ESP理论参照下的临床医学英语教学实践探讨

目的:由于传统的英语教学无法满足全球化对于双语医学教育的新要求,ESP特殊用途英语如何在中国医学教育中得以实践并取得有效成果成了医学教育者的新课题。方法:为了解决这一课题,在上海交通大学医学院进行医学双语教学的试点培训,以学士,硕士和博士三种学历组成人数为3-5人的小型试点班级,目的在跟踪不同阶段的医学生在培训期间的专业素质水平与英语水平的成效,并参照语言学家Pauline Robinson的ESP方法论,归纳总结出适应我国不同阶段学生的教学方法。Pauline Robinson的ESP方法分别为:角色扮演和模仿,案例学习法,项目教学法和演讲。结果:培训教师从三组不同学生的实际情况出发,结合上述四种教学方法,经过三个学期的培训分别得出了博士生组的口语能力,硕士生组听力能力以及本科生的写作阅读能力进步比较突出的结果。结论:中国教育体制所导致的被动接受的学习习惯是中国的特殊情况,而角色扮演和模仿,案例学习法,项目教学法和演讲是紧密相扣的四环相连的教学方法,每一种教学方法都是对彼此的补充和丰富,符合我国当代学生的个性特点和医学教育的方向,从而需要更多的医学教育工作者更好地利用四种教学方法以不断提升医学英语教学的教育事业以更好地帮助医学工作者融入国际舞台。     

Respite care on a children's ward.

In March 1984 a short term respite care facility for handicapped children was opened in a children''s ward catering primarily for acute medical and surgical problems. The facility was based on a four bedded room designed so that if beds became short in the main ward it could revert immediately to the care of acutely sick children. Three nurses were appointed specifically to staff the facility, the nursing budget for the rest of the ward being reduced proportionately. Conversions were funded by charities and some of the conversion work done by volunteers. The main users were totally dependent children aged under 5 with severe mental and physical handicaps. Parents found the service invaluable, and in addition to planned admissions it was usually possible to accept a child at short notice--for example, when some domestic crisis occurred. Only very rarely was admission impossible because of the needs of acutely ill children. A short term respite care facility not only helps parents cope and may provide beneficial experience for a handicapped child but is also a useful training ground for medical students and junior staff.     

The earliest days of first aid.

First aid, as a profession in its own right, has a history of only 120 years. It evolved from the teachings of the Royal Humane Society and military surgeons, who saw the wisdom of training in splinting and bandaging for battlefield wounds. In 1878 two Aberdeenshire military officers, Surgeon-Major Peter Shepherd of the Royal Herbert Military Hospital, Woolwich, London, and Colonel Francis Duncan established the concept of teaching first aid skills to civilians. This radical new enterprise, conducted under the auspices of the newly formed St John Ambulance Association, was a natural evolution from the body''s philanthropic and ambulance transport work. Shepherd conducted the first class in the hall of the Presbyterian school in Woolwich using a comprehensive first aid curriculum that he had developed. Within months of that first class, local Woolwich civilians used their skills when the pleasure boat Princess Alice sank in the Thames at Woolwich, killing 600 people. Within a decade, the new discipline of first aid spread rapidly throughout the world, and by the end of the 19th century, hundreds of thousands of St John first aid certificates had been awarded in four continents. Shepherd''s pioneering classes changed the world''s concept of the need for the provision of skilled prehospital care.     

Differences in abuse reported by female and male Canadian medical students.

OBJECTIVE: To assess differences between male and female medical students concerning their experiences of abuse during training in a large Canadian medical school. DESIGN: Voluntary, anonymous cross-sectional survey of first- and fourth-year medical students during February 1991. SETTING: University of Toronto School of Medicine. PARTICIPANTS: Of 396 first- and fourth-year students surveyed after one of their regular classes, 347 (117 women, 230 men) completed the questionnaire. INTERVENTION: A 165-item, multiple-choice questionnaire concerning experiences of verbal or emotional abuse, sexual harassment and physical abuse, completed within 30 minutes. MAIN OUTCOME MEASURES: Differences between male and female respondents in abuse experiences before and during medical training, the relation between abuse before and during training, and the psychologic and behavioural effects of abuse during training. RESULTS: The experiences of the male and female respondents differed mainly in regard to sexual harassment: 42% (49/117) of the women and 11% (25/230) of the men reported sexual harassment before entering medical school (p < 0.0001); 46% (54/117) and 19% (43/230) respectively reported sexual harassment during medical training (p < 0.0001); and women who reported sexual harassment were the only respondents for whom a significant relation was found between abuse before and during training (p < 0.043). The women were more distressed than the men by all forms of abuse. A significant relation was shown between male students who reported experiencing abuse during medical training and mistreating patients (p < 0.0001). CONCLUSION: Female students'' experiences of sexual harassment differed from those of their male counterparts. As well, the female students'' reactions to and ways of coping with all types of abuse differed from those of the male students.     

Improving the preregistration experience: the New Zealand approach.

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students'' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer''s salary for their clinical work, which is supervised by the firm''s registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.     

Impact of Genetic Counseling and Connexin-26 and Connexin-30 Testing on Deaf Identity and Comprehension of Genetic Test Results in a Sample of Deaf Adults: A Prospective,Longitudinal Study

Using a prospective, longitudinal study design, this paper addresses the impact of genetic counseling and testing for deafness on deaf adults and the Deaf community. This study specifically evaluated the effect of genetic counseling and Connexin-26 and Connexin-30 genetic test results on participants'' deaf identity and understanding of their genetic test results. Connexin-26 and Connexin-30 genetic testing was offered to participants in the context of linguistically and culturally appropriate genetic counseling. Questionnaire data collected from 209 deaf adults at four time points (baseline, immediately following pre-test genetic counseling, 1-month following genetic test result disclosure, and 6-months after result disclosure) were analyzed. Four deaf identity orientations (hearing, marginal, immersion, bicultural) were evaluated using subscales of the Deaf Identity Development Scale-Revised. We found evidence that participants understood their specific genetic test results following genetic counseling, but found no evidence of change in deaf identity based on genetic counseling or their genetic test results. This study demonstrated that culturally and linguistically appropriate genetic counseling can improve deaf clients'' understanding of genetic test results, and the formation of deaf identity was not directly related to genetic counseling or Connexin-26 and Connexin-30 genetic test results.     

Recall in acoustically similar and dissimilar letters by normal and deaf subjects.

Stimulus matrices with 4 X 3 letters from an acoustically similar and dissimilar alphabet were presented tachystoscopically for 5 secs to 41 Ss divided into three groups, i.e. normal and deaf apprentices and deaf children. Each S was administered 42 stimulus matrices. While the difference in the number of errors between the acoustically similar and dissimilar alphabets proved significant in the hearing Ss, it was nonsignificant in the deaf, and in contrast to these two groups, in the children the number of errors with the acoustically similar alphabet was lower than with the dissimilar one. The error matrices indicate a systematic course of errors and their different pattern for the hearing and the deaf Ss. A visual and an articulating code which is reinforced by the length of oral training, may be presumed particularly in the deaf.     

A survey of postgraduate training for family practice.

The results of a survey of Canadian primary care physicians for the Canadian Medical Association (CMA''s) Task Force on Education for the Provision of Primary Care Services are reported. Recent Canadian medical school graduates in primary care practice reported that the three major training routes (rotating and mixed internships and family medicine residencies) each prepared them differently for practice. The graduates of 2-year family medicine residencies were more satisfied with their preparation than were the graduates of the other major training routes. A 2- or 3-year family medicine residency was preferred by 50% of the respondents, although only 33% of them had actually taken one of these routes. There was considerable agreement in the respondents'' assessments of the types of postgraduate education needed for primary care practice. The results of this survey were consistent with the recommendations in the final report of the CMA''s task force.     

Treatment of Raynaud's phenomenon with ketanserin in patients with connective tissue disorders.

The serotonin receptor blocker ketanserin was given orally in a double blind crossover study to 10 patients with connective tissue disorders and Raynaud''s phenomenon. Eight of the 10 patients improved clinically on ketanserin and none on placebo. Digital blood flow was assessed with laser Doppler flowmetry (LDF), photoplethysmography, and skin temperature measurements. Laser Doppler flowmetry was the most useful method, showing a significant reduction in recovery time after a standard cold provocation. Although the resting flow was not significantly improved, digital ulcers healed in four out of five patients, providing evidence of increased nutritive flow. The results of this study suggest that orally administered ketanserin may be an effective and well tolerated treatment for Raynaud''s phenomenon associated with connective tissue disorders, especially scleroderma.     

开展临床指导教师对普通专科医师培训情况的调查结果分析

目的:调查我院专科医师培训开展的整体情况,为继续做好专科医师培训工作提供依据。方法:随机调查我院参与普通专科医师培训轮转科室的指导教师,发放自制调查表。结果:90%以上导师认为科室带教质量高;48.78%导师认为临床科室应为学员每月发放1000元以上生活补助;60.98%导师认为硕士研究生普通专科医师培训时间应为二年;60%以上导师认为应着重硕士研究生临床操作技能、医患沟通能力、病历书写能力及阅片能力等方面能力的培训;50%以上导师认为目前培训中存在的主要问题是生活无保障;图书馆国内外最新文献不足;监管力度不强;临床技能培训针对性不强等。结论:我院开展普通专科医师培训整体情况较好。但仍存在很多问题,在今后的培训过程中应继续为学员的生活提供更多保障,继续加强管理监督,保证培训按计划、按质量完成。     

Consanguinity analysis of congenital deafness in Northern Israel.

Consanguinity analysis of heterogeneous populations was performed on a group of 82 Israeli Jewish families with congenitally deaf probands, including 37 multiplex families with normal parents, 10 multiplex families with deaf parents, and 35 simplex families with deafness of unknown cause. Representative gene frequency was estimated as .0198, with two to four major gene loci per ethnic group. In both the simplex families and those with deaf parents, the only significant etiology found was homozygosity for pathologic recessive genes. Comparison of these findings in Israeli isolates with those in panmictic populations seems to imply that the genetic loci are not identical in the various isolates.     

Suicides in Visually Impaired Persons: A Nation-Wide Register-Linked Study from Finland Based on Thirty Years of Data

Focusing on seasonality, gender, age, and suicide methods a Finnish nation-wide cohort-based study was carried out to compare suicide data between sighted, visually-impaired (WHO impairment level I-II, i.e., visual acuity >0.05, but <0.3) and blind (WHO impairment level III-V, i.e., visual acuity <0.05) victims. Standardized mortality ratios (SMR) of age- and gender-matched populations from official 1982–2011 national registers were used. Group differences in categorical variables were assessed with Pearson''s Chi-square or Fisher''s Exact test and in continuous variables with Mann-Whitney U-test. Seasonality was assessed by Chi-square for multinomials; ratio of observed to expected number of suicides was calculated with 95% confidence level. Hanging, poisoning, drowning, but rarely shooting or jumping from high places, were preferred suicide methods of the blind. Mortality was significantly increased in the visually impaired (SMR = 1.3; 95% CI 1.07–1.61), but in gender-stratified analyses the increase only affected males (1.34; 95% CI = 1.06–1.70) and not females (1.24; 95% CI 0.82–1.88). Age-stratified analyses identified blind males of working age rather than older men (as in the general population) as a high risk group that requires particular attention. The statistically significant spring suicide peak in blind subjects mirrors that of sighted victims and its possible cause in the blind is discussed.     

The developmental emergence of coupled activity as cooperative aggregation in rat pups.

Rat pups (Rattus norvegicus) are born blind and deaf yet manage to wriggle about in a huddle, dynamically adjusting their positions and thereby displaying thermoregulation and energy conservation at the level of the group. As pups develop, their activity and mobility outpace the development of their visual and auditory systems making it increasingly difficult to aggregate and maintain aggregation while still blind and deaf. The developmental emergence of coupled activity may be one mechanism that facilitates aggregation. Our previous research has shown that the activity of a seven-day-old pup is independent of the activity of the litter mates it contacts. However, we hypothesized that, by day 10, more active and mobile pups will exhibit coupled activity, becoming increasingly quiescent when in contact with other behaviourally quiescent pups. In order to test this hypothesis, we used individual-based modelling. Because the structure of the model was complex, we used a Darwinian algorithm for evolving a model that behaved like ten-day-old pups aggregating in an arena. Sensitivity to quiescent individuals was manifested in some litters by the transitory spreading of quiescence across aggregates of both real and virtual pups (a contagion effect). As pups develop, individual behaviour becomes increasingly contingent on the behaviour of others revealing what may be a basic component in the development of cooperative behaviour.     

Sino-U.S. partnerships in research,education, and patient care: The experience of the University of Pittsburgh and UPMC

In 2011, the University of Pittsburgh School of Medicine (UPSOM) and Tsinghua University formed a partnership to further the education of Tsinghua medical students. These students come to UPSOM as visiting research scholars for two years of their eight-year MD curriculum. During this time, the students, who have completed four years at Tsinghua, work full-time in medical school laboratories and research programs of their choice, essentially functioning as graduate students. In their first two months in Pittsburgh, the scholars have a one-week orientation to biomedical research, followed by two-week rotations in four labs selected on the basis of the scholars’ scientific interests, after which they choose one of these labs for the remainder of the two years. Selected labs may be in basic science departments, basic science divisions of clinical departments, or specialized centers that focus on approaches like simulation and modeling. The Tsinghua students also have a brief exposure to clinical medicine. UPSOM has also formed a similar partnership with Central South University Xiangya School of Medicine in Changsha, Hunan Province. The Xiangya students come to UPSOM for two years of research training after their sixth year and, thus, unlike the Tsinghua students, have already completed their clinical rotations. UPSOM faculty members have also paved the way for UPMC (University of Pittsburgh Medical Center), UPSOM’s clinical partner, to engage with clinical centers in China. Major relationships involving advisory, training, managerial, and/or equity roles exist with Xiangya International Medical Center, KingMED Diagnostics, First Chengmei Medical Industry Group, and Macare Women’s Hospital. Both UPSOM and UPMC are actively exploring other clinical and academic opportunities in China.     

Diagnostic value of microtympanometry in primary care.

OBJECTIVE--To determine the reliability, validity, and feasibility of a new hand held microtympanometer. DESIGN--Comparison of microtympanometry by two independent observations of a general practitioner and a nurse, and against a validated reference instrument. SETTING--Primary care health centre of a school for the deaf in the United States. SUBJECTS--111 schoolchildren receiving a regular check up. MAIN OUTCOME MEASURES--Tympanometry with the Grason Stadler 28, classified with a slightly modified Jerger''s classification. RESULTS--Interobserver reliability was 0.95 (Cohen''s kappa). Results of microtympanometry were highly comparable with results of the reference instrument (likelihood ratio of positive results, 161.2). CONCLUSIONS--The microtympanometer could be used in general practice: it is hand held, child friendly, easy to handle, and accurate.     

Increasing the effectiveness of clinical supervision.

Effective use of preceptors in the clinical training and supervision of residents involves four essential steps: careful screening of the preceptor''s practice to ensure it reflects the goals of the residency program and teaching the preceptor about the goals; setting a realistic contract for learning between resident and preceptor; teaching the preceptor to use constructive feedback techniques in the day-to-day supervision of residents; and developing the preceptor''s skills in the reliable and valid evaluation of the resident''s performance. Clinical preceptors must be trained to become effective teachers and evaluators in residency programs.     

Moses Maimonides: rabbi or medicine.

The great medieval Jewish philosopher Moses Maimonides was also a practicing physician who contributed a number of important works to medical literature. Modern students of these treatises have made extravagant claims about Maimonides'' scientific outlook and have attributed to him important discoveries and innovations. Viewed in its historical and religious content, Maimonides'' medical work appears more explanatory than exploratory, though still of considerable interest to students of both the philosophy of science and the history of medicine.     

Anger over HIV questions cancels blood clinic at Ottawa university

Ottawa''s Carleton University cancelled a February blood-donor clinic after the Red Cross failed to hold sensitivity-training sessions for its volunteers. The sessions were requested after students complained that the organization''s screening procedures are insensitive and offend gay students. The Red Cross maintains that rigorous screening, including questions about high-risk sexual behaviour, is essential if the blood supply is to be protected. In March a compromise was announced: the Red Cross will begin sensitivity training for its volunteer workers in April and blood-donor clinics will return to Carleton in the fall.