1 Faculty of medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Quality Improvement in Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 2Quality Improvement in Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 3Internal Medicine Department, Nephrology division, Shiraz University of Medical Sciences, Shiraz, Iran


Introduction: Medical students should be familiar with the endof life ethical issues and its considerations. For teaching end oflife care to medical students, literature is a source of excellentnarratives of patients with experiences of terminally ill conditionin their journey through suffering and one of the most favouritebioethics literature readings has been the death of Ivan Ilych byTolstoy. We used this novel to show medical students end of lifeevents and suffering and asked them to write a reflective essayon it. We aimed to find what students think about terminally illpatients and their journey to death.Methods: In an inductive qualitative content analysis model, 350essays, collected by homogenous sampling, were analyzed. Thefourth year medical students were provided with the Death of IvanIlych novel to read. They were asked to write a reflection essaybased on the reflective stages defined by Sandars. These essaysserved as the unit of analysis, each being read several times and acoding model was formed according to main topics. The relatedconcepts in each unit were named as themes and each theme wasabstracted to a code and the related codes were compared anddeveloped as categories.Results: Qualitative content analysis of 350 essays of fourth yearmedical students revealed three major categories in students’reflection on reading Death of Ivan Ilych as an end of life humanbody. These included: 1) Emotional experience, 2) Empathy andeffective communication, 3) Spirituality and dignity. Analysisof essays showed that this reflection activity may help medicalstudents have a deeper idea of the end of life situation and feelings.Conclusion: This project suggests that literature can be used asan example to introduce new ethical concepts to less experiencedmedical trainees. The students acquired the concept of the storyand reflected the major aspects of the suffering of a human beingin their essays. Having used and evaluated the effect of literatureon facilitating ethical insight in the teaching end of life care, westrongly recommend this method and specially the novella, Deathof Ivan Ilych.Keywords: Education; Death; Medical students; Qualitative study