What Have Medical Students Learned from Bedside Learning in Hospices?

<p>Aim: We investigated what medical students learned on the clinical clerkship in our hospice and how their images of hospice care were changed, with self-reported questionnaires. Methods: Descriptions given in the contents were analyzed using a content analysis method based on Berelson’s methodology. A total of 20 students who participated in the program responded. Results: From their responses, 212 descriptions were extracted and 59 codes elicited. The codes were inductively classified and categorized based on content similarities. Eleven categories were generated: “care for quality of life of patients and families,” “characteristics and effects of palliative care” “practical approaches to end-of-life medicine,” “hospices’ positions in the healthcare system” “development of trust-based relationships with patients and their families,” “cooperation among healthcare professionals,” “appropriate attitudes toward patients and their families,” “being with patients when they pass away,” “opinions of patients and their families,” “characteristics and threats of cancer,” and “mental health for healthcare workers.”The students were found to have acquired a more positive image of hospices. Conclusion: They reported gaining valuable experience from the direct encounters with patients and their family, and that they had acquired behavior appropriate for physicians, as well as knowledge and skills about the basic palliative care.</p>

Evaluating a Palliative Medicine Education Program for Undergraduate Medical Students at a Regional Hospice

<p>Background: There is increasing demand for clinical clerkships in palliative medicine, though conventional medical education has focused only on providing students with sufficient medical knowledge and skills. In Japan, there is no standard program for palliative medicine in undergraduate medical education. Our hospice, in cooperation with a clinical clerkship for palliative medicine launched by Tokyo Medical and Dental University, has developed its own comprehensive bedside learning curriculum. Aim: This study aimed to evaluate the efficacy of the program. Methods: The curriculum involves not only experience in hospice care, ward rounds, and interviews with terminally ill patients, it also provides each medical student with educational sessions moderated by certified hospice nurses and pharmacists. We conducted a self-administered five-point scale questionnaire (with a higher score indicating higher satisfaction) to assess students’ satisfaction and understanding of the program. We also conducted a questionnaire on basic palliative medicine knowledge before and after the program. Results: Twenty students took part in the program. Ratios of scores of 4 or 5 for satisfaction and understanding of the program were 100% and 95%, respectively. Mean rates of correct answers on the pre-program and post-program test were 51% and 85%, respectively; showing a marked increase and emphasizing the educational significance of our curriculum. Students evidently benefit from the experience of bedside learning, and 95% reported having recommended the program to their juniors. Conclusion: These outcomes suggest the program is effective toward developing a standard education program in palliative medicine.</p>

Determination of Adequate Analgesic Dose of Oxycodone Injection in Opioid-switching from Transdermal Fentanyl in Patients with Cancer-related Pain

<p>Opioid-switching (OS) is usually performed with conversion methods based on the equianalgesic dose table. However, the conversion ratios might lead to significant differences in clinical practice. No clear guideline exists for safe, effective switching from transdermal fentanyl (TF) to oxycodone injection (OXJ). We retrospectively investigated the adequate analgesia dose of OXJ in OS from TF by comparing with the equianalgesic calculated dose based on the conversion ratio of 1.0 : 41.7 between TF and OXJ. Patients with a pain scale score of 0 were assigned to the “NRS/VRS=0” group (n=4), and the remaining patients were assigned to the “NRS/VRS>0” group (n=27). During a 4-year period, 31 of 49 patients with cancer-related pain who underwent OS from TF to OXJ were investigated. All patients in the NRS/VRS=0 group (4/4, 100%) and most in the NRS/VRS>0 group (23/27, 85%) achieved adequate analgesia. Among the 27 patients with adequate analgesia, the median effective OXJ dose was 28% (interquartile range, 21-47) of the equianalgesic calculated dose in the well-controlled group and 103% (interquartile range, 71-164) in the poor analgesia group. Strong drowsiness developed in two patients the day after OS, and the OXJ dose was decreased. Our findings suggest that in patients without pain, it might be necessary to reduce the OXJ dose to approximately 30% of the equianalgesic calculated dose for safe OS from TF. Pain intensity and drowsiness due to an opioid overdose should be carefully monitored and may require dose adjustment.</p>