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助理对医科学生准备工作的贡献，为癌症患者和其他患有晚期、限制生命的疾病提供姑息治疗。三年级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、医疗诊断和治疗的原则应用到实际患者的护理中。该提案中的课程改革旨在确保特别与临终关怀有关的原则得到适当的重视和加强。该提案的具体结果目标是提高毕业生(1)对临终任务的核心知识，(2)对临终关怀的态度，(3)对临终病人的情感安慰，(4)对临终关怀的满意度，以及(5)准备在医学实习生层面提供临终关怀的感觉。为了实现这些结果，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，帮助他们在六个所需的第三年助理职位：内科、外科、临床神经科学(神经学和精神病学)、儿科学、家庭医学和护理；(2)开发和实施基于网络的教学技术(EPortfolios)，使学生能够在第三年系统地记录他们接触到的临终学习机会，并及时从教师那里获得反馈；(3)使特定的临终学习目标与最有可能出现的学习机会相匹配，特别是在担任助理的一年中，同时监测学生在整个临终课程中的接触情况；及。(4)提供方便、无威胁的环境，让三年级医科学生可以探讨他们对病人临终疾病或死亡的情绪反应。为实现这些目标，S的过程和结果措施包括维护学生和教职员工网络活动、教职员工、住院医生和学生调查、学生焦点小组的中央数据库，以及在进入医学院时、第二年末和毕业时对整个医学院班级进行姑息关怀知识和态度调查。

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.