A brief home-based palliative care learning experience for medical students and resident doctors in Okinawa, Japan

Shifting perspectives: Unveiling the transformative potential of home visits to persons living with disability in rural settings for medical students

PURPOSE

This study aims to examine the transformative learning experiences of medical students participating in home visits to persons living with disabilities in rural areas of South Africa, in order to explore the potential of such experiences to shape their beliefs about their professional development and clinical practice.

METHODS

Qualitative data was collected from the students through written reflections and semi-structured interviews. The data were analyzed thematically using a phenomenological approach guided by Mezirow's theory of transformative learning.

RESULTS

The findings reveal a three-stage process of transformative learning for the students. Firstly, students held predominantly negative views towards the learning activity, prior to the home visits. Secondly the role of critical reflection facilitated a change in students' perspectives. Finally, there was a change in perspective towards a predominantly positive valuing of the activity to their learning and approach to clinical practice.

DISCUSSION

This study highlights the significance of incorporating home visits and structured critical reflection into undergraduate medical curricula. It underscores the need for further research in this area and contributes to the understanding of transformative learning in healthcare education. The findings emphasize the potential of community-based activities to shape inclusive practices and foster holistic patient care.

A systematic scoping review of reflective writing in medical education

BACKGROUND

Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW's place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed.

METHODS

A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed.

RESULTS

A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations.

CONCLUSIONS

This SSR in SEBA suggests that a structured approach to RW shapes the physician's belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.

Optimising planned medical education strategies to develop learners' person-centredness: A realist review

CONTEXT

Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful.

METHODS

A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness.

RESULTS

Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness.

CONCLUSION

Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.

[Assessment Items Emphasized by Visiting Nurses in How Older Patients Treated at Home and Their Families Decide the Place of Death]

Although 70% of people in Japan wish to die at home, only 13.6% do, and 72.9% die in hospitals. This study aimed to clarify, from the perspective of visiting nurses, the factors influencing patients and their families in deciding the place of death and their satisfaction with end-of-life care at the chosen place. We conducted a survey of 70 visiting nurses with over a year of home nursing experience. They responded to the key factors influencing the decisions of patients and their families regarding place of death, either hospital or home, and the satisfaction at each place of death on a 10-point scale. 67 nurses valued the following two items when the place of death was a hospital: "Less burden of care on the family" and "Specialized treatment to alleviate suffering." The following four items were emphasized in the home: "I can live my own life as I want," "I can have my family be there when I want them to be," "I can receive extensive nursing care," and "I can be seen by my family doctor." The nurses also rated the satisfaction of patients and their families much higher when they die at home than in a hospital. Therefore, improving the treatment environment based on the features of the place of death, and enhancing community-based end-of-life care support, would allow patients and their families to spend their own time in the hospital and get specialized treatment at home, resulting in greater satisfaction with end-of-life care.

Gap between desired and self-determined roles of general practitioners: a multicentre questionnaire study in Japan

BACKGROUND

Primary care physicians have diverse responsibilities. To collaborate with cancer specialists efficiently, they should prioritise roles desired by other collaborators rather than roles based on their own beliefs. No previous studies have reported the priority of roles such clinic-based general practitioners are expected to fulfil across the cancer care continuum. This study clarified the desired roles of clinic-based general practitioners to maximise person-centred cancer care.

METHODS

A web-based multicentre questionnaire in Japan was distributed to physicians in 2019. Physician roles within the cancer care continuum were divided into 12 categories, including prevention, diagnosis, surgery, follow-up with cancer survivors, chemotherapy, and palliative care. Responses were evaluated by the proportion of three high-priority items to determine the expected roles of clinic-based general practitioners according to responding physicians in similarly designated roles.

RESULTS

Seventy-eight departments (25% of those recruited) from 49 institutions returned questionnaires. Results revealed that some physicians had lower expectations for clinic-based general practitioners to diagnose cancer, and instead expected them to provide palliative care. However, some physicians expected clinic-based general practitioners to be involved in some treatment and survivorship care, though the clinic-based general practitioners did not report the same priority.

CONCLUSION

Clinic-based general practitioners prioritised involvement in prevention, diagnoses, and palliative care across the cancer continuum, although lower expectations were placed on them than they thought. Some additional expectations of their involvement in cancer treatment and survivorship care were unanticipated by them. These gaps represent issues that should be addressed.

Evaluation of a training program for community-based end-of-life care of older people toward aging in place: A mixed methods study

AIMS

To evaluate a training program that supports community-based service staff in implementing aging-in-place and end-of-life care programs.

BACKGROUND

Globally, as the population ages, the need for end-of-life care has never been greater. Since Japan is facing the issues of a super-aged population sooner than most countries, there is a particularly urgent need to enhance end-of-life care for older people. Most Japan's older people wish to spend their final days at home, however, only 11-13% end their lives at home, while 73% die in hospitals. As part of care system, small-scale community-based service for aging-in-place established across Japan in 2006 managed locally. These are flexible services using home or facility care or both for the individual to live long term at their preferred place. We developed the end-of-life care educational training program to encourage behavioral changes in community-based service staff of various readiness levels.

DESIGN

Mixed methods study design.

METHODS

A pre-post evaluation of knowledge, confidence and attitude toward end-of-life care, combining quantitative and qualitative data from 53 community-based service staff members who participated in the training program from September 2017 to September 2019. Participants were informed of the end-of-life care process using focus group discussions about end-of-life care and completed surveys evaluating the program before, immediately following and three months after the training. We used the four-level Kirkpatrick model as the evaluation indicator.

RESULTS

Quantitative analysis results indicated that participants were satisfied with the training program. Their knowledge scores regarding end-of-life care significantly improved; they also experienced confidence gains and changes in attitudes, becoming more approving of end-of-life care. Qualitative data revealed details of participants' satisfaction and what was learned. Through the focus group discussions, they created action plans for implementing end-of-life care programs, which some had accomplished in their local centers by the three-month follow-up.

CONCLUSIONS

These results suggest that the training program is effective for promoting end-of-life care through community-based services in Japan. Conducting follow-up training could effectively strengthen participants' commitment to end-of-life care at community-based services. Use of the training program is expected to promote services to support aging-in-place.

Experiential learning of overnight home care by medical trainees for professional development: an exploratory study

OBJECTIVES

In an ageing society, community-based medical education in a home care setting needs to be developed. Drawing on Kolb's experiential learning theory, this study aimed to explore the learning processes in overnight home care by medical trainees in terms of their understanding of terminally ill patients and their conceptualization of themselves as future physicians.

METHODS

An overnight home care program in which a trainee had to take care of terminally ill patients on his/her own under the supervision of a healthcare team was conducted. Nineteen trainees, including eight medical students and 11 residents, participated in this study. Text data of reflective reports written after the overnight care were collected and thematically analyzed.

RESULTS

The trainees' learning experiences in the program were categorized into four stages: predeparture, concrete experience, reflective observation and abstract conceptualization. Although they had mixed feelings, including anxiety, fear and expectations, at the predeparture stage, they could be actively involved in providing medical care and daily life support and in taking care of dying patients at the patients' homes overnight. By reflecting on their experiences, they gained a sense of achievement and identified the aspects upon which they should improve as future physicians. Subsequently, based on their reflective observation, they conceptualized their approaches to home care and the roles/responsibilities of physicians as healers, which led to professional identity formation.

CONCLUSIONS

Overnight home care by medical trainees has the potential as an educational strategy to promote their realistic understanding of home care and facilitate professional identity formation.