Luthy C, Cedraschi C, Pautex S, Rentsch D, Piguet V, Allaz A F
Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
Palliat Med. 2009 Jan;23(1):59-65. doi: 10.1177/0269216308098796. Epub 2008 Nov 7.
Residents in training are first-line physicians in hospital settings and they are in the process of developing knowledge and mastering clinical skills. They have to confront complex tasks calling upon their personal background, professional identity and relationships with the patients. We conducted a qualitative study investigating the difficulties they perceive in end-of-life care. In all, 24 consecutive residents were presented with a written query asking them to indicate the difficulties they identify in the management of patients hospitalised for end-of-life care. Their responses were submitted to content analysis. Physicians' mean age was 28 +/- 2.2 years, 37% were women, average postgraduate training duration was 2.5 +/- 1.3 years. Content analysis elicited eight categories of difficulties: ability to provide adequate explanations, understand the patients' needs, have sufficient theoretical knowledge, avoid flight, avoid false reassurance, manage provision of time, face one's limits as a physician and be able to help despite everything. Residents' responses showed that they identify the complexity of care in terminally-ill patients early in their training. Their responses pointed to the 'right distance' in-between getting involved and preserving oneself as a dimension of major importance.
住院医师培训学员是医院环境中的一线医生，他们正处于积累知识和掌握临床技能的过程中。他们必须应对复杂的任务，这些任务需要他们凭借个人背景、职业身份以及与患者的关系来完成。我们开展了一项定性研究，调查他们在临终关怀中所察觉到的困难。总共向24名连续参与的住院医师培训学员提出了一份书面询问，要求他们指出在管理临终关怀住院患者时所发现的困难。他们的回答被提交进行内容分析。医生的平均年龄为28 ± 2.2岁，37%为女性，平均研究生培训时长为2.5 ± 1.3年。内容分析得出了八类困难：提供充分解释的能力、理解患者需求、具备足够的理论知识、避免逃避、避免给予虚假安慰、管理时间安排、正视自身作为医生的局限以及无论如何都能提供帮助。住院医师培训学员的回答表明，他们在培训早期就认识到了晚期患者护理的复杂性。他们的回答指出，在参与其中和保护自己之间找到“恰当距离”是一个至关重要的方面。
