Teaching Medical Ethics to Meet the Realities of a Changing Health Care System

The changing context of medical practice—bureaucratic, political, or economic—demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.     

Medical simulation: the new tool for training and skill assessment

Medical simulation is a new method to facilitate skill training and assessment. Simulation has achieved a high degree of sophistication in aviation and other fields. However, the complexity of health care, the numerous stakeholders, and the lack of central control of medical education have been barriers to the development and broad implementation of medical simulation. Acceptance by the medical community is growing, with the publication of scientific validation studies, the development of economic models and funding, and the integration of simulation into existing curricula and training programs. The major forces for implementing simulation will most likely come from the medical device industry and from institutions with mandates to improve the quality of health care and enhance patient safety. Certification boards are expected to increase their utilization of simulation technology to objectively assess proficiency of skills relevant to physicians and the health care system. Medical simulation has made the transition from an experimental technology to the clinical world, and the next five to 10 years may be viewed as the golden age of medical simulation.     

医学模拟教学结合以问题为导向的教学模式在重症医学教学中的应用研究

目的:探讨医学模拟教学结合以问题为导向(PBL)的教学模式在重症医学教学中的应用价值。方法:选取2015年1月~2017年1月在我院重症医学科轮转实习的五年制医学生64人作为研究对象。按随机数字表法将64名医学生分为PBL组(n=32)和结合教学组(n=32)。PBL组采用PBL教学,结合教学组采用医学模拟结合PBL教学。分别在入科时和轮转实习结束时对两组学员进行理论考试和技能操作考核,记录成绩并比较。理论考试和技能操作考核后采取发放问卷进行调查的形式获得学员对教学效果的主观评价。结果:轮转实习结束时,两组理论考试分数差异无统计学意义(P0.05);而结合教学组技能操作考核成分数显著高于PBL组,差异具有统计学意义(P0.05)。两组学员在教学方法接受度高、学习兴趣提升、自学能力提升和临床诊疗水平提高所占比例差异无统计学意义(P0.05);结合教学组学员在团队协作能力提高、沟通能力与人文关怀提高和技能操作水平提高所占比例高于PBL组,差异有统计学意义(P0.05)。结论:与单独PBL教学相比较,医学模拟教学结合PBL的教学模式应用于重症医学教学对学员技能操作的掌握有更好的效果,同时能提高学员团队协作能力、沟通能力以及对患者的人文关怀,且受到学员的认同与喜爱,应在重症医学的教学实践中逐步完善并进一步推广应用。     

The Effect of Active Learning Methodologies on the Teaching of Pharmaceutical Care in a Brazilian Pharmacy Faculty

BackgroundIn recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies.MethodsThis pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students'' satisfaction with the course was evaluated.ResultsThirty-three students completed the four evaluations used in the course (i.e., a discursive written exam, seminars, OSCE, and virtual patient); 25 were female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course.ConclusionsThe results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be necessary to compare active learning to traditional methods.     

技能大赛背景下高职生物制药技术综合实训课程教学改革

综合实训是高职学生将理论知识与生产实践有机融合的重要教学环节。本文介绍了技能大赛背景下,学院生物制药技术专业立足“以赛促教、以赛促建、以赛促学、育训结合”特色,以青霉素发酵工艺实验为例,从教学目标、教学内容、教学方法、考核等内容进行的改革与实践,将发酵设备的实践操作与虚拟仿真软件相融合,双向交互式开展课程。突破发酵过程控制的主观依赖性,建立发酵过程参数控制的量化管理和评价,更有利于实现技能大赛与实践教学的高效融合。通过近几年的改革与实践,取得良好的教学效果,为同类课程基于技能大赛的教学实践改革提供了新的思路和借鉴。     

The effect of awareness on the outcome of oral health performed by home care service providers

Objectives: The purpose of this study was to investigate the correlations amongst factors, such as knowledge, attitude, practice and oral health behaviour, in caregiver managers so as to improve the oral health of the dependent elderly. Methods: Data were collected from a sample of 102 caregiver managers from home care service providers using a questionnaire. The respondents were divided into two groups: the group who were aware of effective oral care (A group) and the group who were unaware of effective oral care (U group). The evaluations were frequency distribution tables followed by chi‐squared tests of independence and Fisher’s exact test. Results: Ninety percent of the respondents thought that dependent elderly needed to be provided with oral care and 77% had been trained in oral care. However, only 44% thought that they could provide appropriate oral care and only 52% had experienced its effect on oral health and general health. There was a significant difference in training by dental hygienists between the A group (36%) and the U group (11%). There was also a significant difference in learning of oral care skills. Conclusion: The results suggested a high oral care awareness amongst caregiver managers and an inadequate oral care training system. To improve oral health of the dependent elderly, theoretical teaching alone is not sufficient when providing oral health education and a positive contact with the dental team, especially dental hygienists, is an important factor which supports oral care provided by caregivers.     

Teaching and learning in ecology: a horizon scan of emerging challenges and solutions

We currently face significant, anthropogenic, global environmental challenges and the role of ecologists in mitigating these challenges is arguably more important than ever. Consequently there is an urgent need to recruit and train future generations of ecologists, both those whose main area is ecology, but also those involved in the geological, biological and environmental sciences. Here we present the results of a horizon scanning exercise that identified current and future challenges facing the teaching of ecology, through surveys of teachers, students and employers of ecologists. Key challenges identified were grouped in terms of the perspectives of three groups: students, for example the increasing disconnect between people and nature; teachers, for example the challenges associated with teaching the quantitative skills that are inherent to the study of ecology; and society, for example poor societal perceptions of the field of ecology. In addition to the challenges identified, we propose a number of solutions developed at a workshop by a team of ecology teaching experts, with supporting evidence of their potential to address many of the problems raised. These proposed solutions include developing living labs, teaching students to be ecological entrepreneurs and influencers, embedding skills-based learning and coding in the curriculum, an increased role for learned societies in teaching and learning, and using new technology to enhance fieldwork studies including virtual reality, artificial intelligence and real-time spoken language translation. Our findings are focused towards UK higher education, but they should be informative for students and teachers of a wide range of educational levels, policy makers and professional ecologists worldwide.     

以问题为中心的学习方法在高职社区问诊技能教学中的应用

目的:探讨以问题为中心的教学方法(problem-based learning,PBL)在高职社区问诊教学中的效果,寻求更有效的现代医学教育方法。方法:在高职社区问诊技能学习中开展以问题为中心的教学方法(PBL),分析问诊中存在的问题,以提高知识应用与沟通能力。结果:通过对62名高职医学生进行问诊技能和见习报告评分显示,成绩优良比率为89%,满意度调查显示83.87%的高职医学生对PBL教学方法满意。PBL教学可以让高职医学生灵活的利用自已的时间,进行比较主动的学习,可以更好的发现高职医学生在问诊见习中存在的问题,有利于提高高职医学生的问诊技能及医患沟通能力,但实施中所需时间较长,占用课时多。结论:PBL教学对高职医学生的主动学习能力、问诊技能及医患沟通能力的提高有利,医学生对PBL教学方法满意度高。在医学教育中可以将PBL教学和传统教学方法结合起来,以在有效的时间里达到更好的教学效果。     

对重症医学科进修生的临床教学体会

重症医学在我国发展较为滞后,多数重症医学科医生来自于其他专业,缺乏重症医学专业知识及临床实践经验。建立完善、科学、有效的重症医学科进修生管理和培养模式对于进一步提高危重症救治专业人才的水平至关重要。我科室通过总结多年的进修生教学经验,以"病例分析学习(case based learning,CBL)+多学科协作(multiple department team,MDT)"教学模式为主导,以病例幻灯竞赛为契机激发进修医生学习的主观能动性;以专业英语为特色;重视临床科研教学;制定规范化培训制度,实行导师负责制,开展定期考核。显著提高了重症医学科进修生的医疗及科研水平。     

留学生医学遗传学教学中教学新模式的构建

以发展外国留学生教育为主要标志的教育国际化,是当今世界教育发展的一大趋势。为了提高我校的教学水平和办学层次,我校医学院自2005年秋季开始招收外国留学生。留学生的学习方法和思维模式与中国学生相比有很大差异,而传统的教学模式不能适应留学生的教学的需求。因此构建新型教学模式在留学生医学遗传学教学中至关重要。     

基于群体协同交互式学习模式的“微生物生理学”虚拟仿真实验教学方法

随着我国虚拟仿真实验教学工作的开展,群组式学习模式被越来越多地探讨并应用到实际教学中,但将此学习模式与虚拟仿真类实验课程相结合进行教学研究的实例相对较少。针对微生物类实验实践教学中存在的典型问题,以哈尔滨工业大学“微生物生理学”研究生精品课程建设研究为例,提出基于群体协同交互式学习模式的“微生物生理学”虚拟仿真实验教学研究,以期打造微生物学科一流实验/实践类教学课程。本文阐述了群体协同交互式学习模式的内涵、构成要素及优势,论述了群体协同交互式学习模式在“微生物生理学”虚拟仿真实验教学中的实现过程,并总结了该模式的不足与未来发展方向。     

中美模拟医学教育差异之浅析

随着社会的进步,直接以患者为对象的传统临床实习教学模式面临着严峻考验。计算机技术费飞速发展,为模拟医学教学带来了划时代的进步,使医学教育进入现代医学模拟教学时代。随着现代科技及医疗环境及教学理念的进步,模拟医学教育近年来发展较快。现代模拟教学方式被认为是一种提高患者安全的有效临床教学方法,其教学活动可重复、无风险、可控制且灵活多样。我国这方面也取得了一定发展并具备了一些特点。但是由于整个医学教学氛围、教学习惯、教育体系、考核体系、评估体系的差异,导致和美国存在比较大的差异。如何结合我国的教学现状并配合医学界教学改革进程,探索具有中国特色的模拟训练方案对提高我国医学教学质量及最大可能的保障患者安全具有重要意义。     

Evolution of the New Pathway curriculum at Harvard Medical School: the new integrated curriculum

In 1985, Harvard Medical School adopted a "New Pathway" curriculum, based on active, adult learning through problem-based, faculty-facilitated small-group tutorials designed to promote lifelong skills of self-directed learning. Despite the successful integration of clinically relevant material in basic science courses, the New Pathway goals were confined primarily to the preclinical years. In addition, the shifting balance in the delivery of health care from inpatient to ambulatory settings limited the richness of clinical education in clinical clerkships, creating obstacles for faculty in their traditional roles as teachers. In 2006, Harvard Medical School adopted a more integrated curriculum based on four principles that emerged after half a decade of self-reflection and planning: (1) integrate the teaching of basic/population science and clinical medicine throughout the entire student experience; (2) reestablish meaningful and intensive faculty-student interactions and reengage the faculty; (3) develop a new model of clinical education that offers longitudinal continuity of patient experience, cross-disciplinary curriculum, faculty mentoring, and student evaluation; and (4) provide opportunities for all students to pursue an in-depth, faculty-mentored scholarly project. These principles of our New Integrated Curriculum reflect our vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership.     

Biomechanics - Review of approaches for performance training in spinal manipulation

Motor skills development is an inherent part of clinical training in health disciplines. The conscious use of educational theory to ground learning is receiving increasing attention across health care education. There are three distinct, yet overlapping, stages of motor skill learning; the cognitive, the integrative or associative, and the autonomous; in which a contextual framework for learning content may be structured. The learning is associated with a mapping of changes within the central nervous system by the interactive mechanisms of adaptation, use-dependent plasticity and operant reinforcement. Successful skill learning requires a sufficient amount of practice and the implementation of relevant feedback strategies in the form of knowledge of performance (KP) or knowledge of results (KR). There is a natural maturation of skills that may be accelerated by feedback. Several factors contribute to stronger skills development. "Mixture-of-experts" models systematically sequence tasks into logical blocks of theory, practice and student reflection on performance. Feedback should involve both KP and KR that compares performance to a tangible standard. Rehearsals should balance use of simulators and volunteer simulated patients to provide the full range of safe and effective learning opportunities prior to students accepting a role as care givers to the public in any clinical setting.     

From cancer big data to treatment: Artificial intelligence in cancer research

In recent years, developing the idea of “cancer big data” has emerged as a result of the significant expansion of various fields such as clinical research, genomics, proteomics and public health records. Advances in omics technologies are making a significant contribution to cancer big data in biomedicine and disease diagnosis. The increasingly availability of extensive cancer big data has set the stage for the development of multimodal artificial intelligence (AI) frameworks. These frameworks aim to analyze high-dimensional multi-omics data, extracting meaningful information that is challenging to obtain manually. Although interpretability and data quality remain critical challenges, these methods hold great promise for advancing our understanding of cancer biology and improving patient care and clinical outcomes. Here, we provide an overview of cancer big data and explore the applications of both traditional machine learning and deep learning approaches in cancer genomic and proteomic studies. We briefly discuss the challenges and potential of AI techniques in the integrated analysis of omics data, as well as the future direction of personalized treatment options in cancer.     

On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians

We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of ‘patient’ and the role of ‘physician’. As a ‘physician’ the student operates the medical devices to clinically assess ‘patient’ colleagues and records all results in an electronic ‘patient’ record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated.The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students’ transition from preclinical to clinical subjects.     

标准化患者模拟结合案例情景对普外科见习教学的运用分析

目的：探究标准化患者模拟结合案例情景对普外科见习教学的运用。方法：选取我科2012年本科见习生120例进行随机分组,模拟组、案例组及联合组各40例,分别采用标准化患者模拟、案例情景及标准化患者模拟结合案例情景进行教学,对比三组见习生的学习效果,分析联合教学的运用方法。结果：联合组学生见习结束后学习兴趣、知识掌握情况及讲师满意度均显著高于其他两组,其课堂气氛活跃情况明显优于案例组（P〈0．05）;三组学生传统试题错题数无明显统计学差异（P〉0．05）,联合组学生病例分析错题数明显低于案例组及模拟组（P〈0．05）;见习结束时,联合组知识掌握程度及病历书写能力均显著优于模拟组及案例组,三组数据对比存在统计学差异（P〈0．05）。结论：标准化患者模拟结合案例情景能够有效弥补传统见习教学的不足,提高学生学习积极性、课堂活跃度及学习效果,使其知识掌握情况和病历书写能力得到大幅提升,是一种效果优秀的教学方式,值得广泛推广。     

What Is So Special About a Family Physician?

Around a core of common, acute and chronic, recurrent health problems, a family physician must marshall the traditional episodic management for both inpatient and outpatient illness. He must also be especially adept at recently emerging routines of prevention and early detection. He provides individual and familial psychologic support and counselling, for both its therapeutic and preventive values. In addition, he must relate the individual care of his patient and the patient''s family to the community as a whole. In doing this he will use not only his own skills but those of lay health volunteers, trained allied health care professionals and skilled subspecialists in the limited medical disciplines.The proper preparation of family physicians for this complicated role has far-reaching implications for change in both medical education and medical practice.     

Primary care--opportunities and threats. Developing professional knowledge: making primary care education and research more relevant.

The trio of recent government white papers heralds a new world for primary care. Many changes in the education of future primary health care professionals and in the research ethos of the discipline will be needed to realise this vision. New skills and attitudes, not least in multidisciplinary working; lifelong learning; and greater understanding of and participation in primary care research will have to emerge from educational efforts in the next few years.