医学研究生灾难医学知识的初步调查及对策

目的了解医学研究生对灾难医学相关知识的认知情况。方法通过发放调查问卷,对我校2008-2011年入学的458名医学研究生进行灾难医学相关知识调查分析。结果医学研究生对灾难医学的基本概念、基本急救技术、灾后心理援助以及传染病的预防及处理相关知识掌握较好,但对灾难伤员的检伤分类、灾难医学管理相关知识掌握明显不足。结论医学研究生掌握灾难医学相关知识已明显提高,但仍存在不足,应加强医学研究生急救技能培训、开设灾难医学选修课,以提高我国灾难医学救援整体水平。     

高职高专临床医学教育早期接触临床的途径和方法

随着经济、社会的发展,社会保障制度的完善,基层医院的医疗资源和医疗水平逐渐完善和提高,在基层医院就诊看病的人数也越来越多。因此,大力培养基层医院的临床医学人才是高等医学院校应该担当的责任。本文针对高职高专的短学制临床医学教育,改变传统的教学模式,提出早期接触临床的途径和方法,着力从以下几个方面入手,一是整合基础医学和临床医学的综合课程;二是综合实验项目内容专题化、研究化;三是实行阶段式教学;四是实行临床预见习和观摩手术。因而有效解决了大专层次的临床医学教育学制短、临床技能不足的缺陷。     

" 床旁教育" 在本科教学中的运用与价值

随着现代医学的发展,医学教育目标从1988年《爱丁堡宣言》中"培养促进全体人民健康的医生"进一步丰富完善,200年国际医学教育委员会公布了本科《医学教育全球最低基本要求》,包括职业价值、态度、行为与伦理、医学科学基础知识、临床技能、交流沟通技能、群体健康与卫生系统、信息管理、批判性思维与研究7个基本方面。在新的社会-医学模式中,本科医学教育也不再是单纯的课堂基础医学知识的教育,通过"床旁教育"培养学员职业价值、态度、行为伦理、临床技能、交流沟通、信息管理等能力也更加重要。我们在新的形式下,结合课堂基础医学知识学习,注重"床旁教育"多维一体的本科医学教育,实现了全面培养与提高学员的综合能力。"床旁教育"作为一种教学新模式,是培养学员思维能力和综合素质、提高教学效果的有效方法和手段,值得进一步完善和推广。     

An evaluation of case-based teaching: evidence for continuing benefit and realization of aims

A cross-sectional evaluation of case-based teaching (CBT), a novel physiology learning environment for medical undergraduates, revealed that second, third, and fourth year students, together with their tutors, valued CBT as an experience that met its three major aims. The initiative not only integrated physiology with related basic sciences and clinical medicine but importantly linked students' developing knowledge of theory to practice. CBT was also valued by students as their first introduction to clinical skills, with most tutors believing that it was the nonthreatening environment that helped students gain confidence for their first "real patient" encounters. The greatest support for CBT came from third year medical students, at the crossroads between their preclinical and clinical environments. Fourth year students, now encountering real patients, had moved on to developing their skills in the hospital environment.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

Knowledge Levels and Training Needs of Disaster Medicine among Health Professionals,Medical Students,and Local Residents in Shanghai,China

Background

Disaster is a serious public health issue. Health professionals and community residents are main players in disaster responses but their knowledge levels of disaster medicine are not readily available. This study aimed to evaluate knowledge levels and training needs of disaster medicine among potential disaster responders and presented a necessity to popularize disaster medicine education.

Methods

A self-reporting questionnaire survey on knowledge level and training needs of disaster medicine was conducted in Shanghai, China, in 2012. A total of randomly selected 547 health professionals, 456 medical students, and 1,526 local residents provided intact information. The total response rate was 93.7%.

Results

Overall, 1.3% of these participants have received systematic disaster medicine training. News media (87.1%) was the most common channel to acquire disaster medicine knowledge. Although health professionals were more knowledgeable than community residents, their knowledge structure of disaster medicine was not intact. Medical teachers were more knowledgeable than medical practitioners and health administrators (p = 0.002). Clinicians performed better than public health physicians (p<0.001), whereas public health students performed better than clinical medical students (p<0.001). In community residents, education background significantly affected the knowledge level on disaster medicine (p<0.001). Training needs of disaster medicine were generally high among the surveyed. ‘Lecture’ and ‘practical training’ were preferred teaching methods. The selected key and interested contents on disaster medicine training were similar between health professionals and medical students, while the priorities chosen by local residents were quite different from health professionals and medical students (p<0.001).

Conclusions

Traditional clinical-oriented medical education might lead to a huge gap between the knowledge level on disaster medicine and the current needs of disaster preparedness. Continuing medical education and public education plans on disaster medicine via media should be practice-oriented, and selectively applied to different populations and take the knowledge levels and training needs into consideration.     

The clinical psychologist; his role in private medical practice

The independent diagnosis and treatment of mental and nervous disorders according to California law constitutes practicing medicine. By this yardstick, an increasing number of clinical psychologists are entering the private practice of medicine. The medical profession has not provided through its leadership the opportunity for clinical psychologists to utilize their skills in a legitimate and supervised way in the treatment of private patients, nor has the medical profession taken sufficient interest in modern methods of treating patients with psychogenic disorders. If the psychiatric team is a feasible and practical approach to spreading the base of psychiatric treatment in hospitals and clinics, it should be applicable to private practice settings too. In the team setting, the psychologist can render great assistance to the physician in the diagnosis and treatment of patients with psychogenic disorders without compromising the principle that the primary responsibility for the patient is the physician's. By virtue of his training and experience, it is the psychiatrist who is best qualified to supervise the work of the psychologist; and until such time as the medical profession is better acquainted with psychotherapeutic techniques, the employment of psychologist assistants should be (according to good medical practice) left to the psychiatrist. The need for some regulation of the use of the title "psychologist" is increasing in order to protect the public from quacks who pose as psychologists. However, any law which is directed toward elimination of the quack should specifically define psychotherapy and contain provisions for its use under adequate medical supervision. The medical profession is obligated to take its traditional role in providing the best possible treatment for patients who are in need of it, and psychotherapy is an inherent part of treatment.     

Medical students as medical educators: opportunities for skill development in the absence of formal training programs

All physicians, at some point in their career, are responsible for the education of their peers and junior colleagues. Although medical students are expected to develop clinical and research skills in preparation for residency, it is becoming clear that a student should also be expected to develop abilities as a teacher. A handful of institutions have student-as-teacher programs to train medical students in education, but most students graduate from medical school without formal training in this area. When such a program does not exist, medical students can gain experience in education through participation in peer teaching, course design, educational committees, and medical education scholarship. In doing so, they attain important skills in the development, implementation, and evaluation of educational programs. These skills will serve them in their capacity as medical educators as they advance in their careers and gain increasing teaching responsibility as residents, fellows, and attending physicians.     

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。     

军校预防医学专业本科学员临床课程教学现状及建议

随着医学模式的转变,预防医学已经成为现代医疗体系的重要组成部分,在提高公共卫生健康水平方面发挥着越来越重要的作用。为了更好地开展预防医学工作,预防医学专业学员不仅要掌握牢固的预防医学专业知识,更要具备丰富的临床医学知识。针对预防医学专业本科学员的临床课程教学,我校经过多年的探索与改革,已经积累了丰富经验,教学质量较高;但现阶段仍然存在着一些问题。本文分析我校预防医学专业本科学员临床课程的教学现状及存在的主要问题,并提出建议;从而为进一步提高预防医学专业本科学员的临床课程教学质量提供依据。     

Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine

ObjectiveTo develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills.DesignDevelopment and validation of an assessment instrument and before and after study.SettingVarious postgraduate short courses in evidence based medicine in Germany.ParticipantsThe instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds.InterventionIntensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups.ResultsThe questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention.ConclusionsThe instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.

What is already known on this topic

Numerous observational studies have investigated the impact of teaching evidence based medicine to healthcare professionals, with conflicting resultsMost of the studies were of poor methodological quality

What this study adds

An instrument assessing basic knowledge and skills required for practising evidence based medicine was developed and validatedAn intensive 3 day course on evidence based medicine for doctors from various backgrounds and training level led to a clinically meaningful improvement of knowledge and skills     

人文素质教育与医学免疫学专业教育的整合

当前,人们的健康观念和生活方式发生了改变,对医疗卫生服务的需要和期望也发生了变化。然而,医学教育长期以来过分注重医学生的专业知识教育而忽视了人文素质教育,这使得医学生缺乏爱伤观念,对待病人冷漠、和不负责任,功利心较重,缺少奉献精神,从而加剧了医患关系紧张。因此,把医学生人文教育渗透到医学生专业学习的各个过程,使人文素质教育与医学专业教育完美的整合,才能培养出同时具有精湛医术和人文智慧、德才兼备的医生。医学免疫学是生命科学的前沿学科,是联系基础医学和临床医学的桥梁学科之一,也是医学本科生的一门重要的主干课程,其理论和实验技术发展迅猛。本文从医学免疫学专业理论课、实验课、考核等不同环节探讨了人文素质教育和医学免疫学专业教育的整合,进一步地寻找医学免疫学教学中人文素质教育的有效途径,为医学生的人文素质的全面提高提供有益的支持。     

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.     

康复医学本科教育增加循证医学内容的必要性及教学体会

目的:探讨康复医学本科教育增加循证医学内容的必要性。方法:将我校95名11-12级临床医学本科班选修康复医学专业学生随机分为对照组与观察组,对照组采取传统教学模式,观察组采取循证医学模式。对两组学生的教学效果进行评价。结果:对照组学生对病因学、诊断性试验、治疗性试验、药物不良反应、病情预后、临床经济学、卫生技术评估及临床决策分析等知识的掌握度均显著低于观察组(P0.05);对照组学生的案例测验得分、临床技能考核成绩及学生问卷评分均显著低于观察组(P0.05);对照组中咨询老师及高年资医生、阅读相关杂志及3周内检索过MEDLINE的学生的比率均显著低于观察组(P0.05)。结论:循证医学教学模式的教学效果显著优于传统教学模式,应加以推广。     

“早期接触临床”教学模式在“医学微生物学”课程改革中的探索

“早期接触临床、进入医生角色”是21世纪我国高等医学教育改革的主流方向。立足现行临床医学专业五年制“医学微生物学”教学模式的不足,从理论和实践教学两方面进行改革,增加“早期接触临床”理念的理论课、讨论课和见习课,构建适合本课程的“早期接触临床”教学模式。通过期末考试卷面成绩分析及问卷调查评价教学效果。结果表明“早期接触临床”教学模式可有效整合基础理论与临床实践,激发学生的学习动力,并在一定程度上提高学生的学习成绩和综合分析能力,同时加深学生对医学和职业的理解。     

THE ROLE OF GOVERNMENT IN MEDICINE

On the fundamental question of how far a government should be involved in health services, the author believes these things can appropriately be said: The government should continue to assume complete control over public health measures, and public health officials could well be permitted to invade medical services insofar as is necessary to achieve public health ends.To assist in the production of medical personnel, it is also fitting for the government to provide for increased teaching facilities, higher salaries for teachers in the medical field and scholarships for worthy students.In the area of insurance and prepayment plans, a really intelligent supervision of such devices, with the exercise of no more arbitrary governmental power than is now used by the various other regulatory commissions, is a suitable governmental function. The government''s buying policies for its wards, rather than providing direct medical services for them, should be encouraged. This would give the private practice of medicine a boost and would improve the quality of medical care. Government should encourage the regionalization of medical services with as much of the actual controls exercised at the local level as can be achieved. Private means should be utilized for the provision of these services and public means should be used for their payment when this is an obligation of the government.The problem of mass education in health matters should be tackled by government. It would be a fine thing if the medical profession and governmental agencies could agree upon delineation of their respective roles in the health field.Because further experimentation is needed before the ideal solution is found, both government and organized medicine should encourage the exploration of new approaches.     

新形势下加强医疗服务质量监管的路径选择

卫生服务质量包括公共卫生服务质量和医疗服务质量。其中,医疗服务质量直接关系到患者的生命与健康,是卫生服务的核心工作。目前,医疗服务市场”信息不对称”,因此,如何有效的监管医疗机构的服务质量成为政府的重要职责之一。本文在明确医疗服务质量监管内涵的基础上,结合我国监管现状,指出我国医疗服务领域所存在的监管主体单一、监管力量薄弱、监管法规有待完善、监管过程缺乏常态化、监管结果未能及时公开等方面的不足,并针对上述不足之处,提出四点政策建议：一是以政府为核心,培育多元监管主体;二是以信息化建设为平台,创新监管手段;三是以法规建设为重点,完善监管体系;四是加强监管结果的运用。     

浅谈对医学生临床思维与临床技能提高的培养

为适应目前医学事业发展的需要,医学生的临床思维与临床技能的培养至关重要。在教学中,应不断提高教师自身的业务水平和自身素质,给予学生适当引导和启发,采取灵活多样的教学方式,并鼓励学生学会独立思考能力,激发学生的主动性和创造性,同时理论与实践相结合,推出模拟教学,由此激发学生的学习兴趣;并通过病例的采集归纳和整理,加强基本功的训练。从而提高学生临床思维能力与标准实践技能。     

Developing a Curriculum for Evolutionary Medicine: Case Studies of Scurvy and Female Reproductive Tract Cancers

Most early evolutionary thinkers came from medicine, yet evolution has had a checkered history in medical education. It is only in the last few decades that serious efforts have begun to be made to integrate evolutionary biology into the medical curriculum. However, it is not clear when, where (independently or as part of preclinical or clinical teaching courses) and, most importantly, how should medical students learn the basic principles of evolutionary biology applied to medicine, known today as evolutionary or Darwinian medicine. Most clinicians are ill-prepared to teach evolutionary biology and most evolutionary biologists ill-equipped to formulate clinical examples. Yet, if evolutionary science is to have impact on clinical thought, then teaching material that embeds evolution within the clinical framework must be developed. In this paper, we use two clinical case studies to demonstrate how such may be used to teach evolutionary medicine to medical students in a way that is approachable as well as informative and relevant.     

药用植物学立体化课程体系的构建与实践

药用植物学是医学院中药、药学等相关专业和高等农业院校中药资源开发与利用等专业的专业基础课,是培养相关专业学生掌握和运用药用植物形态解剖学及系统分类学的基本知识和技能,准确识别和鉴定药用植物种类,保证临床用药准确有效的重要课程。课题组通过整合药用植物学教学内容,建立多元化的教学方法,构建多层次实践教学体系,建立合理的综合性考核评价体系,培养学生双创能力。