Schwartz Carolyn E, Clive David M, Mazor Kathleen M, Ma Yunsheng, Reed George, Clay Marjorie
QualityMetric Incorporated, Waltham, Massachusetts, USA.
J Palliat Med. 2005 Oct;8(5):975-86. doi: 10.1089/jpm.2005.8.975.
There is heightened emphasis on teaching end-of-life (EOL) care in the medical school curriculum, but a relative paucity of tools focused on assessing key attitudinal changes due to curricula.
We sought to evaluate the responsiveness of two validated measures of relevant attitudes to changes caused by two EOL curricula: a year-long Elective and a day-long Inter-Clerkship for medical undergraduates.
A case control design (n = 100) and a one group pretest-posttest design (n = 98) were used to ask: (1) Are these two attitudinal measures responsive to changes induced by two undergraduate EOL curricula? (2) Do these two curricula have an additive effect (i.e., taking both yields a stronger attitudinal change than taking only one)? (3) Are there attitudinal and sociodemographic differences between students who took the year-long elective EOL course and those who did not?
Undergraduate medical students.
Two self-report measures: Concept of a Good Death and Concerns about Dying.
Compared to nonelective participants, Elective participants reported less concern about working with dying patients at the end of the course and increased their valuation of clinical criteria in thinking about a "good death." There were trends suggesting decreased general concern about dying and increased valuation of closure, and an interaction suggesting a larger impact on those with higher precourse concern scores. There were no differences between elective and nonelective participants at baseline. The Interclerkship increased students' valuation of personal control aspects of death, and there was a trend in reducing concerns about working with dying patients. We did not find an additive effect of taking both curricula.
We conclude that both measures were responsive to the relatively large effects this study would have been able to detect, and may be useful in future research to substantiate the effectiveness of EOL curricula in influencing attitudes and level of comfort with death and dying.
医学院课程中对临终关怀（EOL）教学的重视程度日益提高，但相对缺乏专注于评估课程导致的关键态度变化的工具。
我们试图评估两种经过验证的相关态度测量方法对两种EOL课程所引起变化的反应性：针对医学本科生的为期一年的选修课和为期一天的实习间课程。
采用病例对照设计（n = 100）和单组前测-后测设计（n = 98）来探讨：（1）这两种态度测量方法是否对两种本科EOL课程引起的变化有反应？（2）这两种课程是否有累加效应（即，同时参加两种课程比只参加一种课程能产生更强的态度变化）？（3）参加为期一年的选修EOL课程的学生与未参加的学生在态度和社会人口统计学方面是否存在差异？
本科医学生。
两种自我报告测量方法：善终概念和对死亡的担忧。
与非选修参与者相比，选修参与者在课程结束时报告称与临终患者合作的担忧减少，并且在思考“善终”时对临床标准的重视程度增加。有趋势表明对死亡的总体担忧减少，对结局的重视程度增加，并且存在一种相互作用，表明对课程前担忧分数较高的人影响更大。基线时选修和非选修参与者之间没有差异。实习间课程提高了学生对死亡个人控制方面的重视程度，并且在减少与临终患者合作的担忧方面有趋势。我们没有发现同时参加两种课程有累加效应。
我们得出结论，这两种测量方法对本研究能够检测到的相对较大的影响有反应，并且可能在未来研究中用于证实EOL课程在影响对死亡和临终的态度及舒适度方面的有效性。
