Solomon Mildred Z, Browning David M, Dokken Deborah L, Merriman Melanie P, Rushton Cynda H
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Arch Pediatr Adolesc Med. 2010 Apr;164(4):315-22. doi: 10.1001/archpediatrics.2010.12.
To determine the impact of an innovative professional educational approach on clinicians' confidence and ability to make institutional improvements in pediatric palliative care.
Evaluation to assess impact of educational intervention on participants and participant institutions.
Retreats lasting 2.5 days.
Physicians, nurses, psychosocial staff, and bereaved parents.
"Relational learning across boundaries" pedagogy.
Analysis of participant questionnaires (n = 782, response rate of 84%), team leader surveys (n = 72, response rate of 71%), and follow-up interview with subsample (n = 21, response rate of 81%). Outcomes included confidence to act and institutional improvements achieved.
Seventy-four percent of team leaders reported significant or moderate improvement in pediatric palliative care after the retreat; only 1% reported no improvement. Ninety-one percent credited the retreat experience as being somewhat or very instrumental to the improvements, which included the establishment of pediatric palliative care and bereavement programs, improvements in interdisciplinary communication, care coordination, clinician-family interaction at the bedside, and educational programs. Participants attributed the impact of the 2.5-day retreat to its key pedagogical features, involvement of family members as equal participants and participation of colleagues from other disciplines and care settings, as well as the ground rules used for the small group seminars.
The intervention was successful in improving clinicians' confidence and catalyzed improvements in pediatric palliative care within participating institutions. Relational learning holds promise for professional learning, especially when the educational goal is tied to enabling a shift in social and ethical norms.
确定一种创新的专业教育方法对临床医生在儿科姑息治疗方面进行机构改进的信心和能力的影响。
评估教育干预对参与者及参与机构的影响。
为期2.5天的务虚会。
医生、护士、心理社会工作人员和丧亲父母。
“跨边界关系学习”教学法。
分析参与者问卷（n = 782，回复率84%）、团队负责人调查（n = 72，回复率71%）以及对一个子样本的后续访谈（n = 21，回复率81%）。结果包括采取行动的信心和取得的机构改进。
74%的团队负责人报告称务虚会后儿科姑息治疗有显著或适度改善；只有1%的人报告没有改善。91%的人认为务虚会经历对这些改进或多或少起到了非常重要的作用，这些改进包括建立儿科姑息治疗和哀伤项目、跨学科沟通的改善、护理协调、床边临床医生与家庭的互动以及教育项目。参与者将为期2.5天的务虚会的影响归因于其关键教学特征、家庭成员作为平等参与者的参与以及来自其他学科和护理环境的同事的参与，以及用于小组研讨会的基本规则。
该干预措施成功提高了临床医生的信心，并促使参与机构的儿科姑息治疗得到改善。关系学习对专业学习具有前景，尤其是当教育目标与促成社会和道德规范的转变相关联时。
