Innovative Curriculum for Mid-Career Training in Palliative Care

姑息治疗中期职业培训的创新课程

• 批准号: 8142186
• 负责人: Frank Douglas Ferris MD
• 金额: $ 31.09万
• 依托单位: SAN DIEGO HOSPICE AND PALLIATIVE CARE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-13 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8142186
• 关键词: Accreditation; Advanced Malignant Neoplasm; Affect; Aging; American; Attention; Attitude; Beds; Behavior; Behavioral; Cancer Center; Carcinoma in Situ; Caring; Competence; Confounding Factors (Epidemiology); Consumption; Country; Coupled; Data; Developing Countries; Development; Diagnosis; Education; Educational Curriculum; Educational Intervention; Educational process of instructing; Environment; Evaluation; Faculty; Family; Fellowship; Fellowship Program; Foundations; Goals; Health; Healthcare Systems; Home environment; Institutes; Institution; International; Intervention; Knowledge; Learning; Malignant Neoplasms; Measures; Medical; Medical Students; Mentors; Morphine; Narcotic Controls; Oncologist; Opioid; Outcome; Palliative Care; Palliative Medicine; Participant; Patient Care; Patients; Physicians; Population; Pre-Post Tests; Principal Investigator; Quality of life; Reporting; Residencies; Scheme; Services; Skin; Societies; Specialist; Structure; Testing; Time; Training; Training Programs; United States; Wood material; Work; base; cancer diagnosis; candidate selection; career; design; education evaluation; end of life; experience; hospice environment; improved; innovation; interest; medical specialties; meetings; palliative; programs; psychological distress; public health relevance; skills; tool

DESCRIPTION (provided by applicant): In the US, there is an enormous gap between the need for physicians with specialist palliative medicine skills and the supply. Traditional fellowship programs will not be able to supply the number of physicians needed in the next 10-20 years. Innovative approaches to bringing mid-career physicians up to specialist levels are needed to help meet this gap. An effective curriculum for mid-career physicians who wish to develop subspecialist level skills in palliative medicine without participating in an ACGME-accredited fellowship program will help fill this gap. This project takes an innovative approach to training and curriculum development that involves: 1. careful selection of candidates, 2. institutional support, 3. a structured period of both didactic and mentored bedside teaching in the home institution and, 4. short mini-residencies of 4-6 weeks in duration that results in physicians with subspecialist skills. Most evaluation schemes of educational interventions measure attitudes and knowledge. Recent innovations have permitted us to measure some skills. Routine behavioral practice and aggregate patient outcomes have been much more difficult to measure. To provide an independent measure of physician training in hospice and end-of-life care, the designed curriculum will be tested with physician populations and healthcare systems where there are few confounding variables - by training mid-career physicians from developing countries and then bringing the proven curriculum to physicians in the US. By utilizing this trainee population, the curriculum can be tested in an environment with no competing educational interventions and no preexisting indications for/or usage of morphine, and there is the potential to see much greater change than in the usual educational intervention in the United States (US). This application tests the hypothesis that a curriculum in palliative care for mid-career physicians that combines didactic information with bedside mentoring while the physician is building a palliative care program improves patient-care outcomes. The primary endpoint will be an increase in morphine and morphine-equivalent opioid consumption in each country where the intervention is targeted as measured and reported by the International Narcotics Control Board (INCB). Five secondary endpoints will provide data from structured and objective evaluation of skill, attitudes, knowledge, and competence, track number and types of patients seen by the mid-career physicians receiving palliative medicine training, and through changes in the situation in each involved country over time. In this application, we specifically aim to: 1. develop a curriculum for mid-career physicians who wish to acquire subspecialty skills in hospice and palliative medicine and 2. evaluate the outcomes of the curriculum with special emphasis on measures of patient and societal outcomes. PUBLIC HEALTH RELEVANCE: The US must develop medical professionals in palliative care, to relieve suffering and improve the quality of life for those with advanced cancer. There are more than 2.4 million new diagnoses of cancer each year; if the 1 million diagnoses of skin and in situ cancers are excluded, that leaves 1.4 million people with 'serious' cancer, and this number is expected to grow significantly over the next few decades with the aging of the US population. Many of these people will experience significant physical and/or psychological distress as their cancers advance. A proven training program for mid-career physicians will respond to the current shortage of physicians capable of providing adequate palliative care for these patients.

描述（由申请人提供）：在美国，对具有专业姑息医学技能的医生的需求与供应之间存在巨大差距。传统的奖学金计划将无法在未来10-20年内提供所需的医生数量。需要创新的方法来使职业中期医生达到专家水平，以帮助弥补这一差距。 一个有效的课程，为职业中期的医生谁希望发展亚专科水平的技能，姑息治疗，而不参加ACGME认证的奖学金计划将有助于填补这一空白。该项目采取创新的培训和课程编制方法，涉及： 1. 仔细挑选候选人， 2. 机构支助， 3. 在家庭机构进行有组织的教学和指导性床边教学， 4. 4-6周的短期微型住院医师，可培养具有亚专科技能的医生。 大多数教育干预措施的评价计划都衡量态度和知识。最近的创新使我们能够衡量一些技能。常规行为实践和总体患者结果更难以衡量。为了提供临终关怀和临终关怀医生培训的独立衡量标准，设计的课程将在医生人群和医疗保健系统中进行测试，其中几乎没有混淆变量-通过培训来自发展中国家的职业中期医生，然后将经过验证的课程带给美国的医生。通过利用这一学员群体，可以在没有竞争性教育干预和没有预先存在的吗啡使用指征的环境中测试课程，并且有可能看到比美国通常的教育干预更大的变化。 该应用程序测试了这样的假设：为职业中期医生提供的姑息治疗课程将教学信息与床边指导相结合，同时医生正在制定姑息治疗计划，从而改善患者护理结果。主要终点将是国际麻醉品管制局（麻管局）衡量和报告的干预措施所针对的每个国家吗啡和吗啡当量阿片类药物消费量的增加。五个次要终点将提供来自技能、态度、知识和能力的结构化和客观评价的数据，跟踪接受姑息医学培训的职业中期医生所见患者的数量和类型，以及每个相关国家随时间推移的情况变化。在本申请中，我们的具体目标是： 1. 为希望获得临终关怀和姑息医学亚专业技能的职业中期医生制定课程， 2. 评估课程的成果，特别强调对患者和社会成果的衡量。 公共卫生关系：美国必须培养姑息治疗方面的医疗专业人员，以减轻晚期癌症患者的痛苦，提高他们的生活质量。每年有超过240万例新的癌症诊断;如果排除100万例皮肤癌和原位癌的诊断，那么就有140万人患有“严重”癌症，随着美国人口的老龄化，这一数字预计将在未来几十年内显着增长。这些人中的许多人将经历显着的身体和/或心理痛苦，因为他们的癌症进展。一个成熟的培训计划，为职业中期的医生将回应目前短缺的医生能够提供足够的姑息治疗这些病人。