Marie Curie Palliative Care Institute Liverpool, UK.
Palliat Med. 2010 Apr;24(3):306-9. doi: 10.1177/0269216309351867. Epub 2010 Feb 1.
The General Medical Council's call to modernize medical education prompted the University of Liverpool Medical School to develop a new undergraduate programme, integrating palliative medicine as 'core' curricula. Following successful piloting, the palliative medicine training programme was further developed and expanded. This paper examines whether the additional investment produces improved outcomes. In 1999, fourth year undergraduate medical students (Cohort 1, n = 217) undertook a 2-week pilot education programme in palliative medicine. Subsequently, the training programme was refined and extended, incorporating advanced communication skills training, an ethics project and individual case presentations (Cohort 2, n = 443). Congruent with the study's theoretical driver of self-efficacy, both cohorts were surveyed pre- and post-programme with validated measures of: (i) self-efficacy in palliative care scale; (ii) thanatophobia scale. No significant differences between cohorts' pre-programme scores were identified. Within each cohort, statistically and educationally significant post-education improvements were recorded in both scales. Further post-education analysis indicated that the extended programme produces significantly greater improvements in all domains of the self-efficacy in palliative care scale (communication, t =-7.28, patient management, t =-5.96, multidisciplinary team-working t =-3.77 at p < 0.000), but not thanatophobia. Although improvements were recorded in both cohorts, participation in the extended education programme resulted in further statistically significant gains. Interpreted through the theoretical model employed, improved self-efficacy and outcome expectancies will result in behavioural change that leads to improved practice and better patient care.
英国医学总会呼吁将医学教育现代化，促使利物浦大学医学院开发了一个新的本科课程，将姑息医学作为“核心”课程纳入其中。在成功试点后，姑息医学培训计划进一步得到了发展和扩展。本文探讨了额外投资是否会产生更好的结果。1999 年，四年级医学生（第 1 组，n=217）参加了为期 2 周的姑息医学试点教育计划。随后，培训计划得到了改进和扩展，纳入了高级沟通技巧培训、伦理项目和个人病例介绍（第 2 组，n=443）。与本研究的自我效能理论驱动因素一致，两个队列在课程前后都使用经过验证的量表进行了调查：（i）姑息护理自我效能量表；（ii）死亡恐惧量表。两个队列的课程前评分均无显著差异。在每个队列中，在两个量表中都记录到了统计学和教育上显著的教育后改善。进一步的教育后分析表明，扩展课程在姑息护理自我效能量表的所有领域（沟通，t=-7.28，患者管理，t=-5.96，多学科团队合作，t=-3.77，均 p<0.000）产生了更大的改善，但对死亡恐惧没有影响。尽管两个队列都有改善，但参加扩展教育计划会带来进一步的统计学显著收益。通过所采用的理论模型进行解释，自我效能和预期结果的提高将导致行为改变，从而提高实践水平并改善患者护理。
