加拿大本科和研究生医学实习生的姑息治疗临床实习：描述性研究。
Palliative care clinical rotations among undergraduate and postgraduate medical trainees in Canada: a descriptive study.
机构信息
Faculty of Medicine (Gagnon), Laval University; Research Centre of the Centre hospitalier universitaire de Québec-Université Laval (Gagnon, Jolicoeur, Labonté), Québec, Que.; Canadian Society of Palliative Care Physicians (Boyle, Taylor, Downar), Surrey, BC; Department of Family Medicine (Boyle), McMaster University, Hamilton, Ont.; Department of Medicine (Downar), University of Ottawa, Ottawa, Ont.
出版信息
CMAJ Open. 2020 Apr 14;8(2):E257-E263. doi: 10.9778/cmajo.20190138. Print 2020 Apr-Jun.
BACKGROUND
The number of medical undergraduate and postgraduate students completing palliative care clinical rotations in Canadian medical schools is currently unknown. The aim of this study was to assess the proportion of Canadian medical trainees completing clinical rotations in palliative care and to determine whether changes took place between 2008 and 2018.
METHODS
In this descriptive study, all Canadian medical schools ( = 17) were invited to provide data at the undergraduate and postgraduate levels (2007/08-2015/16 and 2007/08-2017/18, respectively). Information collected included the number, type and length of palliative care clinical rotations offered and the total number of medical trainees or residents enrolled at each school.
RESULTS
All 17 Canadian medical schools responded to the request for information. At the undergraduate level, palliative care clinical rotations were not offered in 2 schools, mandatory in 2 and optional in 13. Three schools that offered optional rotations were unable to provide complete data and were therefore excluded from further analyses. In 2015/16, only 29.7% of undergraduate medical students completed palliative care clinical rotations, yet this was a significant improvement compared to 2011/12 (13.6%, = 0.02). At the postgraduate level, on average, 57.9% of family medicine trainees completed such rotations between 2007/08 and 2016/17. During the same period, palliative care clinical rotations were completed by trainees in specialty or subspecialty programs in anesthesiology (34.2%), geriatric medicine (64.4%), internal medicine (30.9%), neurology (28.2%) and psychiatry (64.5%).
INTERPRETATION
Between 2008 and 2018, a large proportion of Canadian medical trainees graduated without the benefit of a clinical rotation in palliative care. Without dedicated clinical exposure to palliative care, many physicians will enter practice without vital palliative care competencies.
背景
目前尚不清楚加拿大医学院有多少医学生和研究生完成了姑息治疗临床实习。本研究旨在评估加拿大医学生完成姑息治疗临床实习的比例，并确定 2008 年至 2018 年期间是否发生了变化。
方法
在这项描述性研究中，邀请所有加拿大医学院（= 17 所）提供本科和研究生水平（2007/08-2015/16 年和 2007/08-2017/18 年）的数据。收集的信息包括提供的姑息治疗临床实习的数量、类型和时长，以及每所学校注册的医学生或住院医师的总数。
结果
所有 17 所加拿大医学院都对信息请求做出了回应。在本科阶段，有 2 所学校没有提供姑息治疗临床实习，2 所学校要求必修，13 所学校提供选修。有 3 所提供选修实习的学校无法提供完整的数据，因此被排除在进一步的分析之外。在 2015/16 年，只有 29.7%的医学生完成了姑息治疗临床实习，但与 2011/12 年（13.6%，=0.02）相比，这是一个显著的进步。在研究生阶段，平均有 57.9%的家庭医学实习生在 2007/08 年至 2016/17 年期间完成了此类实习。在此期间，麻醉学（34.2%）、老年医学（64.4%）、内科（30.9%）、神经病学（28.2%）和精神病学（64.5%）等专业或专科培训生也完成了姑息治疗临床实习。
解释
在 2008 年至 2018 年期间，加拿大有很大一部分医学生在没有接受姑息治疗临床实习的情况下毕业。没有专门的姑息治疗临床经验，许多医生在实践中都缺乏重要的姑息治疗能力。
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