Simmons B Brent, Petrie Alison, Gracely Edward
Department of Family, Community, and Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA.
Fam Med. 2018 Apr;50(4):287-290. doi: 10.22454/FamMed.2018.688612.
Hospice and palliative medicine (HPM) is one of three Accreditation Council for Graduate Medical Education accredited clinical subspecialties available to family medicine graduates for fellowship training. Despite this, training is not currently a curriculum requirement. We have pioneered a required 4-week palliative medicine rotation into the curriculum.
Twenty-eight residents who completed the palliative medicine rotation across four classes were surveyed to assess how the rotation improved their level of comfort with providing end-of-life (EOL) care and to demonstrate the need of formal palliative medicine training. Wilcoxon signed ranks test was used to detect statistical differences between the mean level of comfort of residents pre- and postrotation with providing the basic skills needed to practice HPM.
The HPM rotation significantly improved the residents' level of comfort in all areas of measured EOL care (P<0.001). All residents surveyed strongly agreed that the rotation was valuable to their future and 100% of residents strongly agreed that an HPM rotation should be required.
Formal HPM training should be a required component in residency education and considerations should be given to the 4-week format. This rotation provides a model that can be implemented in other residency programs nationally. Implementation of this rotation may help close the enormous gap of patients not receiving quality EOL care.
临终关怀与姑息医学（HPM）是毕业后医学教育认证委员会认可的三个临床亚专业之一，可供家庭医学专业毕业生进行专科培训。尽管如此，目前培训并非课程要求。我们率先在课程中设置了为期4周的姑息医学轮转。
对四个班级中完成姑息医学轮转的28名住院医师进行了调查，以评估该轮转如何提高他们提供临终（EOL）护理的舒适度，并证明正规姑息医学培训的必要性。采用Wilcoxon符号秩检验来检测住院医师轮转前后在提供HPM实践所需基本技能方面的平均舒适度水平之间的统计学差异。
HPM轮转显著提高了住院医师在所有测量的EOL护理领域的舒适度水平（P<0.001）。所有接受调查的住院医师都强烈认为该轮转对他们的未来很有价值，100%的住院医师强烈认为应该要求进行HPM轮转。
正规的HPM培训应成为住院医师教育的必要组成部分，并应考虑采用4周的形式。这种轮转提供了一种可在全国其他住院医师项目中实施的模式。实施这种轮转可能有助于缩小未接受优质EOL护理的患者的巨大差距。
