Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, University Hospital, Newark, New Jersey 07101, USA. @umdnj.edu
J Palliat Med. 2012 May;15(5):516-20. doi: 10.1089/jpm.2011.0457.
Hospice and Palliative Medicine is a newly designated subspecialty of Emergency Medicine (EM). As yet, no well defined palliative care (PC) models for education or training exist. A needs assessment is the first step towards developing a curriculum.
To characterize emergency physicians' (EP) perceived educational and formal training needs for PC related skills.
All EM residents and faculty of one academic facility were asked to complete an anonymous needs-assessment survey. Participants were asked to rank statements related to attitudes about PC and rate their formal training and knowledge in 10 aspects of PC using a 5-point Likert-scale. EPs also ranked 4 learning modalities in order of preference and 12 PC educational topics in order of perceived importance in an EM curriculum.
Ninety-three percent (42/45) of eligible participants completed the survey (28 residents, 14 faculty). Respondents agreed/strongly agreed that PC skills are an important competence for EM (88%, 37/42) and that they would "like to have more training/education in PC" (79%, 33/42). Respondents also disagreed/strongly disagreed with the statement that "PC consult is called when no more can be done for the patient" (90%, 38/42). Important PC topics identified were pain management, discussing code status, and management of dyspnea and other symptoms in terminal illness. Bedside teaching was listed as the preferred learning modality. EM residents reported minimal training in pain management (46%, 13/28), managing hospice patients (54%, 15/28), withdrawal/withholding life support (54%, 15/28), and managing the imminently dying (43%, 12/28). There was no consistent, significant improvement reported in any domain as training and experience progressed from PGY (postgraduate year) 1 to PGY 4 to attending physician.
EPs view PC skills as important for EM practice and report that they are not yet adequately educated and trained in providing PC. Domains of particular interest and targeted areas for PC skills training for EPs may include managing hospice patients, withdrawal of life support, prognostication, and pain management.
缓和医疗与姑息医学是急诊医学（EM）的一个新指定亚专科。目前，还没有针对教育或培训的明确的姑息治疗（PC）模式。需求评估是制定课程的第一步。
描述急诊医师（EP）对 PC 相关技能的教育和正规培训需求。
一家学术机构的所有 EM 住院医师和教师都被要求完成一项匿名需求评估调查。参与者被要求对与 PC 相关的态度陈述进行排名，并使用 5 分李克特量表对 10 个 PC 方面的正规培训和知识进行评分。EP 还按照偏好顺序对 4 种学习模式进行了排名，并按照在 EM 课程中的感知重要性对 12 个 PC 教育主题进行了排名。
93%（42/45）符合条件的参与者完成了调查（28 名住院医师，14 名教师）。受访者同意/强烈同意 PC 技能是 EM 的一项重要能力（88%，37/42），并且他们“希望在 PC 方面接受更多的培训/教育”（79%，33/42）。受访者也不同意/强烈不同意“当患者无法接受更多治疗时，才会进行 PC 咨询”这一说法（90%，38/42）。确定的重要 PC 主题包括疼痛管理、讨论代码状态以及处理终末期疾病的呼吸困难和其他症状。床边教学被列为首选学习模式。EM 住院医师报告在疼痛管理（46%，13/28）、管理临终关怀患者（54%，15/28）、撤回/停止生命支持（54%，15/28）和管理即将死亡的患者（43%，12/28）方面接受的培训较少。从住院医师（PGY）1 到 PGY 4 再到主治医生，培训和经验的进展并没有在任何领域带来一致、显著的改善。
EP 认为 PC 技能对 EM 实践很重要，并表示他们在提供 PC 方面还没有得到充分的教育和培训。EP 特别感兴趣的领域和姑息治疗技能培训的目标领域可能包括管理临终关怀患者、停止生命支持、预后判断和疼痛管理。
