Magnani Jared W, Minor Melissa A, Aldrich Jon Matthew
Stanford University School of Medicine, Stanford, California, USA.
Acad Med. 2002 Apr;77(4):292-8. doi: 10.1097/00001888-200204000-00006.
End-of-life (EOL) and palliative care education in medical school curricula stand at a crossroads. Consensus has emerged that these topics merit systematic instruction throughout medical school training, yet curricula all too often consist of sporadic lectures focused on bioethics instead of clinical skills. The medical student authors identified a deficit in their curriculum, and designed and implemented an EOL curriculum module for their colleagues. In early 2000 the authors surveyed senior medical students about their experiences with EOL and palliative education, identifying deficits in clinical training and recommendations for interventions. They then designed a case-based educational module to teach EOL communication skills to medical students commencing clinical training. Faculty with national and local experience with EOL and palliative care reviewed the curriculum. Twelve of these faculty were oriented to the curriculum and then taught it in pairs to groups of 12 to 16 medical students in 2000 and 2001. The curriculum develops skills, attitudes, and knowledge relevant for communicating bad news and establishing treatment options in the EOL setting by utilizing trigger videos, group discussion, role plays, and case discussions. Approximately 75% of the 86 eligible students attended the module in 2000 and 2001. Feedback has guided the curriculum's refinement by the medical student authors. In addition, a standardized patient exercise, introduced in 2001, allowed students to reinforce the skills learned during the module.
医学院课程中的临终关怀（EOL）和姑息治疗教育正处于十字路口。人们已达成共识，认为这些主题在整个医学院培训中都值得进行系统教学，但课程往往只是由一些侧重于生物伦理学而非临床技能的零星讲座组成。医学生作者发现了他们课程中的不足之处，并为他们的同学设计并实施了一个临终关怀课程模块。2000年初，作者对高年级医学生进行了关于他们临终关怀和姑息治疗教育经历的调查，确定了临床培训中的不足以及干预建议。然后，他们设计了一个基于案例的教育模块，向开始临床培训的医学生传授临终关怀沟通技巧。具有全国和地方临终关怀及姑息治疗经验的教师对该课程进行了评审。其中12名教师熟悉了该课程，然后在2000年和2001年两人一组地向12至16名医学生的小组授课。该课程通过使用触发视频、小组讨论、角色扮演和案例讨论，培养在临终关怀环境中传达坏消息和确定治疗方案所需的技能、态度和知识。在2000年和2001年，86名符合条件的学生中约有75%参加了该模块。医学生作者根据反馈对课程进行了完善。此外，2001年引入的标准化患者练习让学生巩固了在模块中学到的技能。
