Palliative Care Curriculum for Medical Residents

描述(由申请人提供)：有大量证据表明，医生在姑息治疗方面没有接受过足够的培训。在前期工作中，我们为医生制定了评估方法和课程，并为65名住院医生建立了临终关怀轮换制度，每年培训三个内科项目和两个家庭医学项目。我们假设，使用针对医生的姑息治疗教育的国家课程的临终关怀轮换将导致知识、态度和技能的可衡量的改善。研究的主要终点是经验证的36项知识问题的分数，该问题有一个国家参考数据库。次要终点是对姑息治疗的信心和能力进行自我评估的分数。我们将对65名住院医生应用相同的课程来检验这一假设，在五年的时间里，每年从五个不同的培训项目中选出三个。项目将在PGY-1年的第一个月内向其居民管理评估工具。住院医生将被要求完成EPEC课程的四个模块，这是一个全国性的课程，涵盖了医生使用互联网进行自学的姑息治疗的核心能力。教师将帮助学生在住院和家庭临终关怀环境中临床接触患者时应用态度、知识和技能。住院医生将展示与标准化患者的沟通技能。这些仪器将在最后两个月的住院医师培训期间重新管理。将使用心理测量学等同知识考试，以防止重复考试时回忆起物品。我们将使用一组时间序列设计来分析数据。在为期三年的驻地培训期间，将分四个时间段实施这三套评价工具--Pre-1(入职)、Pre-2(轮换开始)、Post-1(轮换结束)和Post-2(出院)。One Group时间系列设计允许我们评估所有住院医师计划主管在三年培训期间寻求纳入姑息治疗课程时考虑的问题：1)如果课程是必修课，与选修课相比，课程会有什么影响？2)轮换需要多长时间？换句话说，时间对任务的影响是什么？3)轮换应该在什么时候开始或结束？4)接触这门课程的内科和家庭医生之间有区别吗？5)培训项目的类型(大学医院、社区教学医院还是军队医院)对信息的保留有影响吗？6)是否有证据表明这些不同因素之间存在年度交互作用？

DESCRIPTION (provided by applicant): There is substantial evidence that physicians do not have adequate training in palliative care. In preliminary work, we have developed evaluation methods and curricula for physicians and established a hospice rotation for 65 residents training in three programs of internal medicine and two programs in family medicine each year. We hypothesize that a hospice rotation using a national curriculum for palliative care education for physicians will result in measurable improvements in knowledge, attitudes and skills. The primary endpoint for study is the scores on a validated 36-item question of knowledge for which a national reference database exists. Secondary endpoints are self-rated scores of confidence and competence in palliative care. We will test this hypothesis applying the same curriculum to 65 resident three from five different training programs each year for five years. Programs will administer the evaluation instruments to their residents within the first month of the PGY-1 year. Residents will be required to complete four modules of the EPEC Curriculum, a national curriculum covering the core competencies of palliative care for physicians using the internet for self-study. Faculty will help the student apply the attitudes, knowledge and skills during clinical exposure to patients in the inpatient and home hospice settings. Residents will demonstrate communication skills with a standardized patient. The instruments will be readministered during the last two months of residency training. Psychometrically equivalent knowledge examinations will be used to prevent recall of items on repeated examination. We will analyze the data using the One-Group Time Series Design. The package of three evaluation instruments will be administered at four time periods during the three years of residency training- Pre 1 (beginning of residency); Pre 2 (beginning of rotation); Post 1 (completion of rotation); Post 2 (completion of residency). The One Group Time Series Design permits us to evaluate questions that are on the minds of all residency program directors as they seek to incorporate a palliative care curriculum within the three-year training period: 1) What effect does the curriculum have if it is required versus elective? 2) How long does the rotation need to be? In other words, what is the effect of time on task? 3) When should the rotation be placed in a 3-year residency, in the beginning or the end? 4) Are there differences between internal medicine and family practice residents who are exposed to this curriculum? 5) Does the type of training program (university hospital versus community teaching hospital versus military hospital) have any effect on the retention of information? and 6) Is there evidence of yearly interaction among these various factors?