Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Harborview Medical Center, Seattle, WA, USA.
Am J Hosp Palliat Care. 2024 May;41(5):492-500. doi: 10.1177/10499091231181567. Epub 2023 Jun 8.
Residents often feel unprepared to care for dying patients and may benefit from more training. Little is known about factors in the clinical setting that promote resident learning about end of life (EOL) care.
This qualitative study aimed to characterize the experiences of residents caring for dying patients and elucidate the impact of emotional, cultural, and logistical factors on learning.
6 US internal medicine and 8 pediatric residents who had cared for at least 1 dying patient completed a semi-structured one-on-one interview between 2019 and 2020. Residents described an experience caring for a dying patient including their confidence in clinical skills, emotional experience, role within the interdisciplinary team, and perspective on how to improve their education. Interviews were transcribed verbatim and investigators conducted content analysis to generate themes.
3 themes (with subthemes) emerged: (1) experiencing strong emotion or tension (loss of patient personhood, emerging professional identity, emotional dissonance); (2) processing the experience (innate resilience, team support); and (3) recognition of a new perspective or skill (bearing witness, meaning making, recognizing biases, emotional work of doctoring).
Our data suggests a model for the process by which residents learn affective skills critical to EOL care: residents (1) notice strong emotion, (2) reflect on the meaning of the emotion, and (3) crystallize this reflection into a new perspective or skill. Educators can use this model to develop educational methods that emphasize normalization of physician emotions and space for processing and professional identity formation.
住院医师通常觉得自己对临终关怀准备不足，可能需要更多的培训。人们对临床环境中促进住院医师学习临终关怀的因素知之甚少。
本定性研究旨在描述住院医师照顾临终患者的经验，并阐明情感、文化和后勤因素对学习的影响。
2019 年至 2020 年，6 名内科住院医师和 8 名儿科住院医师完成了至少 1 次照顾临终患者的半结构化一对一访谈。住院医师描述了照顾临终患者的经历，包括他们对临床技能的信心、情感体验、在跨学科团队中的角色，以及对如何改进教育的看法。访谈内容逐字转录，调查人员进行了内容分析以生成主题。
出现了 3 个主题（带有子主题）：（1）体验强烈的情绪或紧张（失去患者的人格、新兴的专业身份、情感失调）；（2）处理体验（内在的适应力、团队支持）；以及（3）认识到新的视角或技能（见证、意义的赋予、认识到偏见、医生的情感工作）。
我们的数据表明了住院医师学习临终关怀关键情感技能的过程模型：住院医师（1）注意到强烈的情绪，（2）反思情绪的意义，（3）将这种反思转化为新的视角或技能。教育者可以使用该模型来开发教育方法，强调医生情绪的正常化以及处理和专业身份形成的空间。
