Institute for Palliative Medicine, San Diego Hospice, San Diego, CA 92103, USA.
J Palliat Med. 2012 Nov;15(11):1198-217. doi: 10.1089/jpm.2010.0502. Epub 2012 Jul 30.
To assess the impact, retention, and magnitude of effect of a required didactic and experiential palliative care curriculum on third-year medical students' knowledge, confidence, and concerns about end-of-life care, over time and in comparison to benchmark data from a national study of internal medicine residents and faculty.
Prospective study of third-year medical students prior to and immediately after course completion, with a follow-up assessment in the fourth year, and in comparison to benchmark data from a large national study.
Internal Medicine Clerkship in a public accredited medical school.
Five hundred ninety-three third-year medical students, from July 2002 to December 2007.
Pre- and postinstruction performance on: knowledge, confidence (self-assessed competence), and concerns (attitudes) about end-of-life care measures, validated in a national study of internal medicine residents and faculty. Medical student's reflective written comments were qualitatively assessed.
Required 32-hour didactic and experiential curriculum, including home hospice visits and inpatient hospice care, with content drawn from the AMA-sponsored Education for Physicians on End-of-life Care (EPEC) Project.
Analysis of 487 paired t tests shows significant improvements, with 23% improvement in knowledge (F(1,486)=881, p<0.001), 56% improvement in self-reported competence (F(1,486)=2,804, p<0.001), and 29% decrease in self-reported concern (F(1,486)=208, p<0.001). Retesting medical students in the fourth year showed a further 5% increase in confidence (p<0.0002), 13% increase in allaying concerns (p<0.0001), but a 6% drop in knowledge. The curriculum's effect size on M3 students' knowledge (0.56) exceeded that of a national cross-sectional study comparing residents at progressive training levels (0.18) Themes identified in students' reflective comments included perceived relevance, humanism, and effectiveness of methods used to teach and assess palliative care education.
We conclude that required structured didactic and experiential palliative care during the clinical clerkship year of medical student education shows significant and largely sustained effects indicating students are better prepared than a national sample of residents and attending physicians.
评估必修的理论和实践姑息治疗课程对三年级医学生的知识、信心和对临终关怀的关注的影响、保留和效果大小，随着时间的推移，并与全国内科住院医师和教师的一项研究的基准数据进行比较。
在课程结束前和结束后对三年级医学生进行前瞻性研究，并在第四年进行随访评估，并与全国大型研究的基准数据进行比较。
公立认证医学院的内科实习。
2002 年 7 月至 2007 年 12 月期间的 593 名三年级医学生。
在全国内科住院医师和教师的一项研究中，经过验证的关于临终关怀措施的知识、信心（自我评估能力）和关注（态度）的课前和课后表现。对医学生的反思性书面评论进行了定性评估。
必修的 32 小时理论和实践课程，包括家庭临终关怀访问和住院临终关怀，内容取自 AMA 赞助的医生终末期护理教育 (EPEC) 项目。
对 487 对配对 t 检验的分析显示出显著的改善，知识提高了 23%（F(1,486)=881，p<0.001），自我报告的能力提高了 56%（F(1,486)=2,804，p<0.001），自我报告的关注减少了 29%（F(1,486)=208，p<0.001）。对四年级医学生的重新测试显示，信心进一步提高了 5%（p<0.0002），缓解关注提高了 13%（p<0.0001），但知识下降了 6%。该课程对 M3 学生知识的效果大小（0.56）超过了全国比较不同培训水平住院医师的横断面研究（0.18）。学生反思性评论中确定的主题包括相关性、人文主义和用于教授和评估姑息治疗教育的方法的有效性。
我们得出结论，在医学生教育的临床实习年度中，必修的结构化理论和实践姑息治疗课程显示出显著且基本持续的效果，表明学生比全国住院医师和主治医生样本准备更充分。
