Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Healthc (Amst). 2017 Dec;5(4):155-157. doi: 10.1016/j.hjdsi.2016.12.007. Epub 2016 Dec 30.
Recent US healthcare policy changes set the stage for integrating palliative and end-of-life care into routine medicine. However, these changes may not affect the daily practice of medical trainees-fellows, residents, and medical students-who as front-line care providers are not always equipped with the skills needed to treat terminally ill patients. We review evidence on trainees' discomfort with end-of-life care and highlight limitations of recent policy changes. Key barriers to proficiency include inadequate conversational training, prognostic uncertainty, and unfamiliarity with hospice and palliative care. Educator-, accreditor-, and policy-level interventions may improve trainees' experience caring for seriously ill patients.
最近美国的医疗政策改革为将姑息治疗和临终关怀纳入常规医疗奠定了基础。然而，这些变化可能不会影响到实习医生——住院医师、住院医师和医学生——的日常实践，作为一线护理提供者，他们并不总是具备治疗绝症患者所需的技能。我们回顾了关于实习医生对临终关怀的不适应的证据，并强调了最近政策变化的局限性。熟练掌握临终关怀的关键障碍包括对话培训不足、预后不确定以及不熟悉临终关怀和姑息治疗。教育者、认证机构和政策层面的干预措施可能会改善实习医生照顾重病患者的体验。
