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考察非专科临床轮转对医学生临终恐惧及姑息治疗自我效能的影响:在两所医学院校开展的一项前瞻性观察研究。

Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools.

作者信息

Gryschek Guilherme, Cecilio-Fernandes Dario, Barros Guilherme Antonio Moreira de, Mason Stephen, de Carvalho-Filho Marco Antonio

机构信息

Internal Medicine, University of Campinas School of Medical Sciences, Campinas, SP, Brazil.

Department of Medical Psychology and Psychiatry, University of Campinas School of Medical Sciences, Campinas, SP, Brazil.

出版信息

BMJ Open. 2020 Nov 18;10(11):e041144. doi: 10.1136/bmjopen-2020-041144.

Abstract

INTRODUCTION

Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback.

OBJECTIVE

Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools.

DESIGN

Observational prospective study.

SETTING

Medical schools in Brazil.

PARTICIPANTS

134 sixth-year medical students of two medical schools.

METHODS

This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches.

PRIMARY OUTCOMES

SEPC and TS Scales were used to assess students at the beginning and the end of the rotations.

RESULTS

In both schools' students had an increase in SEPC and a decrease in TS scores.

CONCLUSION

Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.

摘要

引言

将姑息治疗(PC)纳入负担过重的医学课程是一项挑战,尤其是在缺乏PC专家的情况下。我们假设,在有足够临床经验且能获得充分反馈的情况下,非专科轮转可以提供有意义的PC学习。

目的

观察在两所不同医学院校将PC主题纳入本科医学生非专科实习的效果。

设计

观察性前瞻性研究。

地点

巴西的医学院校。

参与者

两所医学院校的134名六年级医学生。

方法

这是一项纵向研究,观察了巴西两所医学院校(MS1和MS2)六年级医学生在不同非专科临床轮转中姑息治疗自我效能感(SEPC)和死亡恐惧(TS)的发展情况。我们在MS1的急诊与重症监护轮转期间招募了78名学生,在MS2的麻醉轮转期间招募了56名学生。两所学校都提供了不同学习环境和方法的PC讨论。

主要结局

在轮转开始和结束时使用SEPC和TS量表对学生进行评估。

结果

两所学校的学生SEPC均有所提高,TS得分均有所下降。

结论

将PC能力视为医生核心能力的非专科轮转,对于提高SEPC和降低TS水平可能是有效的。

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本文引用的文献

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Psychology and learning: The role of the clinical learning environment.心理学与学习:临床学习环境的作用。
Med Teach. 2019 Apr;41(4):375-379. doi: 10.1080/0142159X.2019.1567910. Epub 2019 Feb 14.
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Palliative Care in Undergraduate Medical Education-How Far Have We Come?本科医学教育中的姑息治疗——我们已经走了多远?
Am J Hosp Palliat Care. 2017 Sep;34(8):762-773. doi: 10.1177/1049909116659737. Epub 2016 Jul 28.

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