Education about death and dying during surgical residency

Article Abstract:

Between 60 to 80 percent of all deaths occur in the hospital. For the past 20 years medical schools have included in their curricula education regarding death and dying; unfortunately, little attention has been given to this subject in internships and residencies. A study was undertaken to evaluate the attitudes, experience and education of surgical residents in treating dying patients. Questionnaires completed by 53 surgical residents were analyzed. On average, an individual resident treated 2.6 dying patients each month. Most of the surgical residents (74 percent) believed the patients should be told of their terminal condition, but only 42 percent believed the patients wished to discuss this fact. This contrasts with the findings of Kubler-Ross in her research on death and dying. Most residents believed they spent the same or even more time with terminally ill patients who sustained a cardiac arrest than with other cardiac arrest patients. The communication and interaction between the residents and the patient's family was poor; 61 percent of residents did not advise the family of major problems or possible problems that might occur in caring for the sick relative. Communication with the patient's family is very stressful for the physician; relatives are often depressed, anxious and very angry. Most patients and their relatives prefer that death occur at home; however, fewer than half the residents knew what problems would be encountered when the patient was discharged. Neither physicians nor the relatives often know what help is available; social service personnel should be involved in planning the patient's discharge to home. Education in death and dying is not commonly found in residency programs. Most of the residents responding (79 percent) said they would welcome a formal education on death and dying during their residency program. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Terminal care, Beliefs, opinions and attitudes, Curricula, Study and teaching, Residents (Medicine), Graduate medical education, Thanatology, Kubler-Ross, Elisabeth

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A model for the assessment of students' physician-patient interaction skills on the surgical clerkship

Article Abstract:

It is important for medical students to learn how to interact well with their patients. Formal education aimed at helping students acquire these skills is now incorporated in the curricula of many medical schools. However, evaluation of these skills on a daily basis by the faculty is rarely performed. A report is presented of a new technique for evaluating the patient interaction skills of the medical student. A trained nurse instructor evaluated the student-patient interaction while observing the student performing routine wound care and dressing change for the patient. At the time of observation, the students were aware only that they were being evaluated on technique. The instructor used a checklist of nine technical skills and nine interpersonal skills; the student was given immediate feedback by the instructor. The items used to evaluate student-patient interaction included: covers the patient after the procedure; answers questions in layman's terms; discusses the wound care procedure with the patient; introduces self to patient; provides patient with privacy; returns patients' belongings to tray-table and places it within patient's reach; asks visitors to leave; discusses condition or progress of wound with patient; and discusses reasons for procedure. This technique was used during a six-month period to evaluate 78 third-year medical students. The first two items were performed by 70 percent of students; only 37 percent of the students introduced themselves to the patient. Poorest compliance was in discussion of the progress of the wound (7 percent) and reason for procedure (6 percent). The average total score of interaction skills was 35 percent. These results indicate significant deficiencies in patient interaction skills of third year medical students. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Medical students, Physician and patient, Physician-patient relations, Interpersonal relations

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Value of lymph node biopsy in the treatment of patients with the human immunodeficiency virus

Article Abstract:

Patients who are infected with human immunodeficiency virus (HIV) and have AIDS or AIDS-related complex (ARC) often have abnormalities of the lymph glands. It is important to determine which patients with AIDS or ARC would benefit from lymph node biopsy. The indications and value of lymph node biopsy in these patients has not been determined. A study was undertaken of 29 lymph node biopsies obtained from 24 patients (22 men and 2 women) with AIDS or ARC. Indications for biopsy included: new or worsening symptoms with no identifiable cause; disproportionately large node; and exclusion of other disease in a patient with previous infection or cancer. As a result of the biopsy reports, treatment was changed or initiated in 19 patients (64 percent). The procedure resulted in four (14 percent) minor complications (lymphocele, hematoma, wound infection). No accidental puncture injuries of operating room personnel occurred during the procedures. These results indicate that lymph node biopsy procedures may be performed with minimal complications in HIV-infected patients. Biopsy of the lymph nodes is indicated in certain patients with AIDS or ARC and can significantly change patient treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Complications and side effects, Surgery, AIDS patients, AIDS (Disease), Lymph nodes, Biopsy, AIDS-related complex, Lymphadenopathy, Lymph node biopsy

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