Participation of Children in Medical Decision-Making: Challenges and Potential Solutions

Participation in healthcare decision-making is considered to be an important right of minors, and is highlighted in both international legislation and public policies. However, despite the legal recognition of children’s rights to participation, and also the benefits that children experience by their involvement, there is evidence that legislation is not always translated into healthcare practice. There are a number of factors that may impact on the ability of the child to be involved in decisions regarding their medical care. Some of these factors relate to the child, including their capacity to be actively involved in these decisions. Others relate to the family situation, sociocultural context, or the underlying beliefs and practices of the healthcare provider involved. In spite of these challenges to including children in decisions regarding their clinical care, we argue that it is an important factor in their treatment. The extent to which children should participate in this process should be determined on a case-by-case basis, taking all of the potential barriers into account.     

The Status of Medical Education: A Medical Student's Viewpoint

Any educational process involves four distinct stages: the selection of goals, the selection of learning experiences, the organization of these experiences and the evaluation of achievement. If the results of evaluation are unsatisfactory, then the goals were unrealistic, the learning experiences were inadequate, or the experiences were poorly organized.The characteristics of the good physician and the recognition of these in candidates for medical education are matters of great interest. Does a student learn because he has good teachers or because he has proper motivation for success? Is it possible for one to teach another, and if so, what is the best technique of instruction? How can the student best be evaluated?Medical education is in a state of rapid change, but changes of significance will not occur until the quality of the teachers is improved and the barriers of departmental organization are removed, thus putting the students'' instruction in the hands of persons unbiased by concentration on a small field of endeavour.     

高等医学教育中临床实习工作的几点思考

临床实习是医学院校学生走向临床工作不可逾越的阶段,是高等医学教育的重要组成部分,是医学生成长为合格的临床医生的必经之路。然而,目前临床实习过程中存在着带教教员任务繁重,缺乏教学热情;实习学生面临就业、考研等多重压力以及临床教学模式单一、临床实习考核流于形式等问题。针对这些问题所导致的医学生临床实习质量下降的现象,探讨提高实习质量的方法,以保证高等医学人才培养的质量。     

高等医学教育中临床实习工作的几点思考

临床实习是医学院校学生走向临床工作不可逾越的阶段,是高等医学教育的重要组成部分,是医学生成长为合格的临床医生的必经之路。然而,目前临床实习过程中存在着带教教员任务繁重,缺乏教学热情;实习学生面临就业、考研等多重压力以及临床教学模式单一、临床实习考核流于形式等问题。针对这些问题所导致的医学生临床实习质量下降的现象,探讨提高实习质量的方法,以保证高等医学人才培养的质量。     

Law and Society in Seattle: Law-Related Education as Culturally Responsive Teaching

In this article, I provide a portrait (Sara Lawrence-Lightfoot and Jessica Hoffman Davis 1997) of a renowned law-related education (LRE) program, its teacher, and four of its student-participants. Following the portrait, I discuss theoretical explanations for the success of ethnic-minority students in this and other LRE programs. These explanations include the nature of law as a difficult subject, the many convergences between culturally responsive teaching and LRE, and the relation of the content and methods of LRE to the cultural capital, interests, backgrounds, and ethnic identities of the students. I conclude with a discussion of the reciprocal nature of these processes, research on white teachers who are successful in multicultural contexts, the importance of challenging, accelerated classes, and an argument for expanding research on culturally responsive teaching and the achievement of students of color to include attention to the methods and materials of LRE.     

The Oslerian Tradition and Changing Medical Education: A Reappraisal

Although only 21 of Sir William Osler''s 45 years in academic medicine were spent in US medical schools (1884 to 1905), he played a major role in shaping modern medical education in this country. The integration of scholarship with patient care, together with the science and art of medicine, was central to Osler''s teaching and writing throughout his career. A classic generalist and a charismatic clinical teacher, he taught by example and was as concerned with the ideals of medicine as with its science and knowledge.Many changes have reshaped the content, process and concerns of American medical education since Osler''s time. Subspecialization and balkanization of medical education and practice have become dominant. Many of the important issues in medicine today do not fit neatly into the domain of any of the established specialties or medical organizations. There is now an urgent need to promote generalist attitudes in medicine, and the Oslerian tradition has much to offer in approaching today''s problems in medical education and practice.     

Structural and Decision-Making Models: A Political Example

In this paper decision and structural models are distinguished on conceptual and empirical grounds. At one level of analysis the two models discharge different functions and apply to distinct logical universes. At another level, the two models apply to similar kinds of reality. Political data from a village in India provides an example of the application of these models at both levels of analysis. Finally, propositions are formulated that clarify the employment of these models for other kinds of data.     

Decision-Making about Healthcare Related Tests and Diagnostic Strategies: User Testing of GRADE Evidence Tables

Objective

To develop guidance on what information to include and how to present it in tables summarizing the evidence from systematic reviews of test accuracy following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Methods

To design and refine the evidence tables, we used an iterative process based on the analysis of data from four rounds of discussions, feedback and user testing. During the final round, we conducted one-on-one user testing with target end users. We presented a number of alternative formats of evidence tables to participants and obtained information about users’ understanding and preferences.

Results

More than 150 users participated in initial discussions and provided their formal and informal feedback. 20 users completed one-on-one user testing interviews. Almost all participants preferred summarizing the results of systematic reviews of test accuracy in tabular format rather than plain text. Users generally preferred less complex tables but found presenting sensitivity and specificity estimates only as too simplistic. Users found the presentation of test accuracy for several values of prevalence initially confusing but modifying table layout and adding sample clinical scenarios for each prevalence reduced this confusion. Providing information about clinical consequences of testing result was viewed as not feasible for authors of systematic reviews.

Conclusion

We present the current formats for tables presenting test accuracy following the GRADE approach. These tables can be developed using GRADEpro guidelines development tool (www.guidelinedevelopment.org or www.gradepro.org) and are being further developed into electronic interactive tables that will suit the needs of different end users. The formatting of these tables, and how they influence result interpretation and decision-making will be further evaluated in a randomized trial.