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Haardt V, Cambriel A, Hubert S, Tran M, Bruel C, Philippart F. General practitioner residents and patients end-of life: involvement and consequences. BMC Med Ethics 2022; 23:123. [PMID: 36463158 PMCID: PMC9719227 DOI: 10.1186/s12910-022-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. METHODS We surveyed all GP trainees of "Ile de France". The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients' care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. RESULTS 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient's (210 answers, 40%) and relative's communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in "at risk" hospital settings. CONCLUSION Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.
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Affiliation(s)
- Victoire Haardt
- Marie-Thérèse Medical Center, Paris, France ,REQUIEM study group, Paris, France
| | - Amélie Cambriel
- grid.50550.350000 0001 2175 4109Anesthesiology and Intensive Care Medicine Department, APHP-Tenon University Hospital, Paris, France ,REQUIEM study group, Paris, France
| | - Sidonie Hubert
- grid.414363.70000 0001 0274 7763Internal Medicine Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
| | - Marc Tran
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Francois Philippart
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
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Peh TY, Yang GM, Krishna LKR, Yee ACP. Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting? J Palliat Med 2017; 20:141-146. [DOI: 10.1089/jpm.2016.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tan Ying Peh
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
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Lehto JT, Hakkarainen K, Kellokumpu-Lehtinen PL, Saarto T. Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge. BMC Palliat Care 2017; 16:13. [PMID: 28122553 PMCID: PMC5264301 DOI: 10.1186/s12904-016-0182-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. METHODS We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations. Students' knowledge was evaluated using a progress test over three consecutive years. RESULTS We found 53.5 teaching hours addressing PM issues, which exceeds the recommendation of the EAPC. Basics, symptom management, ethics, and communication skills were well established, while education in psychosocial/spiritual aspects, teamwork and self-reflection failed to reach the recommendations. Out of the maximum of 4.0, the progress test mean scores in PM among the third, fourth, fifth and sixth year students were 0.1 (SD 0.71), 0.69 (SD 1.28), 1.38 (SD 1.46) and 2.53 (SD 1.26), respectively (p < 0.001). This growing knowledge was associated with the timely increase in teaching provided through the PM discipline. In addition, the students who completed the optional PM course achieved better mean scores (2.66; SD 1.27) than the others (1.33; SD 1.43) (p < 0.001). CONCLUSIONS The curriculum in PM at the University of Tampere is integrated into the teaching of many disciplines and complied well with the EAPC recommendations. This education led to increasing knowledge in PM among medical students.
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Affiliation(s)
- Juho T Lehto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Oncology, Tampere University Hospital, Tampere, Finland. .,Department of Oncology, Palliative Care Unit, Tampere University Hospital, Teiskontie 35, Rbuilding, 33520, Tampere, Finland.
| | - Kati Hakkarainen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Saarto
- Comprehensive Cancer Center and Faculty of Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review. Palliat Support Care 2015; 14:433-44. [PMID: 26675418 DOI: 10.1017/s1478951515001108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff. METHOD Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills. RESULTS Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills. SIGNIFICANCE OF RESULTS Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.
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Linklater GT, Bowden J, Pope L, McFatter F, Hutchison SMW, Carragher PJ, Walley J, Fallon M, Murray SA. Developing learning outcomes for medical students and foundation doctors in palliative care: a national consensus-seeking initiative in Scotland. MEDICAL TEACHER 2014; 36:441-446. [PMID: 24593771 DOI: 10.3109/0142159x.2014.889289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Undergraduate education in palliative care is essential if doctors are to be competent to care for dying patients and their families in a range of specialties and healthcare settings. However, creating space for this within existing undergraduate and foundation year curricula poses significant challenges. We aimed to develop consensus learning outcomes for palliative care teaching in the university medical schools in Scotland. METHODS The General Medical Council (GMC) outlines a number of learning outcomes with clear relevance to palliative care. Leaders from the five Scottish medical schools identified and agreed a small number of outcomes, which we judged most relevant to teaching palliative care and collated teaching resources to support these. RESULTS Consensus learning outcomes for undergraduate palliative care were agreed by our mixed group of clinician educators over a number of months. There were many secondary gains from this process, including the pooling of educational resources and best practice, and the provision of peer support for those struggling to establish curriculum time for palliative care. DISCUSSION The process and outcomes were presented to the Scottish Teaching Deans, with a view to their inclusion in undergraduate and foundation year curricula. It is through a strong commitment to achieving these learning outcomes that we will prepare all doctors for providing palliative care to the increasing numbers of patients and families that require it.
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Tschudin S, Kaplan Z, Alder J, Huang D, Bitzer J, Leeners B. Psychosomatics in obstetrics and gynecology - evaluation of a compulsory standardized teaching program. J Psychosom Obstet Gynaecol 2013; 34:108-15. [PMID: 23952168 DOI: 10.3109/0167482x.2013.829035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This observational study was aimed at assessing the effect of case supervision in small groups over a two-year period as part of a standardized psychosomatic basic training for future obstetrician-gynecologists from the physicians' perspective. METHODS The supervised groups were evaluated by questionnaires distributed to all 128 candidates at the beginning (T1), at half time (T2) and at the end of the course (T3). Aside from a validated battery of questions on self-efficacy, items included self-estimated psychosomatic competence, professional satisfaction as well as a validation of the training program. RESULTS The training program was associated with a significant increase of self-reported psychosomatic competence (55.0/68.9, p = 0.000) and self-efficacy (2.4/2.8, p = 0.0011). While major changes occurred at the end of the first year of the supervised groups, no further enhancement could be demonstrated throughout the second year. A total of 44 (88%) study participants who answered at T3 considered the training program as helpful. CONCLUSIONS The presented teaching program - more precisely the supervised groups - seemed to be effective in increasing self-estimated psychosomatic competence and self-efficacy in future specialists for obstetrics and gynecology. It may serve as a model for the systematic integration of standardized psychosomatic basic training into the education of obstetrician-gynecologists.
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Affiliation(s)
- Sibil Tschudin
- Department of Obstetrics and Gynaecology, University Hospital Basel, Basel, Switzerland.
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Becker G, Momm F, Deibert P, Xander C, Gigl A, Wagner B, Baumgartner J. Planning training seminars in palliative care: a cross-sectional survey on the preferences of general practitioners and nurses in Austria. BMC MEDICAL EDUCATION 2010; 10:43. [PMID: 20540757 PMCID: PMC2893516 DOI: 10.1186/1472-6920-10-43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Training in palliative care is frequently requested by health care professionals. However, little is known in detail about the subject matters and the educational preferences of physicians and staff or assistant nurses in this field. METHODS All 897 registered GPs and all 933 registered home care nurses in the district of Steiermark/Austria were sent postal questionnaires. RESULTS Results from 546 (30%) respondents revealed that GPs prefer evening courses and weekend seminars, whereas staff and assistant nurses prefer one-day courses. Multidisciplinary sessions are preferred by almost 80% of all professional groups. GPs preferred multi disciplinary groups most frequently when addressing psychosocial needs (88.8%) and ethical questions (85.8%). Staff and assistant nurses preferred multidisciplinary groups most frequently in the area of pain management (88%) and opted for multi disciplinary learning to a significantly higher extent than GPs (69%; p < 0.01). Those topics were ranked first which are not only deepening, but supplementing the professional training. On average, GPs were willing to spend a maximum amount of euro 400 per year for training seminars in palliative care, whereas nurses would spend approximately euro 190 for such classes.The results provide a detailed analysis of the preferences of GPs and nurses and offer guidance for the organisation of training seminars in palliative care. CONCLUSIONS Medical and nursing education programs often pursue separate paths. Yet our findings indicate that in palliative care multidisciplinary training seminars are favoured by both, doctors and nurses. Also, both groups prefer topics that are not only deepening, but supplementing their professional knowledge.
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Affiliation(s)
- Gerhild Becker
- Department of Internal Medicine II, University Medical Center Freiburg, Freiburg, Germany
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Felix Momm
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Peter Deibert
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Carola Xander
- Palliative Care Research Group, University Medical Center Freiburg, Freiburg, Germany
| | - Annemarie Gigl
- Red Cross Austria, National Association Styria, Graz, Austria
| | - Brigitte Wagner
- External consultantions for Socioscientific Studies, Methodology and Statistics Graz, Austria
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Hesselink BA, Pasman HRW, van der Wal G, Soethout MB, Onwuteaka-Philipsen BD. Education on End-of-Life Care in the Medical Curriculum: Students' Opinions and Knowledge. J Palliat Med 2010; 13:381-7. [DOI: 10.1089/jpm.2009.0291] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Berniek A.M. Hesselink
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Gerrit van der Wal
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marc B.M. Soethout
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Mulder SF, Bleijenberg G, Verhagen SC, Stuyt PMJ, Schijven MP, Tack CJ. Improved competence after a palliative care course for internal medicine residents. Palliat Med 2009; 23:360-8. [PMID: 19098108 DOI: 10.1177/0269216308100250] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Residents report that they received inadequate teaching in palliative care and low levels of comfort and skills when taking care of dying patients. This study describes the effects of a problem-based palliative care course on perceived competence and knowledge in a representative Dutch cohort of residents in internal medicine. Before and after the course, we carried out a questionnaire survey and knowledge test in 91 residents. The results show that many residents felt they had limited competence or were incompetent when taking care of patients in the palliative care phase. This was particularly true with respect to communication concerning euthanasia and physician-assisted suicide or hastened death (86% and 85% respectively reported limited competence or incompetence). Participants reported that they received inadequate training in palliative care and believed that specific education would make them feel more competent. The number of times that residents were engaged in palliative care situations and the years of clinical experience had a positive influence on perceived competence. Participating in the course improved perceived competence and knowledge in palliative care. No correlation was found between perceived competence and knowledge of palliative care.
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Affiliation(s)
- S F Mulder
- Division of Medical Oncology, Department of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Hanratty B, Hibbert D, Mair F, May C, Ward C, Corcoran G, Capewell S, Litva A. Doctors' understanding of palliative care. Palliat Med 2006; 20:493-7. [PMID: 16903402 DOI: 10.1191/0269216306pm1162oa] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Palliative care has been challenged to share its message with a wider audience, and for many years it has been articulating an approach that is suitable for all patients. However, it is not clear how widely this message has been accepted. As part of a study into end-of-life care for heart failure, we conducted seven focus groups with doctors in general practice, palliative medicine, cardiology, geriatrics and general medicine. In these, we explored doctors' understanding of palliative care. Participants displayed a reasonable grasp of the wider concept of palliative care, but the specialists' role was ill-defined, reflected in scepticism about their place outside of cancer. Perceptions of palliative care fell into three broad areas: it was more than a service, about managing dying, and the concern of nurses, rather than doctors. Palliative care was welcomed as providing permission to fail, whilst representing a dilemma between quantity and quality of life for the interviewees. Our work suggests that specialist palliative care has been partially successful in getting their message across, and poor understanding or receptivity are not major barriers to implementing palliative care. Educational or other interventions to implement change in palliative care need to acknowledge the complex interaction of factors influencing physicians' behaviour.
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Affiliation(s)
- Barbara Hanratty
- Division of Public Health, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.
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Schildmann J, Cushing A, Doyal L, Vollmann J. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med 2005; 19:93-8. [PMID: 15810746 DOI: 10.1191/0269216305pm996oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To obtain information regarding the involvement of pre-registration house officers (PRHOs) in the discussions on bad news, and the competency and difficulties they perceive in clinical practice. DESIGN Structured telephone interviews. PARTICIPANTS 104 PRHOs. MAIN OUTCOME MEASURES Information about frequency and quality of involvement of PRHOs in discussions on bad news with patients and relatives, perceived competency and difficulties related to this task as well as ethical views concerning the disclosure of bad news. RESULTS 82 PRHOs (78.9%) had initiated the breaking of bad news to a patient at least once, whilst patients themselves had initiated discussions of bad news by asking the doctors questions (92.3%). Almost all (96.2%), indicated that they had broken bad news to relatives of a patient. The majority of the junior doctors participating in our study felt fairly or very confident (90.4%) to break bad news. 'Often' quoted difficulties for over a fifth of the sample included 'Thinking I was not the appropriate person to discuss the bad news', 'Having all the relevant information available', 'Dealing with emotions of patient/relative', 'Lack of privacy' and 'Patients/relatives do not speak English'. Although 99 PRHOs (95.2%) believed that patients should be informed about a serious life threatening illness, 30.8% of the participants stated that doctors need to judge whether or not to tell a patient bad news. Factors most frequently selected by the PRHOs from a given list of possible factors contributing to a gap between theory and practice included problems with the organization of clinics (73.1%), insufficient postgraduate training (63.5%) and lack of staff (54.8%). CONCLUSIONS The results indicate that PRHOs are frequently involved in the breaking of bad news. Whilst no claims can be made for their,actual performance in practice, their perceptions of competency would indicate that the extensive and compulsory undergraduate teaching they had received on this subject has served to prepare them for this difficult task. Organizational and structural aspects need to be taken into account as factors assisting or undermining doctors in their efforts to put into practice ethically sound and skilled communication when disclosing bad news.
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Affiliation(s)
- Jan Schildmann
- Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen.
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Barclay S, Wyatt P, Shore S, Finlay I, Grande G, Todd C. Caring for the dying: how well prepared are general practitioners? A questionnaire study in Wales. Palliat Med 2003; 17:27-39. [PMID: 12597463 DOI: 10.1191/0269216303pm665oa] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT General practitioners (GPs) and generalist hospital doctors provide the majority of palliative and terminal care in the UK. Studies have revealed problems with symptom control and communication in these settings and inadequate training for clinical students and junior doctors. OBJECTIVES To investigate the training of GPs in Wales in palliative medicine throughout their careers, with a focus on the Welsh Valleys, an area of social deprivation and high levels of chronic ill health. To compare these data with those previously obtained from a survey of GPs in East Anglia. To develop regression models that enable the prediction of less well trained medical students and GPs. METHODS A postal questionnaire survey of a random sample of GPs, stratified by practice location (Valleys or elsewhere in Wales). Responders were invited to recall their training in five topics of palliative care (pain control, other symptom control, use of syringe drivers, communication skills and bereavement care) during four career stages (clinical students, junior doctors, GP registrars and GP principals). RESULTS The response rate was 67.6%. Available data enabled evaluation of generalizability and response bias. Contrary to an initial hypothesis, no significant differences were found between Valleys and non-Valleys responders' reported training, although the study was adequately powered. As medical students, 27% reported receiving no training in any topic, 75% no training in bereavement care and 50% no training in communication skills. Training varied across medical schools and was more common for more recent graduates. As junior doctors, 25% reported no training in any topic, 75% no training in bereavement care and 77% no training in communication skills. The GP registrar year provided significantly more coverage of communication, bereavement and syringe drivers than the combined preceding 6 years of general professional training. As GP principals, a high level of training is reported in all topics. The training experience of GPs in Wales is very similar to that previously reported by GPs in East Anglia: this lends support to the generalizability of these data. Logistic regression analysis indicated that the only predictor of less common training as medical students was having qualified less recently. The main predictors of less common training as GP principals was having become a GP more recently and not being a GP trainer. CONCLUSIONS There is still some way to go in ensuring that medical students, junior hospital doctors and GPs are all adequately trained for their important role in caring for dying patients.
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Affiliation(s)
- Stephen Barclay
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, Institute of Public Health, Cambridge, UK.
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Schildmann J, Brunklaus A, Herrmann E, Klambeck A, Ortwein H, Schwarz C. Evaluation of a 'breaking bad news' course at the Charité, Berlin. MEDICAL EDUCATION 2001; 35:806-807. [PMID: 11489113 DOI: 10.1046/j.1365-2923.2001.1014b.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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