Do as I say: curricular discordance in medical school end-of-life care education

J Palliat Med. 2007 Jun;10(3):759-69. doi: 10.1089/jpm.2006.0190.


Purpose: Prior research indicates that medical students face significant personal and ethical challenges when they perceive differences between what is taught in class (formal curriculum) and what is practiced on the wards (informal curriculum). This study seeks to further describe the educational experience and characteristics of students who perceive curricular discordance in end-of-life care (EOLC) training.

Method: Self-administered questionnaire among third-year medical students at a large, urban medical school. Statistics to identify the correlates of perceived curricular discordance.

Results: Completed surveys were returned by 141 students out of a class of 162 (response rate 86.5%). Student perception of curricular discordance was inversely correlated with student perception of educational quality (p=0.001) and their regard for institutional values (p<0.001). Student attitudes and emotional reactions did not correlate with curricular discordance, nor did student age, gender, ethnicity, or prior personal experience with death of a loved one. Students had limited role modeling and feedback. While student informal curricular experiences did not correlate with a perception of curricular discordance, an increased number of informal curricular EOLC experiences did correlate with a perception of poorer educational quality (p=0.05).

Conclusion: Curricular discordance is correlated with a perception of poorer educational quality and more negative regard for institutional EOLC values, but not correlated with other features of student experience or characteristics. Importantly, increased informal EOLC experiences are associated with a more negative assessment of educational quality.

MeSH terms

  • Adult
  • Curriculum*
  • Education, Medical*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Physicians / psychology
  • San Francisco
  • Surveys and Questionnaires
  • Terminal Care*