Boland Jason W, Dikomitis Lisa, Gadoud Amy
Hull York Medical School, University of Hull, Hull, UK.
School of Medicine and RI Primary Care & Health Sciences, Keele University, Keele, UK.
BMJ Support Palliat Care. 2016 Dec;6(4):486-492. doi: 10.1136/bmjspcare-2016-001110. Epub 2016 Aug 2.
Medical students and doctors are becoming better prepared to care for patients with palliative care needs and support patients at the end of life. This preparation needs to start at medical school.
To assess how medical students learn about death, dying and palliative care during a clinical placement using reflective essays and to provide insights to improve medical education about end-of-life care and/or palliative care.
Qualitative study in which all reflective essays written by third-year medical students in 1 year from a UK medical school were searched electronically for those that included 'death', 'dying' and 'palliative care'. The anonymised data were managed using QSR NVivo 10 software, and a systematic analysis was conducted in three distinct phases: (1) open coding; (2) axial coding and (3) selective coding. Ethical approval was received.
54 essays met the inclusion criteria from 241 essays screened for the terms 'death', 'dying' or 'palliative'; 22 students gave consent for participation and their 24 essays were included. Saturation of themes was reached. Three overarching themes were identified: emotions, empathy and experiential and reflective learning. Students emphasised trying to develop a balance between showing empathy and their emotional state. Students learnt a lot from clinical encounters and watching doctors manage difficult situations, as well as from their refection during and after the experience.
Reflective essays give insights into the way students learn about death, dying and palliative care and how it affects them personally as well as the preparation that is needed to be better equipped to deal with these kinds of experiences. Analysis of the essays enabled the proposal of new strategies to help make them more effective learning tools and to optimise students' learning from a palliative care attachment.
医学生和医生在照顾有姑息治疗需求的患者以及在生命末期支持患者方面准备得越来越充分。这种准备工作需要从医学院开始。
通过反思性文章评估医学生在临床实习期间如何学习死亡、临终和姑息治疗，并提供见解以改进关于临终关怀和/或姑息治疗的医学教育。
进行定性研究，通过电子方式搜索一所英国医学院三年级医学生在1年内撰写的所有反思性文章，查找其中包含“死亡”“临终”和“姑息治疗”的文章。使用QSR NVivo 10软件管理匿名数据，并分三个不同阶段进行系统分析：（1）开放编码；（2）轴心编码；（3）选择性编码。获得了伦理批准。
在筛选出的241篇包含“死亡”“临终”或“姑息治疗”的文章中，有54篇符合纳入标准；22名学生同意参与，他们的24篇文章被纳入。主题达到了饱和。确定了三个总体主题：情感、同理心以及体验式和反思性学习。学生们强调要在表达同理心和自身情绪状态之间努力找到平衡。学生们从临床接触、观察医生处理困难情况以及体验过程中和体验后的反思中学到了很多。
反思性文章揭示了学生学习死亡、临终和姑息治疗的方式，以及这如何对他们个人产生影响，还有为更好地应对这类经历所需的准备。对文章的分析有助于提出新策略，使它们成为更有效的学习工具，并优化学生从姑息治疗实习中的学习。
