Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA.
J Palliat Med. 2011 Jan;14(1):59-64. doi: 10.1089/jpm.2010.0281.
Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.
医学教育者一致认为，在各级医学教育中，临终关怀（EOLC）培训必须是不可或缺的一部分。尽管在这一教育领域取得了进展，但仍存在许多差距。本文描述了对三年级医学生进行为期一周的临终关怀轮转的强制性要求所产生的影响。在一年期间完成临终关怀轮转的学生被要求写一篇文章，描述他们所学的最重要的课程。对文章进行定性分析揭示了 10 个核心主题，并生成了详细分析的编码方案。学生的文章反映了知识的获得、情绪反应、认知见解和以关系为中心的技能。评论主要集中在以下主题上：临终关怀的好处和理念；对未来实践的影响；跨学科团队方法；疼痛和痛苦的管理；关于临终关怀的事实；个人影响；与患者和家属的沟通；员工的奉献精神和技能；家庭的角色；以及家庭护理的价值。学生们一致认识到积极榜样的重要性。学习医学的新领域有助于拓宽学生的知识、技能和信念，并扩大他们对疾病和痛苦、医疗保健专业人员的角色以及医学目标的假设。反思和写作带来了对学习过程本身的自我意识。该研究表明，强大的临床 EOLC 体验可以有效地纳入本科教育，并且学生的自我报告构成了有价值的评估模式。需要对培训人员在 EOLC 方面的能力进行纵向评估，以优化这些教育工作。
