「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”

10.6145/jme.200306_7(2).0007

張皓翔(Hao-Hsiang Chang)；胡文郁(Wen-Yu Hu)；邱泰源(Tai-Yuan Chiu)；姚建安(Chien-An Yao)；呂碧鴻(Bee-Horng Lue)；陳慶餘(Ching-Yu Chen)

緩和醫療 ； 醫學生 ； 知識 ； palliative care ； medical students ； knowledge

Journal of Medical Education

7卷2期（2003 / 06 / 01）

150 - 160

繁體中文

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.

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.

1. 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.
2. 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.
3. 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.
4. Charlton R,Ford E(1995).Education needs in palliative care.J Fam Pract,12(1),70-74.
5. Chiu TY,Hu WY,Liu WJ.Factors that influence physicians in providing palliative care in rural communities in Taiwan.Soc Sci Med (reviewing)
6. Dickinson GE(2002).A quarter century of end-of-life issues in U.S. medical school.Death Stud,26(8),635-646.
7. Esteva CM,Llobera CJ,Miralles XJ(2000).Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses.Support Care Cancer,8(6),464-471.
8. Fins JJ,Nilson EG(2000).An approach to educating residents about palliative care and clinical ethics.Acad Med,75(6),662-665.
9. Grauel RR,Eger R,Finley RC(1996).Educational program in palliative and hospice care at the University of Maryland School of Medicine.J Cancer Educ,11(3),144-147.
10. Hu WY,Chiu TY,Dai YZ(2003).Nurses` willingness and the predictors of willingness to provide palliative care in rural communities of Taiwan.J Pain Symptom Manage,26,760-768.
11. Linder JF,Blais J,Enders SR(1999).Palliative education: a didactic and experiential approach to teaching end-of-life care.J Cancer Educ,14(3),154-160.
12. MacLeod R(2000).Learning to care: a medical perspective.Palliat Med,14(3),209-216.
13. Margaret M,Ross RN(1996).The palliative care quiz for nursing(PCQN): the development of an instrument to measure nurses` knowledge of palliative care.J Adv Nursing,23,126-137.
14. Meekin SA,Klein JE,Fleischman AR(2000).Development of a palliative education assessment tool for medical student education.Acad Med,75(10),986-992.
15. O`Connor P(1999).Hospice vs. palliative care.Hospice J,14(3-4),123-137.
16. Ogle KS,Mavis B,Rohrer J(1997).Graduating medical students` competence and educational experience in palliative care.J Pain Symptom Manage,14(5),280-285.
17. Oneschuk D,Hanson J,Bruera E(2000).An international survey of undergraduate medical education in palliative care medicine.J Pain Symptom Manage,20(3),174-179.
18. Ross DD,Keay T,Timmel D(1999).Required training in hospice and palliative care at the University of Maryland School of Medicine.J Cancer Educ,14(3),132-136.
19. Ross DD,O`Mara A,Pickens N(1997).Hospice and palliative care education in medical school: a module on the role of the physician in end-of-life care.J Cancer Educ,12(3),152-156.
20. Seligman PA,Massey E,Fink RS(1999).Practicing physicians` assessments of the impact of their medical-school clinical hospice experience.J Cancer Educ,14(3),144-147.

1. 謝素英、許麗齡、張惠如、余文彬、朱宗藍(2015)。護理人員接受安寧療護在職教育課程需求之探討。長庚護理，26(2)，125-136。