Palliative Care and Pre-Graduate Medical Education: Perspectives of Last-Year Medical Students and Medical Interns
DOI:
https://doi.org/10.24950/O/166/20/1/2021Keywords:
Health Knowledge, Attitudes, Practice, Internship and Residency, Palliative Care, Students, MedicalAbstract
Introduction: In Portugal, the ageing of the population, and the high prevalence of chronic diseases justify the investment in the education of health professionals in palliative care (PC). The main objective of this study was to assess the opinions of medical students and interns about pre-graduate education in PC, and its contribution to the medical profession.
Material and Methods: Qualitative study (online questionnaire) with descriptive treatment of the data. Participants were last-year students at Medical Schools of Portugal and first-year interns.
Results: Of the 221 participants, 61% were students, the majority attended PC classes which lasted <8 hours. Participants considered the discipline of PC relevant for the medical education, but it should have a higher workload and should give the necessary knowledge to any general practitioner. There should be more education on symptoms of terminally ill patients, physical signs of imminent death, and communication of bad news. Participants revealed a good knowledge of the philosophy of PC and felt familiar with the main concepts of PC. Students did not have access to a practical, specialized environment for PC.
Conclusion: In Portugal, although the pre-graduate education in PC is insufficient, it has had a positive effect, with high theoretical knowledge, but with little practice in PC. Medical Schools should invest more in pre-graduate education in PC, through the obligatory curriculum and regular clinical practices, empowering students for an empathic and compassionate relationship between the doctor and the patient in PC.
Downloads
References
Council of Europe. Parliamentary Assembly. Committee on Social Affairs, Health and Sustainable Development. The provision of palliative care in Europe. Report Doc. 14657; 2018 [consultado 2020 Jul 17]. Disponível em: http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.
asp?fileid=25057&lang=en.
Gamondi C, Larkin P, Payne S. Core competencies in palliative care: an EAPC white paper on palliative care education: part 1. Eur J Palliat Care. 2013;20:86-91.
World Health Organization. World Palliative Care Alliance. Global Atlas of Palliative Care at the End of Life; 2014 [consultado 2020 Jul 17]. Disponível em: https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf.
Neto IG. Cuidados Paliativos: Princípios e conceitos fundamentais. In: Barbosa A, Pina PR, Tavares F, Neto IG, editores. Manual de Cuidados Paliativos. 3.ª ed. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2016. p. 1-22.
Comissão Nacional de Cuidados Paliativos. Plano Estratégico para o Desenvolvimento dos Cuidados Paliativos Biénio 2019–2020; 2019 [consultado 2020 Jul 17]. Disponível em: https://www.sns.gov.pt/wp-content/uploads/2019/04/PEDCP-2019-2020-versao-final-10.02.2019.pdf.
Council of Europe. Recommendation Rec (2003) 24 of the Committee of Ministers to Member States on the Organisation of Palliative Care; 2003 [consultado 2020 Jul 17]. Disponível em: https://www.coe.int/t/dg3/health/Source/Rec(2003)24_en.pdf.
Morais AI. Cuidados Continuados e Paliativos (CCP): um estudo descritivo sobre o conhecimento de estudantes de áreas da saúde. [Tese de Mestrado em Psicologia Clínica e da Saúde]. Gandra: Instituto Superior de Ciências da Saúde do Norte; 2013 [consultado 2020 Jul 17]. Disponível em: https://repositorio.cespu.pt/handle/20.500.11816/282
Observatório Português dos Sistemas de Saúde. Relatório Primavera 2017. Viver em tempos incertos: sustentabilidade e equidade na saúde; 2017 [consultado 2020 Jul 17]. Disponível em: http://opss.pt/relatorios/relatorio-primavera-2017/.
Comissão Nacional de Cuidados Paliativos. Plano Estratégico para o Desenvolvimento dos Cuidados Paliativos Biénio 2017–2018; 2016 [consultado 2020 Jul 17]. https://www.sns.gov.pt/wp-content/uploads/2016/09/Plano-Estrat%C3%A9gico-CP_2017-2018-1.pdf.
Bharadwaj P, Vidyasagar MS, Kakria A, Alam UA. Survey of palliative care concepts among medical interns in India. J Palliat Med. 2007;10:654-7.
Yamamoto R, Kizawa Y, Nakazawa Y, Morita T. The Palliative Care Knowledge Questionnaire for PEACE: reliability and validity of an instrument to measure palliative care knowledge among physicians. J Palliat Med. 2013;16:1423-8.
Chover-Sierra E, Martínez-Sabater A, Lapeña-Moñux YR. An instrument to measure nurses knowledge in palliative care: validation of the Spanish version of Palliative Care Quiz for Nurses. PLoS One. 2017;12:e0180622.
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.
Ministério da Saúde, Serviço Nacional de Saúde. Equipas de Cuidados Paliativos. Unidades de Cuidados Paliativos (atualização 15-06-2020) [consultado 2020 Jul 17]. Disponível em: https://www.sns.gov.pt/wp-content/uploads/2020/05/UCP_05052020.pdf.
Assembleia da República. Lei nº 52/2012. Diário da República n.º172/2012, Série I de 2012-09-05. p. 5119-24 [consultado 2020 Jul 17]. Disponível em: https://data.dre.pt/eli/lei/52/2012/09/05/p/dre/pt/html.
Observatório Português de Cuidados Paliativos. Relatório Outono 2019. Secção I. Cobertura e caracterização das equipas e profissionais das equipas de cuidados paliativos. Lisboa, Portugal: Universidade Católica Editora; 2020. p. 5-43 [consultado 2020 Jul 17]. Disponível em: http://www.uceditora.ucp.pt/resources/Documentos/UCEditora/PDF%20Livros/OPCP%20RELAT%C3%93RIO%20OUTONO%202019.pdf.
Lacerda AF, Gomes B. Trends in cause and place of death for children in Portugal (a European country with no Paediatric palliative care) during 1987–2011: a population-based study. BMC Pediatr. 2017;17:215.
Assembleia da República. Resolução da Assembleia da República n.º 5/2017. Diário da República n.º 3/2017, Série I de 2017-01-04 [consultado 2020 Jul 17]. Disponível em: https://data.dre.pt/eli/resolassrep/5/2017/01/04/p/dre/pt/html.
Eychmüller S, Forster M, Gudat H, Lütolf UM, Borasio GD. Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives. BMC Med Educ. 2015;15:213-20.
Quill TE, Abernethy AP. Generalist plus specialist palliative care - creating a more sustainable model. N Engl J Med 2013;368:1173-5.
Eyigor S. Fifth-year medical students’ knowledge of palliative care and their views on the subject. J Palliat Med. 2013;8:941-6.
Dalpai D, Mendes FF, Asmar JA, Carvalho PL, Loro FL, Branco A. Dor e cuidados paliativos: o conhecimento dos estudantes de medicina e as lacunas da graduação. Rev Dor. 2017;18:307-10.
Tran UE, Kircher J, Jaggi P, Lai H, Hillier T, Ali S. Medical students’ perspectives of their clinical comfort and curriculum for acute pain management. J Pain Res. 2018;11:1479-88.
Kopf A, Treede RD, Graven-Nielsen T, Cadavid A, Rathmell J. IASP Curriculum Outline on pain for medicine; 2018 [consultado em 2020 Jul 17]. Disponível em: https://www.iasp-pain.org/Education/CurriculumDetail.aspx?ItemNumber=729.
Direção Geral de Saúde. Circular Normativa nº11. Programa Nacional de Controlo da Dor; 2008 [consultado em 2020 Jul 17]. Disponível em: https://www.dgs.pt/areas-em-destaque/plano-nacional-de-saude/programas-nacionais/programa-nacional-de-controlo-da-dor.aspx.
Cristóvão I, Reis-Pina P. Chronic pain education in Portugal: perspectives from medical students and interns. Acta Med Port. 2019;32:338-47.
Centro Nacional de Observação em Dor - Observador. Estado da arte do ensino da dor em Portugal; 2010 [consultado em 2020 Jul 17]. Disponível em: https://www.dgs.pt/documentos-e-publicacoes/estado-da-arte-do-ensino-da-dor-em-portugal-relatorio-final.aspx.
World Health Organization. WHO Definition of palliative care [homepage na Internet] [consultado 2020 Jul 17]. Disponível em: http://www.who.int/cancer/palliative/definition/en/.
Associação Nacional de Cuidados Paliativos. Organização de serviços em cuidados paliativos – Recomendações da ANCP; 2006 [consultado 2020 Jul 17]. Disponível em: https://www.apcp.com.pt/uploads/Recomendacoes_Organizacao_de_Servicos.pdf.
Coutinho F, Ramessur A. An overview of teaching communication of bad news in medical school: should a lecture be adequate to address the topic? Acta Med Port. 2016;29:826-31.
Alelwani SM, Ahmed YA. Medical training for communication of bad news: A literature review. J Educ Health Promot. 2014;3:51.
Lee AY, Carlon B, Ramsay R, Thirukkumaran T. Integrating exposure to palliative care in an undergraduate medical curriculum: student perspectives and strategies. Int J Med Educ. 2017;8:151-2.
Lima MS. Formação em cuidados paliativos. Influência na vida profissional. Dissertação de Mestrado em Cuidados Paliativos. Faculdade de Medicina da Universidade do Porto; 2018 [consultado 2020 Jul 17]. Disponível em: https://sigarra.up.pt/fmup/pt/pub_geral.pub_view?pi_pub_base_id=242882.
World Health Organization. Fact Sheets - Noncommunicable Diseases; 2018 [consultado 2020 Jul 17]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
Gomes B, Pinheiro MJ, Lopes S, Brito M, Sarmento VP, Ferreira PL, et al. Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study. Palliat Med. 2018;32:891-901.
World Health Organization. Fact Sheets - Palliative Care; 2018. [consultado 2020 Jul 17]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
Stjernswärd J, Foley KM, Ferris FD. The public health strategy for palliative care. J Pain Symptom Manage. 2007;33:486-93.
Pohl G, Marosi C, Dieckmann K, Goldner G, Elandt K, Hassler M, et. al. Survey of palliative care concepts among medical students and interns in Austria: A comparison of the old and the new curriculum of the Medical University of Vienna. Palliat Care Res Treat. 2008;2:1-7.
Jahan F, Shibli HAS, Qatan RS, Kharusi AAA. Perception of undergraduate medical students in clinical years regarding palliative care. Middle East J Age Ageing. 2010;7:22-31.
Carrasco JM, Lynch TJ, Garralda E, Woitha K, Elsner F, Filbet M, et al. Palliative care medical education in European universities: a descriptive study and numerical scoring system proposal for assessing educational development. J Pain Symptom Manage. 2015;50:516-23.
Centeno C, Ballesteros M, Carrasco JM, Arantzamendi M. Does palliative care education matter to medical students? The experience of attending an undergraduate course in palliative care. BMJ Support Palliat Care. 2016;6:128-34.
Hartogh GD. Suffering and dying well: on the proper aim of palliative care. Med Health Care Philos. 2017;20:413-24.
Weber M, Schmiedel S, Nauck F, Alt-Epping B. Knowledge and attitude of final-year medical students in Germany towards palliative care - an interinstitutional questionnaire-based study. BMC Palliat Care. 2011;10:19.
Pinheiro TR. Avaliação do grau de conhecimento sobre cuidados paliativos e dor dos estudantes de medicina do quinto e sextos anos. Mundo Saúde. 2010;34:320-6.
Lemos CF, Barros GS, Melo NC, Amorim FF, Santana AN. Avaliação do conhecimento em cuidados paliativos em estudantes durante o curso de medicina. Rev Bras Educ Med. 2017;41:278-82.
Hesselink BA, Pasman HR, 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;4:381-7.
Pandey S, Gaire D, Dhakal S, Jaishwal N, Kharal PM, Vaidya P. Perception of palliative care among medical students in a teaching hospital. J Nepal Med Assoc. 2015;53:113-7.
Orlander JD, Fincke BG, Hermanns D, Johnson GA. Medical residents’ first clearly remembered experiences of giving bad news. J Gen Intern Med. 2002;17:825-31.
European Association for Palliative Care. Recommendations of the European Association for Palliative Care (EAPC) for the development of undergraduate curricula in palliative medicine at European Medical Schools; 2013 [consultado 2020 Jul 17]. Disponível em: https://www.eapcnet.eu/Portals/0/adam/Content/70PKe-5EvkmDsBh1s1UWPA/Text/Recommendations%20of%20the%20EAPC%20for%20the%20development%20
of%20undergraduate%20curricula%20in%20palliative%20medicine%20at%20European%20Medical%20Schools.pdf
European Federation of Older Persons. Making palliative care a priority topic on the European health agenda: and recommendations for the development of palliative care in Europe; 2004 [consultado 2020 Jul 17] Disponível em: https://www.apcp.com.pt/uploads/Cons.Europa_EURAG_PalliativeCareProject_2004.pdf.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
