의학교육논단 (Korean Medical Education Review)

  • 제22권3호
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  • Pages.146-152
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  • 2020
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  • 2092-5603(pISSN)
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  • 2093-6370(eISSN)
연세대학교 의과대학 (Yonsei university college of medicine)
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우리나라 의과대학의 호스피스 완화의료 교육

Hospice and Palliative Care Education for Medical Students in Korea

  • 김도연 (동국대학교 일산병원 내과) ;
  • 이순남 (이화여자대학교 의과대학 내과학교실)
  • Kim, Do Yeun (Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Lee, Soon Nam (Department of Internal Medicine, Ewha Womans University College of Medicine)
  • 투고 : 2020.09.14
  • 심사 : 2020.10.19
  • 발행 : 2020.10.31
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초록

Hospice and palliative care (HPC) education is an essential component of undergraduate medical education. Since February 4th, 2018, withholding and withdrawing life-sustaining treatment at the end of life (EOL) has been permitted in Korea as put forth by law, the "Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life." Therefore, Korean medical schools have faced a challenge in providing comprehensive HPC education in order to better prepare medical students to be competent physicians in fulfilling their role in caring for patients at the EOL. There have been considerable variations in the evolution and organization of HPC education across Korean medical schools for the past 20 years. In 2016, all medical schools taught HPC curriculum as a separate course or integrated courses, with the most frequently taught topics including: delivering bad news, pain management, and the concept of palliative medicine. However, the content, time allocation, learning format, and clinical skills practice training of HPC education have been insufficient, inconsistent, and diverse. For this reason, we propose a HPC curriculum containing seven domains with 60 learning objectives in a course duration of over 20 hours based on the Palliative Education Assessment Tool (PEAT) as standard HPC curriculum. Furthermore, we recommend development of a national curriculum for HPC/EOL care education to be organized by the HPC board and managed under the accreditation criteria of the Korea Institute of Medical Education and Evaluation.

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참고문헌

  1. Fitzpatrick D, Heah R, Patten S, Ward H. Palliative care in undergraduate medical education: how far have we come? Am J Hosp Palliat Care. 2017;34(8):762-73. https://doi.org/10.1177/1049909116659737
  2. Bharmal A, Morgan T, Kuhn I, Wee B, Barclay S. Palliative and end-of-life care and junior doctors': a systematic review and narrative synthesis. BMJ Support Palliat Care. 2019:bmjspcare-2019-001954.
  3. Walker S, Gibbins J, Paes P, Barclay S, Adams A, Chandratilake M, et al. Preparing future doctors for palliative care: views of course organisers. BMJ Support Palliat Care. 2018;8(3):299-306. https://doi.org/10.1136/bmjspcare-2017-001319
  4. Chen CA, Kotliar D, Drolet BC. Medical education in the United States: do residents feel prepared? Perspect Med Educ. 2015;4(4):181-5. https://doi.org/10.1007/s40037-015-0194-8
  5. Horowitz R, Gramling R, Quill T. Palliative care education in U.S. medical schools. Med Educ. 2014;48(1):59-66. https://doi.org/10.1111/medu.12292
  6. Chiu N, Cheon P, Lutz S, Lao N, Pulenzas N, Chiu L, et al. Inadequacy of palliative training in the medical school curriculum. J Cancer Educ. 2015;30(4):749-53. https://doi.org/10.1007/s13187-014-0762-3
  7. Kim DY, Kim KJ, Shin SJ, Heo DS, Lee SN, Nam EM. Factors that influence attitudes toward end-of-life care among medical students: nationwide survey for fourth-year Korean medical students. Am J Hosp Palliat Care. 2019;36(6):460-5. https://doi.org/10.1177/1049909118822287
  8. Act on Decisions on Life Sustaining Treatment for Patients in Hospice and Palliative Care at the End of Life, Law No. 14013 (Feb 3, 2016).
  9. Korea National Institute for Bioethics Policy. Annual report on life sustaining treatment decision at the end of life [Internet]. Seoul: National Agency for Management of Life-Sustaining Treatment; 2019 [cited 2020 Jun 30]. Available from: https://www.lst.go.kr.
  10. Kim JS, Yoo SH, Choi W, Kim Y, Hong J, Kim MS, et al. Implication of the Life-Sustaining Treatment Decisions Act on end-of-life care for Korean terminal patients. Cancer Res Treat. 2020;52(3):917-24. https://doi.org/10.4143/crt.2019.740
  11. Korean Society of Hospice and Palliative Care. Textbook of hospice and palliative care. Pajoo: Koonja; 2018.
  12. Hong YS. Past, present and future of hospice in Korea. J Korean Med Assoc. 2008;51(6):509-16. https://doi.org/10.5124/jkma.2008.51.6.509
  13. Kim CG. The history of hospice and palliative care in Korea. Korean J Hosp Palliat Care. 2019;22(1):1-7. https://doi.org/10.14475/kjhpc.2019.22.1.1
  14. Kim NC. Guidelines for teaching of hospice and palliative medicine. J Korean Med Assoc. 1998;41(11):1135-40. https://doi.org/10.5124/jkma.1998.41.11.1135
  15. Kim DY. Undergraduate medical curriculum: hospice palliative care education and training certification program. Proceedings of the Korean Society of Hospice and Palliative Care Annual Conference: 2009 Dec 4; Seoul, Korea. Seoul: Korean Society of Hospice and Palliative Care; 2009.
  16. Kim KJ, Kim DY, Shin SJ, Heo DS, Nam EM. Do Korean medical schools provide adequate end-of-life care education?: a nationwide survey of the Republic of Korea's end-of-life care curricula. Korean J Hosp Palliat Care. 2019;22(4):207-18. https://doi.org/10.14475/kjhpc.2019.22.4.207
  17. Schiessl C, Walshe M, Wildfeuer S, Larkin P, Voltz R, Juenger J. Undergraduate curricula in palliative medicine: a systematic analysis based on the palliative education assessment tool. J Palliat Med. 2013;16(1):20-30. https://doi.org/10.1089/jpm.2012.0281
  18. Meekin SA, Klein JE, Fleischman AR, Fins JJ. Development of a palliative education assessment tool for medical student education. Acad Med. 2000;75(10):986-92. https://doi.org/10.1097/00001888-200010000-00011
  19. Mott ML, Gorawara-Bhat R, Marschke M, Levine S. Medical students as hospice volunteers: reflections on an early experiential training program in end-of-lifecare education. J Palliat Med. 2014;17(6):696-700. https://doi.org/10.1089/jpm.2013.0533
  20. Gadoud A, Lu WH, Strano-Paul L, Lane S, Boland JW. A pilot study of interprofessional palliative care education of medical students in the UK and USA. BMJ Support Palliat Care. 2018;8(1):67-72. https://doi.org/10.1136/bmjspcare-2016-001267
  21. Head BA, Furman CD, Lally AM, Leake K, Pfeifer M. Medicine as it should be: teaching team and teamwork during a palliative care clerkship. J Palliat Med. 2018;21(5):638-44. https://doi.org/10.1089/jpm.2017.0589
  22. Nakamura Y, Takamiya Y, Saito M, Kuroko K, Shiratsuchi T, Oshima K, et al. A survey of palliative medicine education in Japan's undergraduate medical curriculum. BMC Palliat Care. 2017;16(1):38. https://doi.org/10.1186/s12904-017-0212-1
  23. Kim HK, Nam E, Lee KE, Lee SN. Awareness and attitude change after end-of-life care education for medical students. Korean J Hosp Palliat Care. 2012;15(1):30-5. https://doi.org/10.14475/kjhpc.2012.15.1.30
  24. Kim DY, Kim KJ, Shin SJ, Kwon I, Nam EM, Heo DS, et al. The necessity for end-of-life care education: a preliminary analysis with interns at two university hospitals. Korean J Hosp Palliat Care. 2017;20(2):111-21. https://doi.org/10.14475/kjhpc.2017.20.2.111
  25. Billings ME, Engelberg R, Curtis JR, Block S, Sullivan AM. Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med. 2010;13(3):319-26. https://doi.org/10.1089/jpm.2009.0293
  26. General Medical Council. Tomorrow's doctors; outcomes and standards for undergraduate medical education [Internet]. London: General Medical Council; 2020 [cited 2020 Jun 30]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes.
  27. Liaison Committee for Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree [Internet]. Washington (DC): Liaison Committee for Medical Education; 2019 [cited 2020 Jun 30]. Available from: https://lcme.org/publications/.
  28. National Hospice Center, National Cancer Center. Manual for standard curriculum for hospice palliative care professionals [Internet]. Goyang: National Hospice Center; 2020 [cited 2020 Jun 30]. Available from: http://hospice.go.kr.