医学生对临终关怀准备程度的感知、临终关怀教育质量和对临终关怀态度的决定因素。
Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care.
机构信息
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington 98104, USA.
出版信息
J Palliat Med. 2010 Mar;13(3):319-26. doi: 10.1089/jpm.2009.0293.
BACKGROUND
Medical students' learning about end-of-life care can be categorized into three learning modalities: formal curriculum, taught in lectures; informal curriculum, conveyed through clinical experiences; and "hidden curriculum," inferred from behaviors and implicit in medical culture. In this study, we evaluated associations between survey items assessing these learning modalities and students' perceptions of their preparation, quality of education, and attitudes toward end-of-life care.
METHODS
Data were collected from a national survey of fourth-year medical students (n = 1455) at 62 medical schools in 2001. Linear regression analyses were performed to assess associations between formal, informal and hidden end-of-life care curricula and students' perceived preparedness to provide end-of-life care, quality of end-of-life care education and attitudes toward end-of-life, controlling for students' demographics and clustered by school.
RESULTS
Students reporting more exposure to formal and informal curricula felt more prepared and rated their end-of-life care education higher. Students with more exposure to a hidden curriculum that devalued end-of-life care perceived their preparation as poorer and had poorer attitudes toward end-of-life care. Minority students had slightly more negative attitudes but no differences in perceived end-of-life care preparation.
CONCLUSIONS
Medical students' sense of preparedness for end-of-life care and perceptions of educational quality are greater with more coursework and bedside teaching. By contrast, the hidden curriculum conveying negative messages may impair learning. Our findings suggest that implicit messages as well as intentional teaching have a significant impact on students' professional development. This has implications for designing interventions to train physicians to provide outstanding end-of-life care.
背景
医学生对临终关怀的学习可分为三种学习模式：正规课程，以讲座形式教授；非正式课程，通过临床经验传达；以及“隐性课程”，从行为推断，隐含在医学文化中。在这项研究中，我们评估了评估这些学习模式的调查项目与学生对其准备情况、教育质量和临终关怀态度的看法之间的关系。
方法
数据来自 2001 年 62 所医学院的 1455 名四年级医学生的全国性调查。进行线性回归分析，以评估正规、非正式和隐性临终关怀课程与学生对提供临终关怀的准备程度、临终关怀教育质量和临终关怀态度之间的关联，同时控制学生的人口统计学特征，并按学校进行聚类。
结果
报告更多接触正规和非正式课程的学生感到更有准备，对临终关怀教育的评价更高。接触贬低临终关怀的隐性课程较多的学生认为自己的准备较差，对临终关怀的态度较差。少数民族学生的态度略为消极，但对临终关怀准备的看法没有差异。
结论
学生对临终关怀的准备感和对教育质量的认知随着课程和床边教学的增加而增强。相比之下，传达负面信息的隐性课程可能会阻碍学习。我们的发现表明，隐性信息和有意教学对学生的专业发展有重大影响。这对设计培训医生提供卓越临终关怀的干预措施具有重要意义。
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