Brookdale Department of Geriatrics and Palliative Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Am J Hosp Palliat Care. 2021 Oct;38(10):1218-1224. doi: 10.1177/1049909120987207. Epub 2021 Jan 22.
Hospitalized patients with serious illness have significant symptom burden and face complex medical decisions that often require goals of care discussions. Given the shortage of specialty palliative care providers, there is a pressing need to improve the palliative care skills of internal medicine (IM) residents, who have a central role in the care of seriously ill patients hospitalized at academic medical centers.
We conducted an anonymous survey of IM residents at a large, urban, academic medical center to identify which aspects of palliative care trainees find most important and their knowledge gaps in palliative care. The survey measured trainees' self-assessed degree of importance and knowledge of core palliative care skills and evaluated frequency of completing advance care planning documentation.
Overall, 51 (23%) IM residents completed the survey. The majority of trainees considered multiple palliative care skills to be "very important/important": symptom management, prognostication, introducing the palliative care approach, discussing code status, and breaking serious news. Across these same skills, trainees reported variable levels of knowledge. In our sample, trainees reported completing healthcare proxy forms and Medical Orders for Life-Sustaining Treatment infrequently.
IM trainees rated core palliative care skills as important to their practice. Yet, they reported knowledge gaps across multiple core palliative care skills that should be addressed given their role as frontline providers for patients with serious illness.
患有重病的住院患者有很大的症状负担，面临着复杂的医疗决策，这些决策通常需要进行关怀目标的讨论。鉴于专业姑息治疗提供者的短缺，迫切需要提高内科（IM）住院医师的姑息治疗技能，他们在学术医疗中心重病患者的护理中起着核心作用。
我们对一家大型城市学术医疗中心的 IM 住院医师进行了匿名调查，以确定姑息治疗受训者认为最重要的方面以及他们在姑息治疗方面的知识差距。该调查衡量了受训者对核心姑息治疗技能的自我评估重要性和知识程度，并评估了完成预先护理计划文件的频率。
总体而言，有 51 名（23%）IM 住院医师完成了调查。大多数受训者认为多项姑息治疗技能“非常重要/重要”：症状管理、预后、引入姑息治疗方法、讨论代码状态和传达坏消息。在这些相同的技能中，受训者报告了不同程度的知识。在我们的样本中，受训者报告说很少填写医疗代理人表格和医疗维持生命治疗的医疗指令。
IM 住院医师将核心姑息治疗技能评为对其实践很重要。然而，他们报告了多个核心姑息治疗技能方面的知识差距，鉴于他们作为重病患者一线提供者的角色，这些差距需要得到解决。
