examination of physiological basis for signs of sudden death and terminal illness. Textbook authors and educators shy away from producing materials on such topics as there is lack of data on what students want to know and for fear of offense/causing distress. Fictional characters and core concepts can help students think about complex ideas in physiology.
Given the feedback/data generated from these classes, along with data from our review of current textbook/curriculum guidance documentation, we are developing recommendations for educators regarding what and how they should be teaching students regarding how we die. This initiative also helped us improve our pastoral care for students by helping them better understand what can be a distressing topic.
This work also aligns with recent recommendations that we help the general public understand the dying process more clearly.
Provide details of how your / the project team’s new teaching approach or solution has been / will be disseminated with colleagues and students within and beyond the University. Is the approach transferable to other disciplines?
This work has already resulted in 5 abstracts related to talks/poster presentations given at national/ international conferences (e.g. Honours student spoke in Copenhagen in 2023). All of these were co-authored/co-presented with students. A paper is current being drafted with two students as lead authors, with two invited articles already published. This work was the focus of an invited research talk given at the University of Leeds in 2023. The work has produced 7 Honours projects, all with different themes. The output from this work has changed teaching delivered during our first-year lectures to a class over ~100, drawn for a variety of schools. UEA has also integrated new teaching based upon this work for several of their healthcare programmes. Our use of non-scientific media such as the Iliad, James Bond, Game of Thrones and Agatha Christie as platforms for this teaching shows how other disciplines could easily adapt our approach.
Identify the key learnings points - what have you / the project team learned from this initiative and how has it further enhanced you / the project team’s practice?
One key thing gained from this project is that this topic has a major impact on every audience. There are always people with their own stories relating to death that they have never been able to share with others. We have been approached by healthcare professionals who have left their jobs because of something that happened during their practice that they didn’t understand and that we have been able to help them understand better. This work has also allowed us to develop a major partnership with UEA that has affected real change in teaching and is driving a whole new programme of educational innovation/research. A key theme of this is working with students as partners – this can ensure we can use inclusive language and examples from around the world. I’ve also learned that students can be profoundly reflective, leading to more reflective questions rather than merely scientific/mechanistic ones in tutorials.
Explain how you have / the project team has evaluated the impact or influence of your initiative.
We already have a significant amount of data derived from student responses in class. When this assessment was first introduced, 56 Level 1 students voluntarily gave their views discussing such topics during such a tutorial. 42 reported that they found cellular death/injury easier to discuss than how people die. A similar emphasis was found in our audit of texts and guidance documents. 54 students said we needed to teach about this more openly/include more in texts, with 2 being unsure. UEA students reported in their reflections that this was the best tutorial they had experienced all year. For the year 3 Game of Thrones tutorial, Year 1 of delivery (n=80): 91.67% rated it 5/5 as totally meeting their learning needs, with 8.33% rating it 4/5. Year 2 of delivery (n = 105): 90% rated it 5/5, 10% rated it 4/5 in terms of meeting their learning needs.