von Gunten Charles F, Twaddle Martha, Preodor Michael, Neely Kathy Johnson, Martinez Jeanne, Lyons John
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California, USA.
Am J Hosp Palliat Care. 2005 May-Jun;22(3):195-203. doi: 10.1177/104990910502200309.
There is compelling evidence that residents training in primary care need education in palliative care. Evidence for effective curricula is needed. The objective of this study was to test whether a clinical elective improves measures of knowledge and skill. Residents from three categorical training programs in internal medicine were recruited to an elective including clinical experiences in an acute hospital palliative care consultation service, on an acute hospice and palliative care unit, and in-home hospice care. A 25-question pre- and post-test and a videotaped interview with a standardized patient were used to assess communication skills and measure outcomes. Residents demonstrated a 10 percent improvement in knowledge after the four-week elective (p < 0.05). All residents demonstrated basic competency in communication skills at the end of the rotation. These results indicate that clinical rotation shows promise as an educational intervention to improve palliative care knowledge and skills in primary care residents. An important limitation of the study is that it is an elective; further studies with a required rotation and/or a control group are needed to confirm the findings.
有令人信服的证据表明，接受初级保健培训的住院医师需要接受姑息治疗方面的教育。需要有效课程的证据。本研究的目的是测试临床选修课是否能提高知识和技能水平。招募了来自三个内科分类培训项目的住院医师参加一门选修课，其中包括在急性医院姑息治疗咨询服务、急性临终关怀和姑息治疗病房以及家庭临终关怀护理方面的临床经验。通过一份25道题的前后测试以及与标准化患者的录像访谈来评估沟通技巧并衡量结果。四周的选修课程结束后，住院医师的知识水平提高了10%（p < 0.05）。所有住院医师在轮转结束时都表现出了沟通技巧的基本能力。这些结果表明，临床轮转作为一种教育干预手段，有望提高初级保健住院医师的姑息治疗知识和技能。该研究的一个重要局限性在于它是一门选修课；需要进一步进行有必修轮转和/或对照组的研究来证实这些发现。
