Smith Grant M, Schaefer Kristen G
1 Harvard Medical School , Boston, Massachusetts.
J Palliat Med. 2014 Dec;17(12):1344-7. doi: 10.1089/jpm.2014.0107.
To improve the quality of care for dying patients, experts have called for all clinicians to be able to provide a generalist level of palliative care. Core clinical clerkships provide an opportunity to incorporate palliative care training to address the lack of required palliative care rotations at most U.S. medical schools.
The objective of this study was to identify and quantify missed opportunities to train third-year medical students in generalist palliative care during required core clerkships.
This study was a cross-sectional survey of third-year students at a leading U.S. medical school without a required palliative care rotation.
Students completed a survey during the last 4 months of the 2012-2013 academic year quantifying and evaluating their experiences caring for dying patients. Attitudes were assessed using a scale from a national survey of students, residents, and faculty.
Eighty-eight students responded (response rate [RR]=56%). More than one-quarter (26%) never participated in caring for a patient who died. More than one-half (55%) never delivered significant bad news and 38% never worked with a specialist in palliative medicine. Eighty-four percent of students who cared for a patient who died and 60% of students who delivered significant bad news had one or more of those experiences that were not debriefed.
At an institution without a required palliative care rotation, third-year medical students rarely or never care for patients who die during core clerkships, and when they do, their teams do not debrief or reflect on these experiences. Clinical faculty, including palliative care consultants, can address missed opportunities for palliative care training during core clerkships by augmenting and routinely debriefing students' experiences giving bad news and caring for dying patients.
为提高临终患者的护理质量，专家呼吁所有临床医生都应具备提供全科姑息治疗的能力。核心临床实习提供了一个纳入姑息治疗培训的机会，以解决美国大多数医学院校所需姑息治疗轮转课程不足的问题。
本研究的目的是识别并量化在必修核心实习期间培训三年级医学生进行全科姑息治疗时错失的机会。
本研究是对美国一所顶尖医学院三年级学生进行的横断面调查，该校没有必修的姑息治疗轮转课程。
学生们在2012 - 2013学年的最后4个月完成了一项调查，对他们照顾临终患者的经历进行量化和评估。态度使用来自一项针对学生、住院医师和教员的全国性调查的量表进行评估。
88名学生做出回应（回应率[RR]=56%）。超过四分之一（26%）的学生从未参与过照顾临终患者。超过一半（55%）的学生从未传达过重大坏消息，38%的学生从未与姑息医学专家合作过。照顾过临终患者的学生中有84%，传达过重大坏消息的学生中有60%，他们的这些经历中至少有一次没有进行汇报总结。
在一所没有必修姑息治疗轮转课程的院校，三年级医学生在核心实习期间很少或从未照顾过临终患者，即便他们照顾了，其团队也不会对这些经历进行汇报总结或反思。临床教员，包括姑息治疗顾问，可以通过强化并定期汇报学生传达坏消息和照顾临终患者的经历，来解决核心实习期间姑息治疗培训错失的机会问题。
