Samala Renato V, Hoeksema Laura J, Colbert Colleen Y
1 Cleveland Clinic, Cleveland, OH, USA.
Am J Hosp Palliat Care. 2019 Oct;36(10):885-892. doi: 10.1177/1049909119836218. Epub 2019 Mar 13.
With the rapid growth in the number of fellowship programs in Hospice and Palliative Medicine (HPM), many are in the process of developing ways to demonstrate that fellows are attaining educational milestones. Reflection and self-assessment are key components of 2 Accreditation Council for Graduate Medical Education (ACGME) competencies, practice-based learning and improvement, and systems-based practice, which have both been historically challenging to learn and assess.
This article describes results of a content analysis of narrative data collected from HPM fellows' self-assessments as they performed hospice home visits independently in a new clinical rotation.
This was a prospective qualitative study.
SETTINGS/PARTICIPANTS: Eight fellows completed 217 unsupervised hospice home visits from 2014 to 2016.
Fellows completed weekly self-assessment forms, which captured both clinical visit information and practice data elicited from responses to open-ended reflection prompts.
Analysis of 29 self-assessment forms generated 6 themes: patient- and family-centered care, self-efficacy, systems-based care, commitment to doing their best, catalyst for professional growth, and purpose and meaning in work. The fellows recognized numerous barriers distinct to providing care in homes. All fellows felt prepared to perform home visits throughout the rotation and after training.
Narrative data collected during the independent home visit rotation provided evidence that HPM fellows detected gaps in their performance, planned for practice improvements in subsequent visits, and valued working within an interprofessional team. Built-in opportunities for fellows to reflect during training are critical in meeting ACGME milestones, and are integral to their professional development.
随着临终关怀与姑息医学（HPM）专科培训项目数量的迅速增长，许多项目正在探索如何证明学员达到了教育里程碑。反思和自我评估是毕业后医学教育认证委员会（ACGME）两项能力要求（基于实践的学习与改进以及基于系统的实践）的关键组成部分，而这两项能力在历史上一直难以学习和评估。
本文描述了对HPM学员在新的临床轮转中独立进行临终关怀家访时的自我评估所收集的叙述性数据进行内容分析的结果。
这是一项前瞻性定性研究。
地点/参与者：8名学员在2014年至2016年期间完成了217次无人监督的临终关怀家访。
学员们每周填写自我评估表，其中既记录了临床家访信息，也记录了从对开放式反思提示的回答中得出的实践数据。
对29份自我评估表的分析产生了6个主题：以患者和家庭为中心的护理、自我效能感、基于系统的护理、尽最大努力的承诺、职业成长的催化剂以及工作的目的和意义。学员们认识到在家中提供护理存在许多独特的障碍。所有学员在整个轮转期间以及培训后都觉得自己已做好进行家访的准备。
在独立家访轮转期间收集的叙述性数据表明，HPM学员发现了自己表现中的差距，计划在后续家访中改进实践，并重视在跨专业团队中工作。在培训期间为学员提供反思的内在机会对于达到ACGME里程碑至关重要，并且是他们职业发展不可或缺的一部分。
