1 Department of Pediatrics, Montefiore Medical Center , Albert Einstein College of Medicine, Bronx, New York.
2 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York.
J Palliat Med. 2018 Jan;21(1):22-27. doi: 10.1089/jpm.2017.0154. Epub 2017 Aug 2.
The Institute of Medicine and the American Academy of Pediatrics has called for improvement in education and training of pediatricians in pediatric palliative care (PPC). Given the shortage of PPC physicians and the immediate need for PPC medical education, this study reports the outcomes of a problem-based learning (PBL) module facilitated by academic general and subspecialty pediatric faculty (non-PPC specialists) to third year medical students. Objectives/Setting: To test the effectiveness of a PPC-PBL module on third year medical students' and pediatric faculty's declarative knowledge, attitudes toward, perceived exposure, and self-assessed competency in PPC objectives.
A PBL module was developed using three PPC learning objectives as a framework: define core concepts in palliative care; list the components of a total pain assessment; and describe key principles in establishing therapeutic relationships with patients. A PPC physician and nurse practitioner guided pediatric faculty on facilitating the PPC-PBL. In Part 1, students identified domains of palliative care for a child with refractory leukemia and self-assigned questions to research and present at the follow-up session. In Part 2, students were expected to develop a care plan demonstrating the three PPC objectives.
Measures included a knowledge exam and a survey instrument to assess secondary outcomes.
Students' declarative knowledge, perceived exposure, and self-assessed competency in all three PPC learning objectives improved significantly after the PPC-PBL, p = 0.002, p < 0.001, and p < 0.001, respectively. There were no significant differences in faculty knowledge test scores from baseline to follow-up, but scores were generally high (median >80%). Students and faculty rated palliative care education as "important or very important" at baseline and follow-up.
This study suggests that key concepts in PPC can be taught to medical students utilizing a PBL format and pediatric faculty resulting in improved knowledge and self-assessed competency in PPC.
美国儿科学会和医学研究院呼吁改进儿科医生在儿童舒缓治疗(PPC)方面的教育和培训。鉴于 PPC 医生短缺以及对 PPC 医学教育的迫切需求,本研究报告了由学术型普通儿科和亚专科儿科教师(非 PPC 专家)为三年级医学生提供基于问题的学习(PBL)模块的结果。目的/背景:测试 PPC-PBL 模块对三年级医学生和儿科教师在 PPC 目标方面的陈述性知识、态度、感知暴露度和自我评估能力的有效性。
使用三个 PPC 学习目标作为框架开发了 PBL 模块:定义姑息治疗的核心概念;列出全面疼痛评估的组成部分;描述与患者建立治疗关系的关键原则。一位 PPC 医生和护士从业者指导儿科教师进行 PPC-PBL。在第 1 部分中,学生确定了患有难治性白血病的儿童的姑息治疗领域,并为自己分配了要研究和在后续会议上介绍的问题。在第 2 部分中,学生应制定一个体现三个 PPC 目标的护理计划。
测量包括知识考试和调查工具,以评估次要结果。
学生在所有三个 PPC 学习目标方面的陈述性知识、感知暴露度和自我评估能力在 PPC-PBL 后均显著提高,p=0.002,p<0.001 和 p<0.001。教师的知识测试分数从基线到随访没有显著差异,但分数普遍较高(中位数>80%)。学生和教师在基线和随访时都将姑息治疗教育评为“重要或非常重要”。
本研究表明,利用 PBL 格式和儿科教师可以向医学生教授 PPC 的关键概念,从而提高 PPC 的知识和自我评估能力。