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在临床技能教学中使用新近死亡的患者:其伦理和教育挑战。

Using newly deceased patients in teaching clinical skills: its ethical and educational challenges.

作者信息

Saber Mahboobeh, Enjoo Seyed Ali, Mahboudi Ali, Tabei Seyed Ziaadin

机构信息

Medical Ethics Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Medical Ethics Department, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

J Adv Med Educ Prof. 2018 Apr;6(2):78-85.

Abstract

INTRODUCTION

The newly deceased patients have long been used in medical schools to teach clinical skills without any challenges as it helps to train skilled doctors. Nowadays, the use of moulages and simulators are common in teaching clinical skills since these tools provide the opportunity for frequent practice without any pain and injury. There are specific procedures which still require the use of cadavers. However, the increased significance of patient rights has generally challenged the practicality of using the deceased bodies for this purpose. This study was designed with the aim of determining to what extent clinical skill training is dependent on the recently deceased patients.

METHODS

This was a cross-sectional mixed-method triangulation design conducted in two phases. In the first phase, a researcher-made questionnaire was used to collect quantitative data of the medical students and residents. The data were used to assess the frequency of experience. In the second stage, semi-structured interviews were conducted with faculty members and fellows in order to evaluate the educational impact of this type of procedure and the influential factors. The quantitative data were analyzed using statistical software, and the qualitative codes were extracted following a content analysis. Finally, a comparative analysis was performed.

RESULTS

Twenty five residents (26%) and seven medical students (14%) had the experience of performing procedures on the recently deceased patients for training purposes. About half of the residents and 33% of the medical students had observed their colleagues practicing procedures on cadavers. In the qualitative phase, the main categories included professional ethics, law and educational requirements.

CONCLUSION

A relatively low number of medical students and residents had experienced procedures on the newly deceased patients. In this regard, ethical, religious and legal concerns might have played a part despite the desire to learn. It would be effective to direct these educational experiences toward procedures that cannot be mastered through moulages and simulators, and to lay the legal and executive ground so that performing these procedures under the supervision of professors, and with a level of documentation would have no legal challenges.

摘要

引言

长期以来,医学院一直使用新近死亡的患者来教授临床技能,且未遇到任何挑战,因为这有助于培养熟练的医生。如今,模具和模拟器在临床技能教学中很常见,因为这些工具提供了频繁练习的机会,且不会造成任何疼痛和伤害。仍有一些特定程序需要使用尸体。然而,患者权利重要性的日益增加,总体上对为此目的使用死者尸体的实用性提出了挑战。本研究旨在确定临床技能培训在多大程度上依赖于新近死亡的患者。

方法

这是一项分两个阶段进行的横断面混合方法三角测量设计。在第一阶段,使用研究人员制作的问卷收集医学生和住院医师的定量数据。这些数据用于评估经验频率。在第二阶段,对教员和研究员进行半结构化访谈,以评估此类程序的教育影响和影响因素。定量数据使用统计软件进行分析,定性编码通过内容分析提取。最后进行比较分析。

结果

25名住院医师(26%)和7名医学生(14%)有过为培训目的对新近死亡的患者进行操作的经历。约一半的住院医师和33%的医学生观察过他们的同事在尸体上练习操作。在定性阶段,主要类别包括职业道德、法律和教育要求。

结论

相对较少的医学生和住院医师有过对新近死亡的患者进行操作的经历。在这方面,尽管有学习的愿望,但伦理、宗教和法律方面的担忧可能起到了一定作用。将这些教育经验导向通过模具和模拟器无法掌握的程序,并奠定法律和执行基础,以便在教授的监督下进行这些程序并进行一定程度的记录,从而不会面临法律挑战,这将是有效的。

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