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第三年临床实习对医学生准备的贡献，为癌症患者和其他患有晚期、限制生命的疾病的人提供姑息治疗。第三年医学课程的目的不是产生预期的居民或研究员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，开始应用医患关系、医学诊断和治疗的原则来照顾实际的病人。本提案中的课程变化旨在确保特别与临终关怀有关的原则得到适当的强调和加强。该提案的具体成果目标是提高毕业生的（1）核心临终任务的知识，（2）对临终护理的态度，（3）对临终患者的情感安慰，（4）对临终指导的满意度，以及（5）在实习生水平上提供临终护理的准备感。为了实现这些成果，该提案有以下过程目标：（1）为教师和居民提供教材和教学策略，以帮助他们在六个必需的第三年见习中更多地利用与临终关怀有关的“可教时刻”：医学，外科学，临床神经科学（神经病学和精神病学）、儿科、家庭医学和门诊护理;（2）开发和实施基于网络的教学技术（e Portfolio），使学生能够系统地记录他们在整个第三年中接触到的临终学习机会，并从教师那里获得及时的教育材料和反馈;（3）配合个别见习职位最有可能出现的学习机会，以达致特定的临终学习目标，同时监察学生在见习年内接受完整的临终课程的情况;及（4）提供容易接触、没有威胁的环境，让三年级医学生可以探讨他们对病人末期疾病或死亡的情绪反应。这些目标的过程和结果的措施包括维护学生和教师的网络活动，教师，居民和学生的调查，学生焦点小组，并管理姑息治疗的知识和态度调查，以整个医学院进入医学院后，在第二年年底，毕业后的集中数据库。

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.