Crawford Gregory B, Zambrano Sofia C
Dr. Crawford is Mary Potter Associate Professor of Palliative Medicine, School of Medicine, University of Adelaide, and senior consultant in palliative medicine, Central Adelaide Local Health Network, Adelaide, South Australia, Australia. Dr. Zambrano is palliative care research officer, School of Medicine, University of Adelaide, and visiting research fellow, School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
Acad Med. 2015 Mar;90(3):338-44. doi: 10.1097/ACM.0000000000000632.
To explore how junior doctors (doctors in postgraduate training) retrospectively perceived the influence of their undergraduate palliative care attachments (clinical electives) on their current medical practice.
From 2008 to 2013, 100 students participated in palliative care attachments at the University of Adelaide School of Medicine. In 2013, the authors invited 14 of these, now junior doctors, to be in this study. Participants took part in one-on-one, semistructured interviews. Interview data were analyzed for themes.
Nine junior doctors participated. They were sent a summary of the findings to check whether the themes captured each participant's experiences. Eight replied and agreed. Two main themes were identified: (1) from apprehension to gaining a sense of control, and (2) gaining perspective on the practice of medicine. Participants perceived that the learning experiences from the attachments provided them with a sense of confidence and control over their interactions with dying patients and families. This positive influence not only was present when caring for patients at the end of life but also influenced the participants' identity as medical practitioners.
Findings suggest that junior doctors trained earlier in palliative care have enhanced competencies of professionalism, patient-centered medicine, psychosocial and spiritual aspects of palliative care, communication, teamwork, and self-awareness. Learning a palliative approach can help them make a difference in treating dying patients, but also in general patient care. Therefore, physicians trained in palliative care may be better prepared to contribute to a health care system that is person-centered, ethically conscientious, and personally fulfilling.
探讨低年资医生(正在接受研究生培训的医生)如何回顾性地看待其本科阶段姑息治疗实习(临床选修课)对他们当前医疗实践的影响。
2008年至2013年期间,100名学生参加了阿德莱德大学医学院的姑息治疗实习。2013年,作者邀请了其中14名现已成为低年资医生的学生参与本研究。参与者参加了一对一的半结构式访谈。对访谈数据进行主题分析。
9名低年资医生参与了研究。他们收到了研究结果摘要,以检查这些主题是否涵盖了每位参与者的经历。8人回复并表示同意。确定了两个主要主题:(1)从忧虑到获得掌控感,以及(2)对医疗实践有了新认识。参与者认为,实习中的学习经历使他们在与临终患者及其家属的互动中获得了信心和掌控感。这种积极影响不仅在照顾临终患者时存在,还影响了参与者作为医生的身份认同。
研究结果表明,早期接受姑息治疗培训的低年资医生在专业素养、以患者为中心的医疗、姑息治疗的心理社会和精神层面、沟通、团队合作及自我意识等方面的能力得到了提升。学习姑息治疗方法不仅有助于他们在治疗临终患者方面发挥作用,在一般患者护理中也能有所作为。因此,接受过姑息治疗培训的医生可能更有能力为一个以患者为中心、符合道德规范且能实现个人价值的医疗保健系统做出贡献。