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「人與醫學」課程醫學生緩和醫療認知之介入性研究

An Interventional Study Assessing Palliative Care Learning amongst Junior Medical Students Undertaking the Course “The Human Side of Medicine”

摘要


Palliative care is an important and emerging medical specialty in the area of end-of-life care. Almost all physicians are required to take care of a terminally ill patient at some point in their care, but previous studies from around the world have identified inadequate palliative care training for both medical students and general practitioners. The objectives of this study were to understand junior medical student knowledge of palliative care and how it improved after a one week training course. The study, a quasi-experimental design, recruited eighty medical students between 2001 and 2003 participating in a one-week course named “The human side of medicine” in the hospice palliative care unit of the National Taiwan University Hospital. The questionnaire, assessing medical student palliative care knowledge and attitudes towards ethical dilemmas, was used to assess knowledge of palliative care philosophy and clinical management, and attitudes regarding common ethical issues before and after the training course. The findings showed that the training increased medical student knowledge of palliative care philosophy with a mean score of 4.12 before the training and 4.75 afterwards (range 0-6; t=3.534, p<0.001). Their knowledge of clinical management increased as well, with a mean score of 5.86 before training and 7.69 afterwards (range 0-12; t=7.651, p<0.001). Regarding attitudes towards four common ethical dilemmas, medical students mostly agreed on discharge planning (mean: 4.35, range 1-5) before the course and truth-telling (4.600) after the training course. However, the issue of ‘artificial hydration and nutrition does not benefit terminal patients’ was the most contentious issue both before and after the training. Based on the findings of this study, an appropriate palliative care training program can increase medical student understanding of palliative care philosophy, management and attitudes in the area of ethical decision-making. The results of this study should encourage those providing or planning to provide training opportunities for medical students in the area of end-of-life care.

關鍵字

緩和醫療 醫學生 知識

並列摘要


Palliative care is an important and emerging medical specialty in the area of end-of-life care. Almost all physicians are required to take care of a terminally ill patient at some point in their care, but previous studies from around the world have identified inadequate palliative care training for both medical students and general practitioners. The objectives of this study were to understand junior medical student knowledge of palliative care and how it improved after a one week training course. The study, a quasi-experimental design, recruited eighty medical students between 2001 and 2003 participating in a one-week course named “The human side of medicine” in the hospice palliative care unit of the National Taiwan University Hospital. The questionnaire, assessing medical student palliative care knowledge and attitudes towards ethical dilemmas, was used to assess knowledge of palliative care philosophy and clinical management, and attitudes regarding common ethical issues before and after the training course. The findings showed that the training increased medical student knowledge of palliative care philosophy with a mean score of 4.12 before the training and 4.75 afterwards (range 0-6; t=3.534, p<0.001). Their knowledge of clinical management increased as well, with a mean score of 5.86 before training and 7.69 afterwards (range 0-12; t=7.651, p<0.001). Regarding attitudes towards four common ethical dilemmas, medical students mostly agreed on discharge planning (mean: 4.35, range 1-5) before the course and truth-telling (4.600) after the training course. However, the issue of ‘artificial hydration and nutrition does not benefit terminal patients’ was the most contentious issue both before and after the training. Based on the findings of this study, an appropriate palliative care training program can increase medical student understanding of palliative care philosophy, management and attitudes in the area of ethical decision-making. The results of this study should encourage those providing or planning to provide training opportunities for medical students in the area of end-of-life care.

並列關鍵字

palliative care medical students knowledge

參考文獻


Barclay S,Todd C,Grande G(1997).How common is medical training in palliative care? A postal survey of general practitioner.Br J Gen Pract.47(425),800-804.
Barnard D,Quill T,Hafferty FW(1999).Preparing the ground: contributions of the preclinical years to medical education for care near the end of life. Working Group on the Pre-clinical Years of the National Consensus Conference on Medical Education for Care Near the End of Life.Acad Med.74(5),499-505.
Benedetti C,Dickerson ED,Nichols LL(2001).Medical education: a barrier to pain therapy and palliative care.J Pain Symptom Manage.21(5),360-362.
Charlton R,Ford E(1995).Education needs in palliative care.J Fam Pract.12(1),70-74.
Chiu TY,Hu WY,Liu WJ.Factors that influence physicians in providing palliative care in rural communities in Taiwan.Soc Sci Med (reviewing).

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