Drama and Digital Training Help Medical Students Face Requests for Hastened Death

When a patient with a terminal illness asks a physician whether assisted dying might be an option, the words that follow can shape the entire course of care. In Germany, where assisted suicide has been legal since a landmark constitutional court ruling, doctors can no longer assume such conversations lie outside their professional remit. Yet medical students consistently report that they feel unequipped for these moments, lacking both the communication skills and the legal knowledge to respond with clarity and compassion. A new study from RWTH Aachen University, published in BMC Medical Education, examines how future physicians can be trained for this emotionally charged territory, and the findings reveal a striking contrast between two very different teaching approaches.

The research emerged from the Erasmus+-funded ELPIS project, short for E-Learning on Palliative Care for International Students, a European collaboration aimed at strengthening palliative care education across borders. In 2023, the team led by Miriam Wegmann of the Department of Palliative Medicine at RWTH Aachen University offered medical students two voluntary training formats designed to build communication skills around the wish for hastened death. The first was a drama seminar, an in-person, theatre-based exercise in which students enacted difficult clinical scenarios in front of their peers. The second was an online tool, a structured digital module that allowed students to rehearse conversations at their own pace and away from the gaze of an audience. Both formats were deliberately unconventional by the standards of traditional medical curricula, which have historically privileged factual knowledge over the subtle craft of dialogue.

To understand how students experienced these formats, the researchers conducted qualitative interviews with fifteen medical students from RWTH Aachen University. Semi-structured interviews were transcribed in full and then analysed using qualitative content analysis, a method that combines inductive coding, in which themes emerge from the material itself, with deductive coding, in which predefined categories drawn from theory and prior literature are applied to the data. The dual approach allowed the team to capture both unexpected emotional responses and systematically anticipated themes such as realism, safety, and perceived learning gain. Supplementary tables published alongside the article document participant characteristics and exemplary quotations, and a supplementary figure details the final coding system, offering an unusually transparent window into the analytical process.

The drama seminar emerged in the interviews as an experience of remarkable emotional intensity. All fifteen students described it as immersive, and central to their accounts was the demand for genuine empathic engagement: to portray a patient pleading for help in dying, or a physician struggling to answer, students had to inhabit perspectives that most had never seriously considered. Participants reported that this embodied role-play triggered deep self-reflection, forcing them to confront their own attitudes toward death, autonomy, and professional duty. Crucially, the seminar also provided a rare opportunity to practise communication skills under pressure, articulating responses in real time rather than merely reading about them. In the vocabulary of medical education research, the drama format functioned as an affective and behavioural simulator, engaging dimensions of learning that lectures and textbooks rarely touch.

That intensity, however, carried a cost. Several students reported experiences of emotional overload when performing in front of their peers, a finding that speaks to a well-documented vulnerability in simulation-based education. Improvisational theatre in front of an audience of fellow students, particularly on a subject as intimate as a request for hastened death, can heighten performance anxiety to the point where the educational value is partially eclipsed by distress. The authors did not conclude that the drama seminar should be abandoned; rather, the interviews suggest that its benefits and its emotional risks are two sides of the same immersive coin, and that thoughtful pedagogical scaffolding is needed to keep the experience within a productive learning zone rather than a harmful one.

The online tool presented a nearly inverted profile. Students valued its flexibility, noting that they could engage with the material at times and in settings of their own choosing, and they praised its structured design, which guided them through conversational scenarios in a predictable, stepwise fashion. Most strikingly, the digital environment was perceived as emotionally safe: no peer was watching, no mistake was witnessed, and students with limited prior exposure to end-of-life conversations could experiment without social consequences. For novice learners in particular, this psychological safety appeared to lower the barrier to first engagement with a topic that many find intimidating. The format thus functioned as a gentle entry point, building familiarity and vocabulary before the stakes of live interaction were introduced.

The limitations of the online tool were, in the students’ assessment, the mirror image of its strengths. Because the interaction was mediated and scripted, participants described a reduced sense of realism, an absence of non-verbal interaction, and a diminished feeling of authenticity. A screen cannot frown, hesitate, or begin to weep; it cannot convey the tremor in a patient’s voice that makes a request for assisted dying so hard to meet. Communication in real clinical encounters is saturated with non-verbal signals, and a purely digital rehearsal inevitably strips away part of that complexity. The students were not rejecting the tool but recognising its proper place: excellent for preparation, insufficient on its own for mastery.

Perhaps the most actionable insight from the study is the students’ own proposal for how the two formats should be combined. Participants suggested a hybrid or blended learning approach in which the online tool serves as a preparatory phase before the drama seminar. In this sequence, the digital module would supply foundational knowledge, structured language, and emotional acclimatisation, while the drama seminar would then provide the high-fidelity, embodied practice that only live role-play can offer. The researchers note that such a blended design may reduce the emotional barriers that currently make drama-based training intimidating for some students, supporting a stepwise approach to communication training that mirrors how other complex clinical skills, from surgery to resuscitation, are progressively taught.

Beneath the pedagogical findings lies a more sobering discovery. The interviews revealed a marked lack of knowledge among the students regarding the legal framework governing assisted suicide in Germany. Even though the legal situation places direct ethical and communicative demands on practising physicians, many students could not accurately describe what the law permits, requires, or prohibits. The authors argue that this gap reinforces the need to integrate legal and ethical education into the medical curriculum alongside communication training, so that graduates can ground their conversations in accurate legal understanding rather than uncertainty. Communication skills and legal literacy, the study suggests, are not separable competencies in this domain; a physician who listens beautifully but does not know the law cannot guide a patient responsibly.

Taken together, the findings from Aachen sketch a template for how medical schools might prepare the next generation of physicians for one of the most difficult conversations in medicine. The drama seminar supplies immersion, empathy, and authentic practice, while the online tool supplies safety, structure, and accessibility, and the students themselves have articulated a sensible blueprint for combining them. As assisted dying becomes legally recognised in a growing number of jurisdictions worldwide, the demand for conversations about hastened death will reach an ever-larger share of clinicians, making preparation not a luxury but a professional necessity. The Aachen study, conducted within a European palliative care education network and published open access, indicates that neither technology nor theatre alone is sufficient, but that a carefully sequenced blend of the two, embedded within legal and ethical teaching, may finally give medical students the right words when patients need them most.

Subject of Research: Medical students' perceptions of drama-based and online communication training for conversations on the wish for hastened death

Article Title: Finding the right words: preparing medical students for communication on the wish for hastened death – medical students’ perceptions of drama-based and online communication training

Article References: Wegmann, M., Lemos, M., Fink, D., Scherg, A., & Elsner, F. (2026). Finding the right words: preparing medical students for communication on the wish for hastened death – medical students’ perceptions of drama-based and online communication training. BMC Medical Education. https://doi.org/10.1186/s12909-026-10403-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10403-7

Keywords: medical education, assisted suicide, hastened death, communication training, drama-based learning, online learning, hybrid teaching, palliative care, medical ethics, legal education, qualitative interviews, RWTH Aachen University