Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Continuing Professional Development, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
J Pain Symptom Manage. 2020 Sep;60(3):678-687.e3. doi: 10.1016/j.jpainsymman.2020.05.009. Epub 2020 May 16.
It is widely recognized that physicians of all backgrounds benefit from having a general palliative care skill set to optimally manage their patients at the end of life. However, strategies to teach palliative care skills to trainees outside palliative medicine vary widely. In this report, we provide an evidence-based and cross-disciplinary palliative care framework applicable to a spectrum of specialty training environments and intended for nonpalliative care trainees.
We developed and implemented a concise, multimodal, and evidence-based pilot palliative care curriculum focused on essential general palliative care skills required by physicians providing patient care along the continuum of life across specializations. A needs assessment (local research, literature review, and consensus expert opinion) in combination with learner characteristics (Kolb Learning Style Inventory, Palliative Medicine Comfort and Confidence Survey, and knowledge pretest) informed the development of a curricular outline. The first iteration of the curriculum was formulated and delivered. Extensive evaluation, reassessment, and feedback led to a second iteration, which is presented here.
Although the context will differ according to specialization, there are essential palliative care skills required of most specialist physicians. General palliative themes identified for focus include symptom management, communication, psychosocial aspects of care, care coordination and access, and myths and pitfalls in palliative care.
Specialty trainees' value embedded training in essential themes in palliative care within the context of their training program. The process and results of this project, including the provision of a framework, may be applied to postgraduate training programs in various specialties.
人们普遍认识到,所有背景的医生都受益于掌握一般的姑息治疗技能,以在患者生命末期为其提供最佳治疗。然而,在姑息医学之外向受训者教授姑息治疗技能的策略差异很大。在本报告中,我们提供了一个基于证据和跨学科的姑息治疗框架,适用于一系列专业培训环境,面向非姑息治疗受训者。
我们开发并实施了一个简洁、多模式且基于证据的姑息治疗试点课程,重点是为沿着生命各个阶段提供医疗服务的医生提供的基本通用姑息治疗技能,涵盖了各个专业领域。需求评估(当地研究、文献综述和共识专家意见)与学习者特征(科尔布学习风格量表、姑息医学舒适度和信心调查以及知识前测)相结合,为课程大纲的制定提供了信息。该课程的第一版已制定并交付。广泛的评估、重新评估和反馈促成了第二版,现呈现于此。
尽管根据专业领域的不同,情况会有所不同,但大多数专科医生都需要掌握基本的姑息治疗技能。确定的重点姑息治疗通用主题包括症状管理、沟通、护理的心理社会方面、护理协调和获取以及姑息治疗的误区和陷阱。
专科受训者重视在其培训计划背景下接受姑息治疗基本主题的培训。该项目的过程和结果,包括提供的框架,可以应用于各种专业的研究生培训计划。