Division of Palliative Care, Department of Family and Community Medicine and Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
J Palliat Med. 2018 Jan;21(S1):S57-S62. doi: 10.1089/jpm.2017.0396.
This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the "hidden curriculum" in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.
本文对已发表的文献和可利用资源进行快速回顾，以教育加拿大医生提供姑息治疗和临终关怀。从综述中得出了几个关键信息。首先，加拿大医生已经有许多姑息治疗教育资源。其次，许多姑息治疗教育资源在医生培训中并未得到充分利用。第三，我们知道一些姑息治疗教育干预措施既经济又具有可扩展性，而另一些则成本高昂且耗时；我们对哪些姑息治疗教育干预措施会影响医生的行为和患者的护理知之甚少。第四，特别有两个姑息治疗能力领域可以得到很好的教授：症状管理和沟通技巧（例如，告知坏消息和预先医疗指示）。第五，姑息治疗教育干预措施受到医学教育“隐性课程”的影响；必须结合继续教育和师资发展，才能使医生的行为发生持久的改变。第六，本科和研究生医学培训正从基于时间的培训模式向基于能力的培训和评估转变。第七，加拿大几乎每一位医生都应该能够提供基本的姑息治疗；在专门领域执业的医生应接受针对其领域的姑息治疗教育，而不是通用的教育干预措施。对于每个关键信息，都提供了一个或多个影响，这些影响可以作为改善加拿大姑息治疗整体状况的框架建议。
