Brown Janine, Goodridge Donna, Thorpe Lilian
College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
Faculty of Nursing, University of Regina, Saskatchewan, Canada.
Can Med Educ J. 2020 Dec 7;11(6):e79-e89. doi: 10.36834/cmej.69325. eCollection 2020 Dec.
This paper offers insight into (1) the driving and restraining forces impacting the inclusion of medical assistance in dying (MAID) in health sciences curricula, (2) the required resources for teaching MAID, and (3) the current placement of MAID in health sciences curricula in relation to end-of-life care concepts.
We conducted a qualitative exploratory study in a Canadian province using Interpretive Description, Force Field Analysis, and Change as Three Steps. We interviewed ten key informants (KI), representing the provincial health sciences programs of medicine, nursing, pharmacy, and social work. KIs held various roles, including curriculum coordinator, associate dean, or lecturing faculty. Data were analyzed via the comparative method using NVivo12.
Curriculum delivery structures, resources, faculty comfort and practice context, and uncertainty of the student scope of practice influenced MAID inclusion. Medical and pharmacy students were consistently exposed to MAID, whereas MAID inclusion in nursing and social work was determined by faculty in consideration with the pre-existing course objectives. The theoretical and legal aspects of MAID were more consistently taught than clinical care when faculty did not have a current practice context. Care pathways, accreditation standards, practice experts, peer-reviewed evidence, and local statistics were identified as the required resources to support student learning. MAID was delivered in conjunction with palliative care and ethics, legalities, and professional regulation courses.
The addition of MAID in health sciences curricula is crucial to support students in this new practice context. Identifying the drivers and restrainers influencing the inclusion of MAID in health sciences curricula is critical to support the comprehensiveness of end-of-life education for all students.
本文深入探讨了以下几个方面：（1）影响医学辅助死亡（MAID）纳入健康科学课程的推动因素和限制因素；（2）教授MAID所需的资源；（3）MAID在健康科学课程中与临终关怀概念相关的当前设置情况。
我们在加拿大的一个省份进行了一项定性探索性研究，采用解释性描述、力场分析和变革三步走的方法。我们采访了十位关键信息提供者（KI），他们分别代表该省医学、护理、药学和社会工作等健康科学项目。关键信息提供者担任各种角色，包括课程协调员、副院长或授课教师。使用NVivo12通过比较法对数据进行分析。
课程交付结构、资源、教师的舒适度和实践背景以及学生实践范围的不确定性影响了MAID的纳入。医学和药学专业的学生始终接触到MAID，而护理和社会工作专业对MAID的纳入则由教师根据预先设定的课程目标来决定。当教师没有当前的实践背景时，MAID的理论和法律方面的教学比临床护理方面的教学更加一致。护理路径、认证标准、实践专家、同行评审证据和当地统计数据被确定为支持学生学习所需的资源。MAID与姑息治疗以及伦理、法律和专业监管课程一起讲授。
在健康科学课程中增加MAID对于在这种新的实践背景下支持学生至关重要。识别影响MAID纳入健康科学课程的驱动因素和限制因素对于支持所有学生临终教育的全面性至关重要。
