Undergraduate Medical Education for End of Life Care

匹兹堡大学医学院建议开发一个为期四年的医学院课程，每年为接近生命尽头的患者提供最佳的，阶段适当的有效和富有同情心的护理。虽然本科医学课程本身并不能使医生成为临终关怀的专家，但它可以灌输给予这种护理的兴趣，这种护理所需的基本知识，技能和态度，以及学习更多知识的愿望。建议的主要内容包括：（i）调整现时医学院的课程，以便尽量利用现有的机会，引入有关临终关怀的内容;（ii）引入一个新的课程，让学生有机会长时间接触有生命危险的病人;以及（3）提供教师发展经验，以增加实践和教授最佳临终护理的临床角色模型的数量。这是一个循序渐进的，渐进的方法，同样重视课程的变化和教师的知识基础和教学技能，这样当学生从临床前到医学院的临床几年，教师的榜样将到位，以加强增强的临终教育学生将与他们一起进入他们的实习。这项建议的具体目标是：（1）增加学生有关临终关怀的科学和人文知识：（2）向医学生灌输医生提供有效和富有同情心的临终关怀的重要性的理解和接受;以及（3）扩大临床教师的承诺，将临终关怀的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。目前的应用程序集中在学生的基本知识和态度，对临终关怀，提出修改在第1年和第2年的课程，以及教师的发展过程。第二个应用程序将集中在相关的临床技能和行为，通过与教师的榜样和教师的扩大池工作，以实现在第3年和第4年的课程变化。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、客观标准化临床考试、临床情景书面分析和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.