Horowitz Robert, Gramling Robert, Quill Timothy
Department of Medicine/Palliative Care, University of Rochester Medical Center, Rochester, New York, USA.
Med Educ. 2014 Jan;48(1):59-66. doi: 10.1111/medu.12292.
Medical educators in the U.S.A. perceive the teaching of palliative care competencies as important, medical students experience it as valuable and effective, and demographic and societal forces fuel its necessity. Although it is encouraged by the Association of American Medical Colleges, the only palliative care-related mandate in U.S. medical schools is the Liaison Committee on Medical Education directive that end-of-life (EoL) care be included in medical school curricula, reinforcing the problematic conflation of EoL and palliative care.
A review of US medical school surveys about the teaching of palliative and EoL care reveals varied and uneven approaches, ranging from 2 hours in the classroom on EoL to weeks of palliative care training or hospice-based clinical rotations.
Palliative care competencies are too complex and universally important to be relegated to a minimum of classroom time, random clinical exposures, and the hidden curriculum.
Given the reality of overstrained medical school curricula, developmentally appropriate, basic palliative care competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment.
美国的医学教育工作者认为姑息治疗能力的教学很重要，医学生认为其有价值且有效，而人口统计学和社会力量也促使其成为必要。尽管美国医学院协会对此表示鼓励，但美国医学院校唯一与姑息治疗相关的要求是医学教育联络委员会的指令，即医学院课程应纳入临终关怀，这强化了临终关怀与姑息治疗之间存在问题的混淆。
对美国医学院校关于姑息治疗和临终关怀教学的调查进行回顾后发现，教学方法各不相同且不均衡，从在课堂上讲授两小时的临终关怀到数周的姑息治疗培训或基于临终关怀机构的临床轮转。
姑息治疗能力过于复杂且普遍重要，不能仅局限于最少的课堂时间、随机的临床接触和隐性课程。
鉴于医学院校课程负担过重的现实，应明确适合不同发展阶段的基本姑息治疗能力，并将其融入医学院课程的每一年，同时注意避免课程负担过重和教育被忽视这两大威胁。
