Why are newly qualified doctors unprepared to care for patients at the end of life?
Why are newly qualified doctors unprepared to care for patients at the end of life?
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DOI：
10.1111/j.1365-2923.2010.03873.x
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发表时间：
2011-04-01
影响因子：
6
通讯作者：
Forbes, Karen
中科院分区：
文献类型：
--
作者：
Gibbins, Jane;McCoubrie, Rachel;Forbes, Karen
死亡和垂死发生在几乎所有的医学领域;这是至关重要的，以装备医生的知识，技能和态度，他们需要照顾病人在生命的尽头。鲜为人知的是，医生了解临终关怀，而在医学院，他们如何学会照顾垂死的病人在他们的第一年作为doctors.MethodsWe进行了一项定性研究，使用面对面的访谈，有目的的样本21个新的合格的医生谁在不同的医school.ResultsData进行了分析，使用不断的比较方法。出现了两大类主题。第一个涉及到医学院的临终关怀的经验，包括：缺乏曝光;文化的“书记员和标志”;保持和远离垂死的病人;缺乏检查;变量的经验，和理论意识。第二组主题涉及最近获得资格的医生的经验，包括：认识到病人确实会死;边做边学;老年人的作用;医院文化中的死亡和垂死;护理人员的角色，和姑息治疗团队的作用。结论本科医学教育目前未能准备初级医生在照顾垂死的病人，在医学院期间与这些患者进行有意义的接触。这种缺乏接触的情况使实习医生无法意识到自己的学习需求，只有当他们作为医生进入病房并被期望照顾这些病人时，这种需求才会变得明显。新获得资格的医生认为，他们在新的角色中很少接受关于姑息治疗或临终关怀的正式教学，医院环境中的文化不鼓励学习这一主题。他们还报告说，他们在“做这项工作”的同时从“试错法”中学习，但他们的技能和知识有限，因此他们向通常的医疗团队以外的人寻求建议，主要是护理人员和姑息治疗团队的成员。
ContextDeath and dying occur in almost all areas of medicine; it is essential to equip doctors with the knowledge, skills and attitudes they need to care for patients at the end of life. Little is known about what doctors learn about end-of-life care while at medical school and how they learn to care for dying patients in their first year as doctors.MethodsWe carried out a qualitative study using face-to-face interviews with a purposive sample of 21 newly qualified doctors who trained in different medical schools.ResultsData were analysed using a constant comparative approach. Two main groups of themes emerged. The first pertained to medical school experiences of end-of-life care, including: lack of exposure; a culture of 'clerking and signs'; being kept and keeping away from dying patients; lack of examinations; variable experiences, and theoretical awareness. The second group of themes pertained to the experiences of recently qualified doctors and included: realising that patients really do die; learning by doing; the role of seniors; death and dying within the hospital culture; the role of nursing staff, and the role of the palliative care team.ConclusionsUndergraduate medical education is currently failing to prepare junior doctors for their role in caring for dying patients by omitting to provide meaningful contact with these patients during medical school. This lack of exposure prevents trainee doctors from realising their own learning needs, which only become evident when they step onto the wards as doctors and are expected to care for these patients. Newly qualified doctors perceive that they receive little formal teaching about palliative or end-of-life care in their new role and the culture within the hospital setting does not encourage learning about this subject. They also report that they learn from 'trial and error' while 'doing the job', but that their skills and knowledge are limited and they therefore seek advice from those outside their usual medical team, mainly from nursing staff and members of palliative care teams.