Donna M. Ambrozy

Understanding Physicians' Skills at Providing End-of-Life Care

BACKGROUND: A framework for understanding and evaluating physicians’ skills at providing end-of-life care from the perspectives of patients, families, and health care workers will promote better quality of care at the end of life.OBJECTIVE: To develop a comprehensive understanding of the factors contributing to the quality of physicians’ care for dying patients.DESIGN: Qualitative study using focus groups and content analysis based on grounded theory.SETTING: Seattle, Washington.PARTICIPANTS: Eleven focus groups of patients with chronic obstructive pulmonary disease, AIDS, or cancer (79 patients); 3 groups of family members who had a loved one die of chronic disease (20 family members); 4 groups of nurses and social workers from hospice or acute care settings (27 health care workers); and 2 groups of physicians with expertise in end-of-life care (11 physicians).RESULTS: We identified 12 domains of physicians’ skills at providing end-of-life care: accessibility and continuity; team coordination and communication; communication with patients; patient education; inclusion and recognition of the family; competence; pain and symptom management; emotional support; personalization; attention to patient values; respect and humility; and support of patient decision making. Within these domains, we identified 55 specific components of physicians’ skills. Domains identified most frequently by patients and families were emotional support and communication with patients. Patients from the 3 disease groups, families, and health care workers identified all 12 domains. Investigators used transcript analyses to construct a conceptual model of physicians’ skills at providing end-of-life care that grouped domains into 5 categories.CONCLUSIONS: The 12 domains encompass the major aspects of physicians’ skills at providing high-quality end-of-life care from the perspectives of patients, their families, and health care workers, and provide a new framework for understanding, evaluating, and teaching these skills. Our findings should focus physicians, physician-educators, and researchers on communication, emotional support, and accessibility to improve the quality of end-of-life care.

Physicians' Interactions with Health Care Teams and Systems in the Care of Dying Patients: Perspectives of Dying Patients, Family Members, and Health Care Professionals

This study investigated the specific physician skills required to interact with health care systems in order to provide high quality care at the end of life. We used focus groups of patients with terminal diseases, family members, nurses and social workers from hospice or acute care settings, and physicians. We performed content analysis based on grounded theory. Groups were interviewed. Two domains were found related to physician interactions with health care systems: 1) access and continuity, and 2) team communication and coordination. Components of these domains most frequently mentioned included taking as much time as needed with the patient, accessibility, and respect shown in working with health team members. This study highlights the need for both physicians and health care systems to improve accessibility for patients and families and increase coordination of efforts between health care team members when working with dying patients and their families.

Faculty Development for Ambulatory Care Education.

Faculty play an important role in the delivery of quality instruction in the ambulatory setting. As medical schools and residency programs move more clinical training to ambulatory care settings, more faculty must be recruited and trained. Medical educators have attempted to prepare faculty to teach in ambulatory care settings by conducting faculty development programs. This study documents the current practices of a sample of 14 peer-nominated medical educators who conduct this type of faculty development program. The authors conducted telephone interviews to learn what these educators taught, how they conducted and evaluated their programs, and the theoretical framework guiding their selection of program content and format. Results show that these faculty development programs were delivered almost exclusively in the workshop format, and that there was remarkable similarity in the topics and strategies used. Evaluation was generally limited to satisfaction ratings. Based on the results of this study, the authors recommend that faculty development programs that now emphasize the teaching encounter itself should give equal emphasis to (1) the importance of pre-instructional planning; (2) teaching faculty how to employ post-instructional techniques such as reflection; and (3) training learners and clinic staff to collaborate with faculty in the learning process.

The shift to primary care: emerging influences on specialty choice.

No abstract available.

Problem-Based Learning (PBL) in Eight-Year Program of Clinical Medicine in Xiangya School of Medicine: New Mode Needs Exploration

Introduction Problem-based learning (PBL) is an educational method characterized by the use of patient problems as a context for students to learn problem-solving skills and to acquire knowledge on basic and clinical sciences. PBL was introduced to Eight-year program in Xiangya School of Medicine since 2006. Since traditional curricula hardly reach an excellent agreement on the integration of clinical learning and practice, application of PBL into teaching of systematic anatomy can avoid some of the problems existing in traditional curricula. Methods A total of 100 students from Eight-year program of clinical medicine participated PBL program. Groups (4–5 students per group) were presented with a certain case a week in advance. Each group worked together to gather information, discuss possible mechanisms and causes, develop hypotheses and strategies to test the hypotheses, and then prepare for presentation and discussion in lectures. In each lecture, the assigned tutor guided students to refine their hypotheses, commented on their presentation and discussion, and introduced updated clinical progresses. Results We applied questionnaires with 24 close-set and 2 open-set questions, among a total of 75 students from above after accomplishment of PBL lectures. We demonstrated that greater satisfactions on acquirement of knowledge and roles of tutors were achieved via PBL lectures. The survey also suggested more productive approaches to study. Discussion PBL motivates students to learn systematic anatomy and improves comprehensive ability. Existed Problems were reflected in the progression of PBL teaching and feedbacks from survey: (1) students can not rapidly adapt themselves to PBL in transforming their thinking pattern, (2) many students are confused about the objectives of PBL and how to concentrate on lectures, (3) resources provided by school are limited. Furthermore, traditional evaluation of students’ performance is not favorable in conditions of PBL. Agreement is reached on some details. Future perspective Application of PBL in our education system means modification of PBL education based on feasibility of current education and students’ abilities. Since PBL is not fixed worldwide, we are required to explore a better mode to fit our education system. To further carry out PBL lectures, some suggestions are given.