Palliative Care Curriculum for Medical Residents

描述（由申请人提供）：有大量证据表明医生没有接受过适当的姑息治疗培训。在初步工作中，我们为医生制定了评估方法和课程，并在三个内科项目和两个家庭医学项目中建立了每年65名住院医师的临终关怀轮转培训。我们假设安宁疗护轮转使用国家课程缓和疗护教育医师将导致可测量的知识、态度和技能的改善。研究的主要终点是一个经过验证的36项知识问题的得分，该问题存在一个国家参考数据库。次要终点是姑息治疗的信心和能力的自评分数。我们将用同样的课程对65名住院医生进行检验，每年有3名住院医生来自5个不同的培训项目，为期5年。各项目将在PGY-1年度的第一个月内对其居民实施评估工具。住院医师将被要求完成EPEC课程的四个模块，这是一个覆盖姑息治疗核心能力的国家课程，供医生使用互联网进行自学。教师将帮助学生在住院病人和家庭临终关怀环境中应用临床接触病人的态度，知识和技能。住院医师将展示与标准化病人的沟通技巧。这些仪器将在住院医师培训的最后两个月重新使用。心理计量学等效知识考试将用于防止重复考试中回忆项目。我们将使用单组时间序列设计来分析数据。在住院医师培训的三年期间，将在四个时期管理整套三种评价工具- - Pre - 1（住院医师开始）；Pre 2（开始旋转）；岗位1（轮岗结束）；岗位2（实习期结束）。一组时间序列设计允许我们评估所有住院医师项目主管在寻求将姑息治疗课程纳入三年培训期间时所考虑的问题：1)如果课程是必修的，与选修的相比，课程有什么影响？2)旋转需要多长时间？换句话说，时间对任务的影响是什么？3) 3年实习期的轮岗时间是开始还是结束？4)内科住院医师与家庭执业住院医师接触本课程后是否有差异？5)培训项目类型（大学医院、社区教学医院、军队医院）对信息保留有影响吗？6)这些因素之间是否有每年相互作用的证据？

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?