Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE.
Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Hosp Med. 2024 Nov;19(11):1044-1052. doi: 10.1002/jhm.13489. Epub 2024 Aug 18.
Medical trainees are at the forefront of end-of-life care provision in the hospital setting but often feel unprepared to manage the complex emotions after patient death.
To systematically identify and synthesize the published literature on interventions to support medical trainees dealing with patient death.
Searches were conducted in MEDLINE, Scopus, Embase, Psych Info, Cochrane Database of Systematic Reviews, CINAHL, and ERIC from inception to June 30, 2023. English language peer-reviewed publications of interventions to support medical students and residents/fellows dealing with patient death. Studies of practicing clinicians and nonphysician healthcare trainees were excluded. Two reviewers independently determined study eligibility. Discrepancies were resolved through consensus and a third reviewer served as a tiebreaker if needed.
Of the 9107 articles retrieved, 973 underwent full-text review, and 50 studies met inclusion criteria. Most interventions targeted residents (n = 32; 64%) and were conducted in North America (n = 45, 90%). Types of interventions included preventive measures involving educational lectures and workshops (n = 19; 38%), clinical placements (n = 10; 20%), and postventions (n = 16; 32%), including debriefing and memorial services. Several interventions incorporated the arts (n = 5; 10%), including movies, drama, and artwork, and most incorporated reflective narratives (n = 16; 32%). Most interventions were limited in frequency and duration.
This review identified several interventions to support trainees through the experience of patient death but also highlighted areas for improvement. Strengthening support for medical trainees will foster emotionally resilient physicians who are better equipped to deliver high-quality, empathetic care to dying patients and their families.
在医院环境中，医学实习生处于提供临终关怀的前沿，但他们往往感到无法应对患者死亡后的复杂情绪。
系统地识别和综合已发表的文献，以了解支持医学实习生处理患者死亡的干预措施。
从建库到 2023 年 6 月 30 日，在 MEDLINE、Scopus、Embase、Psych Info、Cochrane 系统评价数据库、CINAHL 和 ERIC 中进行了检索。纳入的文献为支持处理患者死亡的医学生和住院医师/研究员的干预措施的英文同行评审出版物。排除了针对在职临床医生和非医师医疗保健实习生的研究。两名审查员独立确定研究的合格性。如有分歧，则通过共识解决；如有必要，第三名审查员作为仲裁人。
在检索到的 9107 篇文章中，有 973 篇进行了全文审查，有 50 项研究符合纳入标准。大多数干预措施针对住院医师（n=32；64%），并在北美进行（n=45，90%）。干预措施的类型包括涉及教育讲座和研讨会的预防措施（n=19；38%）、临床实习（n=10；20%）和事后干预（n=16；32%），包括汇报和追悼会。一些干预措施结合了艺术形式（n=5；10%），包括电影、戏剧和艺术作品，大多数干预措施都包含了反思性叙述（n=16；32%）。大多数干预措施在频率和持续时间上都受到限制。
本综述确定了一些干预措施，以支持实习生应对患者死亡的经历，但也强调了需要改进的领域。加强对医学实习生的支持，将培养出更有情感韧性的医生，使他们能够更好地为临终患者及其家属提供高质量、富有同情心的护理。
