End-of-life Education in the 3rd Year of Medical School

描述（由申请人提供）：匹兹堡大学医学院建议加强三年级临床见习生对医学生为癌症患者和其他晚期、限制生命的疾病提供姑息治疗的准备。第三年医学课程的目的不是培养住院医生或研究员所期望的临床专业知识水平。相反，它是为学生提供机会，通过观察、实践和反馈，开始将医患关系、医学诊断和治疗的原则应用到实际病人的护理中。该提案中的课程改革旨在确保与临终关怀特别相关的原则得到适当的强调和加强。该建议的具体结果目标是提高毕业生(1)对核心临终任务的了解，(2)对临终关怀的态度，(3)对临终病人的情感安慰，(4)对临终指导的满意度，以及(5)在医疗实习生水平上提供临终关怀的准备感。为了实现这些成果，该提案有以下过程目标：(1)为教师和住院医生提供教材和教学策略，帮助他们在六个必需的三年级见习生中更多地利用与临终关怀相关的“教学时刻”：医学、外科、临床神经科学（神经病学和精神病学）、儿科、家庭医学和门诊护理；(2)开发和实施基于网络的教学技术（eportfolio），使学生能够在整个第三年系统地记录他们接触生命终结学习的机会，并及时收到教育材料和教师的反馈；(3)将特定的临终学习目标与最有可能出现在特定见习岗位上的学习机会相匹配，同时监测学生在整个见习年度中接触到完整的临终课程的情况；(4)提供方便、无威胁的环境，让医三学生可以探索他们对病人晚期疾病或死亡的情绪反应。这些目标的过程和结果措施包括维护一个集中的数据库，包括学生和教师的网络活动，教师、住院医生和学生的调查，学生焦点小组，以及在进入医学院、第2年结束和毕业时对整个医学院班级进行姑息治疗知识和态度调查。

DESCRIPTION (provided by applicant): The University of Pittsburgh School of Medicine proposes to enhance the third-year clinical clerkships' contribution to medical students' preparation to provide palliative care to cancer patients and others with advanced, life-limiting illnesses. The purpose of the third-year medical curriculum is not to produce the level of clinical expertise expected of residents or fellows. Rather, it is to provide students with opportunities to begin to apply-through observation, practice, and feedback-the principles of the physician-patient relationship, medical diagnosis, and treatment to the care of actual patients. The curriculum changes in this proposal aim to ensure that the principles that relate particularly to end-of-life care receive appropriate emphasis and reinforcement. The specific outcome aims of the proposal are to improve graduating students' (1) knowledge of core end-of-life tasks, (2) attitudes toward end-of-life care, (3) emotional comfort with dying patients, (4) satisfaction with their end-of- life instruction, and (5) feeling of preparedness to provide end-of-life care at the level of a medical intern. To achieve these outcomes, the proposal has the following process aims: (1) to provide faculty and residents with teaching materials and pedagogical strategies to help them take increased advantage of "teachable moments" related to end-of-life care in six required third-year clerkships: Medicine, Surgery, Clinical Neurosciences (Neurology and Psychiatry), Pediatrics, Family Medicine, and Ambulatory Care; (2) to develop and implement web-based instructional technologies (ePortfolios) that enable students to record systematically their exposure to end-of-life learning opportunities throughout the third year, and to receive just-in-time educational materials and feedback from faculty; (3) to match specific end-of-life learning objectives to the learning opportunities most likely to arise in particular clerkships, while monitoring students' exposure to the full end-of-life curriculum across the clerkship year as a whole; and (4) to provide easily accessible, non-threatening settings in which third-year medical students may explore their emotional reactions to their patients' terminal illnesses or deaths. Process and outcome measures for these aim s includ e maintenance of a centralized data base of student and faculty web activity, faculty, resident, and student surveys, student focus groups, and administration of a palliative care knowledge and attitude survey to the entire medical school class upon entering medical school, at the end of Year 2, and upon graduation.