|Title:||An Internentional Study Assessing Palliative Care Learning Amongst Junior Medical Students Undertaking the Course
|Keywords:||緩和醫療;醫學生;知識;palliative care;medical students;knowledge||Issue Date:||2003||Journal Issue:||n.2||Start page/Pages:||150-160||Source:||醫學教育,v.7||Abstract:||
癌症末期患者照顧幾乎是所有醫師均會碰到的課題，緩和醫療已成為末期生命照顧重 要的一環，然而無論是臨床醫師或醫學生的緩和醫療教育，國內外均相當缺乏。本研 究旨在評估一般課程階段醫學生對緩和醫療的認知，以及經過一週訓練課程後，學生 在緩和醫療認知的改變情形，以作為未來緩和醫療教育的參考。研究採單組前後測準 實驗設計，並以民國九十年至九十二年兩年間，在「人與醫學」為期一週的課程中， 選修緩和醫療病房實習的80位一般課程階段醫學生為對象，以「醫學生緩和醫療認知 量表」評估學生對緩和醫療的理念、基本處置與倫理情況思考的認知。結果顯示，學 生對緩和醫療理念回答得分較高，課程前、後答對平均總分分別為4.15與4.75(範圍0 -6;t=3. 35, p<0.001)，緩和醫療的一般處置知識則表現較差，課程前、後答對平均 總分分別為5.86與7.69，但也有顯著進步(範圍0-12；t=7.65, p<0.001)。另外，在 四個癌末常見倫理困境思考之認同度方面，課程前以出院安排最高(4.35;範圍1-5)， 課程後則以病情告知最被認同(4.60)，而癌末不必使用人工水分營養的論點，則不論 課程前、後(2 .54及3.08)，認同度接最低。本研究的結果發現，透過適當的緩和醫 療課程訓練，可以增進一般課程階段醫學生對緩和醫療的認知並改變倫理決策的態度 。這些進步可期望奠定醫學教育中末期醫療訓練的良好基礎。 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.
|Appears in Collections:||護理學系所|
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