M.U. Bashir is associate consultant, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota. H.C. Nordhues is chief resident, Internal Medicine Residency Program, and instructor of medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota. S.P. Merry is assistant professor of family medicine, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota. A.P. Sawatsky is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: http://orcid.org/0000-0003-4050-7984.
Acad Med. 2019 Aug;94(8):1170-1177. doi: 10.1097/ACM.0000000000002763.
International health electives (IHEs) provide numerous educational benefits; potential harms are less well understood. One potential harm is trainee distress associated with increased patient death during IHEs. The purpose of this study was to explore residents' and fellows' IHE experiences with patient death.
The authors used applied thematic analysis to explore residents' and fellows' IHE experiences with patient death. The Mayo International Health Program supports IHEs from all specialties across three Mayo Clinic sites. Data were collected and analyzed in two steps. First the authors collected, coded, and analyzed narrative reflections from 43 postrotation reports gathered in 2001-2017 and identified themes relating to experiences with patient death. Second, in 2016-2017 the authors conducted semistructured interviews with six previous participants to refine thematic analysis.
Participants described impacts of experiencing increased patient death and identified themes in two domains: difficult experiences with patient death and potential interventions to help residents process their experiences. They identified four themes illustrating why these experiences were difficult: lack of preparation for increased exposure to death, lack of closure, consequences of limited resources, and differences in cultural beliefs regarding death. While pretrip preparation for dealing with death was viewed as important, trainees identified support during and debriefing after IHEs as additional important interventions.
Given the popularity of IHEs, residency programs should consider the effect on trainees of increased exposure to patient death. Study findings can inform IHE preparation, support, and debriefing to minimize distress associated with witnessing patient deaths on IHEs.
国际卫生实习（IHE）提供了许多教育益处；潜在的危害则了解较少。潜在的危害之一是实习医生在 IHE 期间因患者死亡而感到痛苦。本研究的目的是探讨住院医生和研究员在 IHE 期间经历患者死亡的情况。
作者采用应用主题分析方法来探讨住院医生和研究员在 IHE 期间经历患者死亡的情况。梅奥国际健康计划支持来自三个梅奥诊所站点的所有专业的 IHE。数据分两步收集和分析。首先，作者从 2001-2017 年收集的 43 份轮转报告中收集、编码和分析叙事反思，并确定与患者死亡经历相关的主题。其次，在 2016-2017 年，作者对之前的六名参与者进行了半结构化访谈，以完善主题分析。
参与者描述了经历患者死亡增加的影响，并确定了两个领域的主题：与患者死亡相关的困难经历和潜在的干预措施，以帮助住院医生处理这些经历。他们确定了四个主题，说明了为什么这些经历是困难的：缺乏对增加接触死亡的准备、缺乏结束感、资源有限的后果以及对死亡的文化信仰的差异。虽然出国前准备应对死亡被认为很重要，但住院医生还确定了在 IHE 期间和之后的支持以及事后反思是另外重要的干预措施。
鉴于 IHE 的普及，住院医师培训计划应考虑增加接触患者死亡对住院医生的影响。研究结果可以为 IHE 的准备、支持和反思提供信息，以最大限度地减少在 IHE 上目睹患者死亡所带来的痛苦。
