Goldberg Gabrielle R, Weiner Joseph, Fornari Alice, Pearlman R Ellen, Farina Gino A
Assistant Professor, Department of Science Education, the Zucker School of Medicine at Hofstra/Northwell.
Associate Professor, Department of Psychiatry, the Zucker School of Medicine at Hofstra/Northwell.
MedEdPORTAL. 2018 Oct 9;14:10760. doi: 10.15766/mep_2374-8265.10760.
The literature documents inadequate palliative medicine training in undergraduate and graduate medical education. As the population lives longer, many people will experience multiple chronic illnesses and the associated symptom burden. All physicians involved in clinical care of patients need to be equipped with the knowledge, attitudes, and skills necessary to provide palliative care, yet most physicians do not feel adequately prepared. We designed a curriculum to provide a meaningful palliative care-ethics (PCE) clinical experience to prepare senior medical students for future practice regardless of specialty choice.
The Zucker School of Medicine at Hofstra/Northwell integrated a PCE experience into the required 4-week acting internship in critical care (AICC). Students met weekly with an interprofessional faculty member and presented clinical cases focusing on communication and/or bioethical challenges. Faculty facilitators ensured that the presentations integrated discussion of communication skills. During the final session, students shared written reflections. Students were invited to complete a satisfaction survey postrotation and 1 year after graduation.
The curriculum was evaluated positively by the graduating classes of 2015 ( = 28) and 2016 ( = 56) at the end of the course and 1 year postgraduation. Qualitative analysis of the class of 2018 fourth-year students' reflective writing demonstrated themes of role modeling, suffering, family, and goals of care.
It is feasible to incorporate an interprofessional PCE experience into a required AICC. Students indicated a better understanding of palliative care and, at 1 year postgraduation, reported feeling comfortable caring for patients with serious illness.
文献记载了本科和研究生医学教育中姑息医学培训不足的情况。随着人口寿命延长，许多人将经历多种慢性疾病及其相关的症状负担。所有参与患者临床护理的医生都需要具备提供姑息治疗所需的知识、态度和技能，但大多数医生认为自己准备不足。我们设计了一门课程，旨在提供有意义的姑息治疗伦理（PCE）临床体验，以使高年级医学生为未来的实践做好准备，无论其专业选择如何。
霍夫斯特拉/诺斯韦尔扎克医学院将PCE体验纳入了为期4周的重症监护实习（AICC）这一必修课程中。学生们每周与一名跨专业教员会面，并汇报聚焦于沟通和/或生物伦理挑战的临床病例。教员促进者确保汇报内容融入了沟通技巧的讨论。在最后一节课上，学生们分享了书面反思。我们邀请学生在轮转结束后以及毕业后1年完成满意度调查。
2015届（n = 28）和2016届（n = 56）毕业生在课程结束时以及毕业后1年对该课程给予了积极评价。对2018届四年级学生反思性写作的定性分析显示出了榜样、痛苦、家庭和护理目标等主题。
将跨专业PCE体验纳入必修的AICC是可行的。学生们表示对姑息治疗有了更好的理解，并且在毕业后1年报告称在护理重病患者时感到得心应手。
