提高重病患者护理水平：全国性调查结果定义医学生和住院医师基本姑息治疗能力。
Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents.
机构信息
Dr. Schaefer is director of education, Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and instructor, Department of Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Chittenden is associate director and director of education, Palliative Care Division, Department of Medicine, Massachusetts General Hospital, and assistant professor, Department of Medicine, Harvard Medical School, Boston Massachusetts. Dr. Sullivan is director for research, The Academy at Harvard Medical School, director for education research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Periyakoil is director of palliative care education and training and director, Internet-based Successful Aging and End of Life (iSAGE) mini-fellowship, Stanford University School of Medicine, and associate director of palliative care services, Veterans Administration Palo Alto Health Care System, Palo Alto, California. Dr. Morrison is director of hospice and palliative medicine education and director, Hospice and Palliative Medicine Fellowship, Department of Medicine, Section of Geriatrics, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut. Dr. Carey is chair, Section of Palliative Medicine, Division of General Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota. Dr. Sanchez-Reilly is associate director for education and evaluation, Geriatric Research, Education Clinical Center, South Texas Veterans Health Care System, and clinical associate professor of geriatrics and palliative care, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Dr. Block is chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, codirector, Harvard Medical School Center for Palliati
出版信息
Acad Med. 2014 Jul;89(7):1024-31. doi: 10.1097/ACM.0000000000000271.
PURPOSE
Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts.
METHOD
Proposed competencies were derived from existing hospice and palliative medicine fellowship competencies and revised to be developmentally appropriate for students and residents. In spring 2012, the authors administered a Web-based, national cross-sectional survey of palliative care educational experts to assess ratings and rankings of proposed competencies and competency domains.
RESULTS
The authors identified 18 comprehensive palliative care competencies for medical students and IM/FM residents, respectively. Over 95% of survey respondents judged the competencies as comprehensive and developmentally appropriate (survey response rate = 72%, 71/98). Using predefined cutoff criteria, experts identified 7 medical student and 13 IM/FM resident competencies as essential. Communication and pain/symptom management were rated as the most critical domains.
CONCLUSIONS
This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.
目的
鉴于美国姑息治疗专家短缺，为确保患有严重危及生命疾病的患者得到高质量的护理，需要确定和教授通科姑息治疗能力。本研究的目的是通过对姑息治疗专家进行全国性调查，为医学生和内科/家庭医学（IM/FM）住院医师定义基本能力。
方法
拟议的能力源自现有的临终关怀和姑息医学奖学金能力，并进行了修订，以使其适合学生和住院医师的发展。在 2012 年春季，作者对姑息治疗教育专家进行了基于网络的全国性横断面调查，以评估拟议能力和能力领域的评分和排名。
结果
作者分别确定了医学生和内科/家庭医学住院医师的 18 项综合姑息治疗能力。超过 95%的调查受访者认为这些能力全面且适合发展（调查回复率=72%，71/98）。使用预先定义的截止标准，专家确定了 7 项医学生和 13 项内科/家庭医学住院医师的基本能力。沟通和疼痛/症状管理被评为最关键的领域。
结论
这项针对姑息治疗专家的全国性调查为医学生和内科/家庭医学住院医师确定了全面且基本的姑息治疗能力，这些能力具体、可衡量，并可用于报告教育成果；为本科和研究生医学教育中的姑息治疗课程提供了一个顺序；并强调了在沟通和疼痛管理方面对医学实习生进行教育的重要性。下一步包括寻求更广泛的医学教育界利益相关者的投入和认可。
Zotero 插件