Cuidados paliativos e Ensino Médico: Revisão sistemática

Autores

DOI:

https://doi.org/10.33448/rsd-v10i1.11976

Palavras-chave:

Cuidados Paliativos; Competências; Educação Médica; Graduação.

Resumo

Introdução: Cuidados paliativos (CP) estão no quotidiano dos serviços de saúde, face ao aumento da carga das doenças crônicas, do envelhecimento e incorporação tecnológica na saúde. Há consenso sobre a importância do ensino em CP na graduação, entretanto muitas escolas não o praticam. Esta revisão objetivou sintetizar o conhecimento produzido em estudos científicos sobre ensino em CP na graduação em medicina e seu impacto na formação médica. Métodos:  Foi realizada revisão sistemática de estudos publicados no PubMed, com os descritores: “medical education” OR “curriculum”; ”palliative care” AND “clinical competence”. Foram encontrados 89 artigos, excluídos 67 títulos e resumos e 22 artigos foram analisados.  Resultados: A leitura dos artigos deu origem a três categorias temáticas. Na primeira categoria, elenca-se abordagem biopsicossocial e espiritual, cuidado centrado na pessoa e família, comunicação, trabalho interprofissional, e manejo de sintomas como competências essenciais. Na segunda, os desafios e estratégias apontados foram o escasso tempo curricular no ensino em CP, a falta de contexto clínico para o aprendizado reflexivo, o déficit de docentes preparados e a sua ausência formal nos currículos. O impacto do ensino em CP na aprendizagem na graduação refere-se a ser catalisador do desenvolvimento profissional e propiciar competências emocionais aos futuros médicos. Conclusão: Os estudos analisados demonstram benefícios do ensino em CP na formação médica, através de um ensino longitudinal, uma vez que potencializam a aquisição de competências essenciais no exercício da medicina e em especial no trato de pessoas portadoras de doenças ameaçadoras à vida.

Referências

Annear, M. J., Lea, E., Lo, A., Tierney, L., & Robinson, A. (2016). Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences. BMC Geriatr;16-38. 10.1186/s12877-016-0211-8.

Back, A. L., Steinhauser, K. E., Kamal, A. H., & Jackson, V. A. (2016). Building Resilience for Palliative Care Clinicians: An Approach to Burnout. Prevention Based on Individual Skills and Workplace Factors. J Pain Symptom Manage. Aug;52(2):284-91. 10.1016/j.jpainsymman.2016.02.002

Brown, C. E., Back, A. L., Ford, D. W., Kross, E. K., Downey, L., Shannon, S. E., Curtis, J. R., & Engelberg, R. A. (2018). Self-Assessment Scores Improve After Simulation-Based Palliative Care Communication Skill Workshops. Am J Hosp Palliat Care. Jan;35(1):45-51. 10.3928/01484834-20180720-08

Carroll, T., El-Sourady, M., Karlekar, M., & Richeson, A. (2019). Primary Palliative Care Education Programs: Review and Characterization. Am J Hosp Palliat Care. Jun;36(6):546-49. 10.1177/1049909118809947.

Crawford, G. B., & Zambrano, S. C.(2015). Junior doctors' views of how their undergraduate clinical electives in palliative care influenced their current practice of medicine Acad Med; 90(3): 338-44. 10.1097/ACM.0000000000000632

Ellman, M. S., Fortin, A. H., Putnam, A., & Bia, M. (2016). Implementing and Evaluating a Four-Year Integrated End-of-Life Care Curriculum for Medical Students. Teach Learn Med.28(2):229-39. 10.1080/10401334.2016.1146601

Eychmüller, S., Forster, M., Gudat, H., Lütolf, U. M., & Borasio, G. D. (2015) Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives.Med Educ. 2015 Nov 27;15:213. 10.1186/s12909-015-0485-0

Gibbins, J., McCoubrie, R.; Maher, J., & Forbes, K.(2009). Incorporating palliative care into undergraduate curricula: lessons for curriculum development Med Educ; 43(8): 776-83. 10.1111/j.1365-2923.2009.03400.x

Kriesen, U., Altiner, A., & Müller-Hilke, B. (2018). Perception of bedside teaching within the palliative care setting-views from patients, students and staff members. Ann Palliat Med. Oct;7(4):411-19. 10.21037/apm.2018.05.01

Lehto, J. T., Hakkarainen, K., Kellokumpu-Lehtinen, P. L., & Saarto, T. (2017). Undergraduate curriculum in palliative medicine at Tampere University increases students' knowledge. BMC Palliat Care. Jan 25;16(1):13. 10.1186/s12904-016-0182-8

MacPherson, A., Lawrie, I., Collin, S., & Forman, L. (2014).Teaching the difficult-to-teach topics BMJ Support Palliat Care;,4(1): 87-91. 10.1136/bmjspcare-2012-000408

Murray, S. A., Firth, A., Schneider, N., Van den Eynde, B., Gomez-Batiste, X., Brogard T., et al. (2015). Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care. Palliat Med;29(2):101-11. https://eapcnet.wordpress.com/2015/02/11/toolkit-for-the-development-of-palliative-care-in-the-community/

Pastrana, T., Wenk, R., & De Lima, L. (2016). Consensus-Based Palliative Care Competencies for Undergraduate Nurses and Physicians: A Demonstrative Process with Colombian Universities. J Palliat MedJan;19(1):76-82. 10.1089/jpm.2015.0202

Parikh, P. P., White, M. T., Buckingham, L., & Tchorz, K. M.(2017) Evaluation of palliative care training and skills retention by medical students.J Surg Res; 211: 172-77. 10.1016/j.jss.2016.11.006

Peh, T. Y.,Yang, G. M., Krishna, L. K., & Yee, A. C. (2017).Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting? J Palliat Med. Feb;20(2):141-46. 10.1089/jpm.2016.0293

Romotzky, V., Galushko, M., Düsterdiek, A., Obliers, R., Albus, C., Ostgathe, C., & Voltz, R. (2015)."It's Not that Easy"--Medical Students' Fears and Barriers in End-of-Life Communication.J Cancer Educ; 30(2): 333-39. 10.1007/s13187-014-0712-0.

Samala, R. V., Hoeksema, L. J., & Colbert, C. Y. (2019). A Qualitative Study of Independent Home Visits by Hospice Fellows: Addressing Gaps in ACGME Milestones by Fostering Reflection and Self-Assessment.Am J Hosp Palliat Care. Oct;36(10):885-92. doi.org/10.1177%2F1049909119836218

Saylor, J., Vernoony, S., Selekman, J., & Cowperthwait, A. (2016). Interprofessional Education Using a Palliative Care Simulation. Nurse Educ. May-Jun;41(3):125-29. 10.1097/NNE.0000000000000228.

Schaeffer, K. et al. (2014). Raising the bar for the seriously III patients: Results of a National survey to define essential competencies of medical students and residents. NIH - Public access. Author manuscript. Acad Med. July;89(7): 1024-31. 10.1097/ACM.0000000000000271

Schiessl, C., Walshe, M., Wildfeuer, S., Larkin, P., Voltz, R., & Juenger, J. (2013). Undergraduate curricula in palliative medicine: a systematic analysis based on the palliative education assessment tool. J Palliat Med; 16(1): 20-30. 10.1089/jpm.2012.0281.

Schillerstrom, J. E.,Sanchez-Reilly, S., & O'Donnell, L.(2012).Improving student comfort with death and dying discussions through facilitated family encounters. Acad Psychiatry, 36(3): 188-90. 10.1176/appi.ap.10020032.

Schneidernam, L. J. (2011) Defining Medical Futility and Improving Medical Care. Journal of Bioethical Inquiry,8:123-31. 10.1007/s11673-011-9293-3.

Shaheen, A., Denton, G. D., Stratton, T. D., & Hoellein, A. R.(2014). Chretien KC End-of-life and palliative care curricula in internal medicine clerkships: a report on the presence, value, and design of curricula as rated by clerkship directors Acad Med; 2014, 89(8): 1168-73. 10.1097/ACM.0000000000000311.

Smith, A., Carey, C., Sadler, J., Smith, H., Stephens, R., & Frith, C. (2019). Undergraduate education in anaesthesia, intensive care, pain, and perioperative medicine: The development of a national curriculum framework. Med Teach. Mar;41(3):340-46. 10.1080/0142159X.2018.1472373.

Smith, G. M., & Schaefer, K. G. (2014).Missed opportunities to train medical students in generalist palliative care during core clerkships. J Palliat Med; 17(12): 1344-7.

Schulz-Quach, C., Wenzel-Meyburg, U., & Fetz, K. (2018). Can elearning be used to teach palliative care? - medical students' acceptance,knowledge, and self-estimation of competence in palliative care after elearning. BMC Med Educ. Apr 27;18-82. 10.1186/s12909-018-1186-2

Spalding, J., &Yardley, S. (2016). 'The nice thing about doctors is that you can sometimes get a day off school': anaction research study to bring lived experiences from children, parents and hospice staff into medical students' preparation for practice BMJ Support Palliat Care. Dec;6(4):459-64. 10.1136/bmjopen-2016-01389

Taquete, S. R., & Rego, S. et all, (2005) Situações conflituosas vivenciadas por estudantes de medicina. Rev Assoc Med Bras; 51(1): 23-28. ISSN 1806-9282. https://doi.org/10.1590/S0104-42302005000100015.

Taquete, S. R., & Borges, L. M. (2020). Pesquisa qualitativa para todos: Vozes..

Vergo, M. T., Sachs, S., MacMartin, M. A., Kirkland, K. B., Cullinan, A. M., & Stephens, L. A. (2017). Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills. J Palliat Med. May ;20(5):542-47. 10.1089/jpm.2016.0348

Von Gunten, F., Mullan, P. B., Nelesen, R., Garman, K., McNeal, H., Savoia, M., et all. (2017). Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After aClinical Curriculum With a Hospice. Am J Hosp Palliat Care. Sep;34(8):713-20. 10.1177/1049909116655767

Weber, M.,Schmiedel, S., Nauck, F., & Alt-Epping, B. (2016).Knowledge and attitude of medical students in Germany towards palliative care : Does the final year of medical school make a difference?]. Schmerz. Jun;30(3):279-85. 10.1007/s00482-015-0055-8

World Health Organization.(2002). National cancer control programmes: policies and managerial guidelines, (2nd ed.) Geneva: World Health Organization, books.google.com. https://www.who.int/cancer/publications/nccp2002/en/

World Health Organization. (2014). Global Atlas of Palliative Care at the end-of-life. http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf

Downloads

Publicado

25/01/2021

Como Citar

CASTRO, A. A. .; TAQUETTE, S. R. .; PEREIRA, C. A. R. . Cuidados paliativos e Ensino Médico: Revisão sistemática. Research, Society and Development, [S. l.], v. 10, n. 1, p. e50210111976, 2021. DOI: 10.33448/rsd-v10i1.11976. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/11976. Acesso em: 29 nov. 2024.

Edição

Seção

Ciências Educacionais