Hospice Home Immersion Project: Advancing Medical Education
Hospice Home Immersion Project: Advancing Medical Education
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临终关怀之家浸入式项目：推进医学教育
DOI：
10.4236/ijcm.2015.63021
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
A. Gaul
中科院分区：
文献类型：
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作者：
M. Gugliucci;Himanshu Malhotra;A. Gaul
新英格兰大学骨科医学院 (UNECOM) 临终关怀项目于 2014 年在缅因州南部进行了试点。它被设计和实施为一种体验式医学教育学习模式，医学生被“接纳”到当地临终关怀之家并在那里生活 48 小时。在此项目之前，美国医学院，特别是 UNECOM 的姑息治疗和临终关怀教育都是通过传统医学教育方法完成的。临终关怀沉浸项目采用定性人种学和自传研究设计，通过观察独特的环境或“文化”（临终关怀之家），并报告医学生在沉浸之前、期间和之后的生活经历。临终关怀沉浸项目的目的是为二年级医学生提供在临终关怀之家生活 48 小时的第一手经验，以回答以下问题：“对我来说，住在临终关怀之家是什么样的？”结果侧重于学生的共同主题，包括 1) 未知领域； 2）支持； 3) 员工的角色； 4）沉浸式学习在姑息治疗和临终关怀中的作用； 5）面对死亡和临终； 6) 临床珍珠。该项目使垂死和死亡变得人性化，让学生认识到死亡是生命的一部分，能够参与减轻痛苦、增加舒适度、重视沟通和人际关系的护理过程是多么荣幸。学生们报告了在患者护理方面新发现的技能，例如 1）身体接触的重要性； 2) 临终沟通对于患者、家属和工作人员的重要性； 3）真实和真诚的价值来自于对自己的满意，这让沉默传达了关怀； 4) 与该人（而不是其绝症）及其家人的联系和认识； 5) 提前与患者及其家人讨论临终计划的重要性。尽管这对于教职员工和临终关怀之家工作人员来说是一次时间密集的经历，但学生所经历的深度学习以及推进死亡和临终医学教育的机会是非常值得付出努力的。
The University of New England College of Osteopathic Medicine (UNECOM) Hospice Immersion project was piloted in 2014 in southern Maine. It was designed and implemented as an experiential medical education learning model whereby medical students were “admitted” into the local Hospice Home to live there for 48 hours. Until this project, palliative and end of life care education at US Medical Schools and specifically UNECOM were accomplished through traditional medical education methods. The Hospice Immersion project utilizes qualitative ethnographic and autobiographic research designs, whereby a unique environment or “culture” (Hospice Home) is observed and life experiences of the medical student before, during, and immediately after the immersion are reported by him/her. The purpose of the Hospice Immersion project is to provide second year medical students with firsthand experiences of living in the Hospice Home for 48 hours to answer the question: “What it is like FOR ME to live in the Hospice Home?” The results focus on the students’ common themes that include 1) Unknown Territory; 2) Support; 3) Role of Staff; 4) Role of Immersion Learning in Palliative and End of Life Care; 5) Facing Death and Dying; and 6) Clinical Pearls. This project humanizes dying and death, solidified student realization that dying is a part of life and what an honor it is to be a part of the care process that alleviates pain, increases comfort, values communication, and human connections. Students report new found skills in patient care such as the 1) importance of physical touch; 2) significance of communication at the end of life for the patient, family, and staff; 3) the value of authenticity and sincerity that comes from being comfortable with oneself, which allows silence to communicate caring; 4) connection with and awareness of the person (rather than their terminal illness) and their family; and 5) the importance of speaking with patients and their families about end of life plans in advance. Although this is a time intensive experience for the faculty member and the Hospice Home staff, the depth of learning experienced by the students and opportunities to advance medical education in death and dying are well worth the efforts.