Preparing for the inevitable: a scoping review of death and dying education in U.S. medical schools

PURPOSE: Knowledge about death, dying, loss, grief, and end-of-life care is an essential skill for physicians. However, end-of-life education is often incorporated into medical school curricula in the United States as electives. This scoping review explores the current empirical literature on how death and dying is taught in U.S. medical schools to identify evidence-based teaching practices and areas of opportunities to enhance death and dying education for future physicians. METHOD: The authors conducted a systematic scoping review in PubMed and EMBASE, using PRISMA-ScR guidelines, of articles focused on death and dying education conducted in a U.S. MD-granting medical school setting between January 2010 and April 2025. Successive reviews of the titles, abstracts, and full texts were performed, as well as forward and backward citation searches. The initial search yielded 4,959 records; ultimately, the analytic sample for this review was 43 articles. RESULTS: Overall, the 43 included articles described significant variation in how death and dying is taught in medical schools. Twenty-one studies used quantitative methodologies, 13 used qualitative methodologies, and 9 used mixed or multiple methods. In line with competency-based medical education standards, the authors organize the findings around the knowledge, skills, and abilities model. Over half of the articles (n = 25) emphasized knowledge acquisition, 22 integrated skills-based components, and 28 addressed the assessment of abilities. Simulation training was common within skills-based interventions. CONCLUSIONS: There remains a sizeable gap in evidence-based medical education related to knowledge, skills, and abilities pertaining to end-of-life care. The authors offer next steps for developing, implementing, and measuring evidence-based interventions to improve end-of-life care competency. The authors advocate for continued implementation of evidence-based educational interventions, regardless of anticipated specialty area, throughout all preclinical and clinical years.