A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

Submitted: February 9, 2021
Accepted: April 21, 2021
Published: May 26, 2021
Abstract Views: 1201
PDF: 481
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


The medical students’ well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students’ clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The “Interpretive Description” approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students’ subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students.



PlumX Metrics


Download data is not yet available.


Hynes J, Maffoni M, Argentero P, et al. Palliative medicine physicians: doomed to burn? BMJ Support Palliat Care 2019;9:45-6. DOI: https://doi.org/10.1136/bmjspcare-2018-001731
Maffoni M, Argentero P, Giorgi I, et al. Healthcare professionals’ moral distress in adult palliative care: a systematic review. BMJ Support Palliat Care 2019;9:245-54. DOI: https://doi.org/10.1136/bmjspcare-2018-001674
Costa EF, Santos SA, Santos AT, et al. Burnout Syndrome and associated factors among medical students: a cross-sectional study. Clinics 2012;67:573-80. DOI: https://doi.org/10.6061/clinics/2012(06)05
Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med 2008;149:334-41. DOI: https://doi.org/10.7326/0003-4819-149-5-200809020-00008
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA 2016;316:2214-36. DOI: https://doi.org/10.1001/jama.2016.17324
Thurn T, Anneser J. Medical students' experiences of moral distress in end-of-life care. J Palliat Med 2020;23:116-120. DOI: https://doi.org/10.1089/jpm.2019.0049
Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online 2018;23:1530558. DOI: https://doi.org/10.1080/10872981.2018.1530558
Burr J, Beck Dallaghan GL. The relationship of emotions and burnout to medical students' academic performance. Teach Learn Med 2019;2019:1-8. DOI: https://doi.org/10.1080/10401334.2019.1613237
Boland JW, Barclay S, Gibbins J. Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students. Med Teach 2019;41:1359-65. DOI: https://doi.org/10.1080/0142159X.2018.1533243
Kitto S. "What is an Educational Problem?" Revisited. J Contin Educ Health Prof 2019;39:223-4. DOI: https://doi.org/10.1097/CEH.0000000000000272
Thorne S. Interpretive description: Qualitative research for applied practice. London: Routledge; 2016. DOI: https://doi.org/10.4324/9781315545196
Hunt MR. Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work. Qual Health Res 2009;19:1284-92. DOI: https://doi.org/10.1177/1049732309344612
Ronggui H. RQDA: R-based Qualitative Data Analysis. R package version 0.2-8; 2016. Retrieved May 2019.
Hatem DS, Halpin T. Becoming doctors: Examining student narratives to understand the process of professional identity formation within a learning community. J Med Educ Curric Dev 2019;6:2382120519834546. DOI: https://doi.org/10.1177/2382120519834546
Wilson I, Cowin LS, Johnson M, et al. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med 2013;25:369-73. DOI: https://doi.org/10.1080/10401334.2013.827968
Sasso L, Bagnasco A, Bianchi M, et al. Moral distress in undergraduate nursing students: A systematic review. Nurs Ethics 2016;23:523-34.
Percy M, Richardson C. Introducing nursing practice to student nurses: How can we promote care compassion and empathy. Nurse Educ Pract 2018;29:200-5. DOI: https://doi.org/10.1016/j.nepr.2018.01.008
Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-13. DOI: https://doi.org/10.1016/j.mayocp.2015.08.023
Maffoni M, Argentero P, Giorgi I, et al. Underneath the white coat: Risk and protective factors for palliative care providers in their daily work. J Hosp Palliat Nurs 2020;22:108-14. DOI: https://doi.org/10.1097/NJH.0000000000000623
Gadoud A, Adcock Y, Jones L, et al. “It's not all doom and gloom”: perceptions of medical students talking to hospice patients. J Palliat Med 2013;16:1125-9. DOI: https://doi.org/10.1089/jpm.2013.0036
Uchino BN, Carlisle M, Birmingham W, et al. Social support and the reactivity hypothesis: conceptual issues in examining the efficacy of received support during acute psychological stress. Biol Psychol 2011;86:137-42. DOI: https://doi.org/10.1016/j.biopsycho.2010.04.003
Gallagher O, Saunders R, Tambree K, et al. Nursing student experiences of death and dying during a palliative care clinical placement: Teaching and learning implications. In Transformative, innovative and engaging. Proceedings of the 23rd Annual Teaching Learning Forum, 30-31 January 2014. Perth: The University of Western Australia. Available from: http://ctl.curtin.edu.au/professional_development/conferences/tlf/tlf2014/refereed/gallagher.pdf
Zanatta F, Maffoni M, Giardini A. Resilience in palliative healthcare professionals: a systematic review. Support Care Cancer 2020;28:971-8. DOI: https://doi.org/10.1007/s00520-019-05194-1
Ranse K, Ranse J, Pelkowitz M. Third-year nursing students’ lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemp Nurse 2018;54:160-70. DOI: https://doi.org/10.1080/10376178.2018.1461572
Head BA, Earnshaw LA, Greenberg RB, et al. “I will never forget”: what we learned from medical student reflections on a palliative care experience. J Palliat Med 2012;15:535-41. DOI: https://doi.org/10.1089/jpm.2011.0391
Hynes J. I want you to pretend to be sincere. Med Educ 2016;50:1219-23. DOI: https://doi.org/10.1111/medu.13097
Maffoni M, Argentero P, Giorgi I, et al. Healthcare professionals' perceptions about the Italian law on advance directives. Nurs Ethics 2020;3:796-808. DOI: https://doi.org/10.1177/0969733019878831
Wittenberg-Lyles EM, Goldsmith J, Ragan SL, et al. Medical students’ views and ideas about palliative care communication training. Am J Hosp Palliat Care 2010;27:38-49. DOI: https://doi.org/10.1177/1049909109347327
Coleman AM. Physician attitudes toward advanced directives: a literature review of variables impacting on physicians attitude toward advance directives. Am J Hosp Palliat Care 2013;30:696-706. DOI: https://doi.org/10.1177/1049909112464544
De Valck C, Bensing J, Bruynooghe R, et al. Cure-oriented versus care-oriented attitudes in medicine. Patient Educ Couns 2001;45:119126. DOI: https://doi.org/10.1016/S0738-3991(00)00201-9
Bordignon SS, Lunardi VL, Barlem ELD, et al. Moral distress in undergraduate nursing students. Nurs Ethics 2019;23:523-34. DOI: https://doi.org/10.1177/0969733015574926
Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol 2017;22:51-67. DOI: https://doi.org/10.1177/1359105315595120

How to Cite

Maffoni, Marina, Karin Olson, Julia Hynes, Piergiorgio Argentero, Ilaria Setti, Ines Giorgi, and Anna Giardini. 2021. “A Journey through Roses and Thorns: Becoming a Physician by Learning from Patients With Life-Threatening Illnesses. A Qualitative Study With International Medical Students”. Monaldi Archives for Chest Disease 91 (3). https://doi.org/10.4081/monaldi.2021.1800.