Educational and emotional barriers to palliative care electives in Caribbean medical schools.

324 Background: Given the increasing complexity of end-of-life care and the expanding role of palliative medicine in modern healthcare, exposure to this specialty through medical student rotations is more important than ever. However, such exposure remains limited. Caribbean medical schools, which educate a large number of international graduates who pursue residencies in the United States, are strategically positioned to shape early exposure to this field. Despite this, little is known about why few students opt for palliative care rotations during their final year. Clarifying these influences is key to promoting student engagement and addressing workforce shortages in this specialty. Methods: A voluntary, anonymous survey was distributed electronically to fourth-year students across four Caribbean medical schools. The 20-item instrument used branching logic and included Likert-scale, multiple-choice, and open-ended items. The survey assessed interest in palliative care electives, perceived preparedness, views on end-of-life communication, emotional readiness, career alignment, and potential incentives for participation. Chi-square testing was used to examine differences in elective interest across intended specialties. Mann-Whitney U tests compared median scores for emotional preparedness and confidence in end-of-life care between students with high and low interest. Results: A total of 102 students completed the survey. Only 5% rated their interest in a palliative care elective as high, and just 6% had actively scheduled or completed such a rotation. Interest varied by specialty intention, with those pursuing internal medicine more likely to express interest compared to students aiming for surgical specialties (27% vs. 10%; p = 0.039). Reported obstacles included a lack of formal exposure to palliative care during training (61%), discomfort managing end-of-life issues (67%), and unclear expectations of a student’s role within palliative teams (43%). Qualitative comments revealed recurring concerns about insufficient training in death-related communication (n = 46), a desire for more structured learning opportunities (n = 54), and uncertainty about how palliative care fits into their long-term career plans (n = 31). Students who reported lower emotional readiness also tended to rate their interest in the elective lower ( p = 0.032). Conclusions: Uptake of palliative care rotations among Caribbean medical students is limited by emotional discomfort, lack of exposure, and unclear student roles. Strengthening mentorship, introducing earlier communication training, and clarifying student responsibilities may boost engagement. Future work should integrate structured palliative experiences into core curricula and assess their impact on student interest and career decisions.