Undergraduate Medical Education for End of Life Care

匹兹堡大学医学院（University of Pittsburgh School of Medicine）建议制定一项为期四年的医学院课程，其中每年为接近生命尽头的患者提供有效和富有同情心的护理，做出最佳的、适合阶段的贡献。虽然本科医学课程本身不能把医生培养成临终关怀方面的专家，但它可以培养医生对临终关怀的兴趣，培养他们对临终关怀所需的基本知识、技能和态度，以及学习更多知识的愿望。该建议的主要内容是：(I)调整目前医学院的课程，以最大限度地利用目前存在的机会引入临终内容；(2)引入新的课程内容，让学生长时间接触危及生命的病人；(3)提供教师发展经验，以增加实践和教授最佳临终关怀的临床榜样的数量。这是一种循序渐进的方法，对课程变化、教师的知识基础和教学技能给予同样的关注，这样当学生从医学院的临床前阶段转到临床阶段时，教师的榜样就会到位，以加强学生将带到他们的工作岗位上的增强的临终教育。该提案的具体目的是：(1)增加学生对临终关怀的科学和人文知识；(2)向医学生灌输医生在提供有效和富有同情心的临终关怀方面的重要性；(3)扩大临床教师的承诺，将临终内容纳入他们的临床教学，并提高他们对这样做的机会和方法的认识。本申请集中于学生对临终关怀的基本知识和态度，提出一年级和二年级课程的修改，以及教师发展过程。第二项申请将侧重于相关的临床技能和行为，通过与扩大的教师榜样和讲师合作，在三年级和四年级实施课程改革。我们将通过调查、前后测试、课程注册和出勤数据、课程评估、课程考试、客观的标准化临床检查、临床情景书面分析和情况汇报访谈来衡量整个项目目标的实现情况。

The University of Pittsburgh School of Medicine proposes to develop a four-year medical school curriculum in which each year makes the optimal, stage-appropriate contribution to effective and compassionate care of patients near the end of life. While the undergraduate medical curriculum by itself cannot prepare physicians to be experts in end-of-life care, it can instill an interest in giving such care, the basic knowledge, skills, and attitudes required for such care, and a desire to learn more. The major components of the proposal are: (I) to adjust the current medical school curriculum to take maximum advantage of presently existing opportunities to introduce end-of-life content; (2) to introduce a new curricular component to provide students with prolonged exposure to patients with life-threatening illnesses; and (3) to provide faculty development experiences to increase the number of clinical role models who practice and teach optimal end-of-life care. This is a step-by-step, incremental approach that pays equal attention to curricular change and to the knowledge base and teaching skills of the faculty, so that when students move from the preclinical to the clinical years of medical school, faculty role models will be in place to reinforce the enhanced end-of-life education the students will bring with them into their clerkships. The specific aims of this proposal are: (1) to increase students' scientific and humanistic knowledge related to end-of-life care: (2) to instill in medical students understanding and acceptance of the importance in the physician's role of providing effective and compassionate end-of-life care; and (3 ) to broaden the commitment of the clinical faculty to incorporating end-of-life content into their clinical teaching, and increase their awareness of the opportunities and methods for doing so. The present application concentrates on students' basic knowledge and attitudes toward end-of-life care, proposing modifications in Years 1 and 2 of the curriculum, and the faculty development process. A second application will concentrate on the relevant clinical skills and behaviors, by working with the enlarged pool of faculty role models and instructors to implement curricular changes in Years 3 and 4. We will measure the attainment of aims throughout the project using surveys, pre/post tests, course enrollment and attendance data, course evaluations, course examinations, objective standardized clinical examinations, written analyses of clinical scenarios, and de-briefing interviews.