K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C. Whitehead is director and scientist, Wilson Centre, University Health Network, associate professor, Department of Family and Community Medicine, University of Toronto, vice president for education, Women's College Hospital, and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Ontario, Canada. J. Katz is professor and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Ontario, Canada. F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, scientist, Wilson Centre, University Health Network, and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2018 May;93(5):775-780. doi: 10.1097/ACM.0000000000002053.
Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula.
This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015.
Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value.
Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.
有证据表明，随着医学培训的进行，医生对慢性疼痛患者的看法逐渐变得消极，从而对这些患者的同理心下降。很少有定性研究关注这个问题，因此，塑造这一过程的经验仍然未知。本研究探讨了医学生如何通过非正式和正式课程了解慢性疼痛管理。
本研究采用了一种建设性的定性方法，其理论框架是隐性课程理论。对不同培训阶段的医学生和住院医师进行了 13 次开放式访谈；受访者有治疗慢性疼痛患者、观察这些患者护理或两者兼有的经验。访谈内容包括医疗培训阶段、工作总体描述和管理慢性疼痛患者的具体经验。所有访谈均于 2015 年 6 月至 8 月在多伦多进行。
大多数受访者表示，慢性疼痛的管理具有挑战性且回报不足，他们认为至少部分原因是他们认为疼痛是主观的。受训者还讲述了他们无法治愈慢性疼痛，使他们对如何提供护理感到困惑，并认为导师似乎认为这些患者的教育价值很小。
特别是因为慢性疼痛是主观的和不可治愈的，倾听和沟通对患者护理至关重要。医疗教育者不应该被庇护，而应该有机会反思为这一人群提供以患者为中心的护理所需的技能。这种方法有可能使受训者和患者都受益匪浅。
