Medical grand rounds: alive and well and living in Canada.

Grand rounds have long been the principal educational activity of departments of medicine at teaching hospitals. Several recent articles have suggested that there has been a general deterioration in the quality of grand rounds. To evaluate their status in Canada we mailed a questionnaire to the chairmen of the departments of medicine at the 53 Canadian teaching hospitals; of the 48 responses received (91%), 38 were from chairmen, 5 were from senior department members, and 5 were from chief residents. The results indicated that grand rounds continued to be the principal teaching exercise of the departments. Of the respondents 98% felt that the quality had improved or stayed the same. The overall attendance was considered to have improved or remained unchanged for the past decade by 75%; 25% thought that it had declined. The diminished emphasis on patient-related topics concerned 10%. The respondents gave numerous suggestions, which should help organizers to improve the impact of grand rounds on learning.     

The fault lines of academic medicine

Unprecedented advances in biomedical research and the upheaval in health care economics have converged to cause seismic changes in the traditional organization of medical schools and academic health centers. This process is particularly evident in departments of internal medicine. The activities and functions of academic medicine are in the midst of separation and realignment along lines that do not honor historical departmental and divisional boundaries. The organization of a successful medical school or department must be dynamic, constantly serving its constituents to accommodate progress and change and to promote optimal structure for academic productivity.     

医学病例在高校普通遗传学教学中的运用

遗传学是生命科学、医学、农学等相关领域的核心课程。作为21世纪生命科学中发展最为迅速的学科之一,教学内容复杂、更新快,遗传学知识对人一生的影响也日益增强,特别是与医学相关的遗传学知识更是受到大众关注。为使学生更容易理解深奥的遗传学知识,使教学内容更贴近生活,在教学过程中引入医学病例,将相应的医学病例同遗传学理论知识结合并作出适当的延伸,将有利于提高学生的遗传学知识综合分析能力,同时提高学生的学习积极性和实用技能。本文根据现代遗传学教学体系,引入相应的医学病例,强调培养学生综合遗传分析能力,为综合性大学、师范院校的普通遗传学教学提供参考。     

PBL教学模式在内科临床教学的应用探讨

内科是临床科室的重要组成部分,内科教学是为培养医务工作者的重要步骤,是医学生由学生向医生角色转变的桥梁。传统临床教学以知识灌输为主,学生学习积极性较低,教学质量较低。上世纪60、70年代问题导向(PBL)的教学方法被提出,为教学改革提供了一个全新的思路。本文将PBL教学方法应用于内科临床教学工作中,结合本学科的特点,以学生为中心,以问题为向导,充分发挥学生的学习积极性,提高教学质量,促进学生主动学习能力提高,帮助医学生建立完整的内科诊疗过程思维,进而达到临床内科教学目标。     

Prevalence of viral hepatitis among the hospital staff in CSR between 1980 and 1982

The hepatitis morbidity data were used to study prevalence rate of manifest viral hepatitis among the hospital staff members in CSR over a 3-year period between 1980 and 1982. This study showed that the overall hepatitis morbidity rate was 2.68 per 1,000 health personnel and was 3.6 times as high as that recorded in a normal population matched by age. The mean HBsAg positivity rate was 1.67 per 1,000 and was 5.8 times the rate in the control population group. The rate of HBsAg-negative cases of hepatitis was 1.01 per 1,000 health personnel and was higher than double the rate of morbidity encountered in an age-matched normal population. The highest morbidity rates were recorded in the lower-grade and auxiliary health personnel. When compared with an age-matched normal population the hospital staff members at all departments had distinctly higher morbidity rates than the general population, but the highest risk of acquiring viral hepatitis was evidently run by the personnel at departments of renal dialysis, biochemistry, hematology, infectious diseases, internal medicine, surgery, urology and TRD (tuberculosis and respiratory diseases). Of a total number of recorded cases of viral hepatitis those with HBsAg positivity predominated, especially at departments of urology, TRD, internal medicine, renal dialysis, psychiatry and hematology. Analyzed by specialty and professional status of personnel these viral hepatitis morbidity rates encountered among the hospital staff members seem to point to at least two conclusions: this infection in the health personnel is work-related and its transmission and spread is dependent on the frequency and intensity of contact with the blood and other secretions of infectious patients.     

" 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。     

Canadian departments of pediatrics and family medicine: in need of family therapy?

Whether and how much the departments of pediatrics in Canadian medical schools collaborate with the family medicine departments in training for child care were the focus of a survey conducted in 1983-84. Responses to a questionnaire sent to department heads indicated that in general the most supportive relationships existed in the western provinces, with progressively more problems uncovered from west to east. The responses concerning the roles of pediatricians and family physicians paralleled this trend, with the western view being that pediatricians are consultants and not competitors for primary care. Many respondents supported the expansion of family medicine, particularly into ambulatory and behavioural areas. The data provide some cause for concern about the future health care of children, as the forecasted oversupply of physicians is likely to encourage competition rather than consultation between the two groups. Also, many Canadian pediatricians accept the US model of pediatrics, which includes primary care, although in Canada the ratio of family physicians to pediatricians is six times that in the United States, and Canadian specialists are concentrated in urban centres. This means that family physicians will continue to provide most of the child care in Canada and need adequate training. They also need to develop cooperative, supportive relationships with specialists in child health care to enhance appropriate referral patterns.     

航空航天医学专业本科临床教学质量监控评价指标体系研究

目的:探讨航空航天医学专业本科临床教学质量监控评价指标体系,为航空航天医学专业本科临床教学质量提供监控标准。方法:参照《军队院校教学评价方法》,通过资料收集、专家座谈、个案分析方法,重点对航空航天医学人才的知识结构进行剖析,从教育设计(A1),教学条件(A2),过程管理(A3),质量评价(A4)四个角度分析,采用德尔菲法(Delphi)最终确定指标体系各要素。结果:目标层为:航空航天医学专业本科临床教学质量监控评价指标体系。中间层为ABCD四个等级;备选层为:教育设计、教学条件、过程管理、质量评价。汇总意见,构建航空航天医学本科临床教学质量监控评价指标体系。航空航天医学专业本科临床教学质量监控评价指标体系的实证应用结果:某军医大学检查结果得25个A标准,得3个B标准,达到优秀标准。结论:航空航天医学专业本科临床教学质量监控评价指标体系可行、有效。     

Human genetics teaching in U.S. medical schools.

Information about instruction in genetics was obtained fron 103 of the 107 U.S. four-year medical schools. Seventy-two percent of the schools provide a compulsory course in genetics, but there was great variation in duration, content, departmental responsibility for giving the course, and in the disciplines of those doing the teaching. The variability in the number of hours devoted to teaching genetics was reflected in the competence of the students in giving correct answers to questions on genetics posed by the National Board of Medical Examiners. Electives and continuing education courses on genetics are given by two-thirds and one-half of the schools, respectively; but the subject receives very little attention in departments of preventive, community, or family medicine or in schools of allied health sciences. These findings suggest that genetics has not yet found a natural and comfortable context in the curricula of U.S. medical schools.     

Bringing Conservation Medicine into the Veterinary Curriculum: The Tufts Example

The Center for Conservation Medicine at Tufts University School of Veterinary Medicine (TuftsCCM), has helped to define the concept of conservation medicine as a new science that examines the interaction between human, animal, and environmental health. One the Center’s main objectives in pursuing this new science has been to incorporate conservation medicine and ecosystem health principles into the veterinary curriculum. Environmental influences on disease dynamics in animals has always had a place in veterinary medicine, but often has not been adequately explored. Many opportunities exist within a traditional veterinary curriculum to strengthen this perspective, and to bring depth and new meaning to the understanding of disease and the role of animals in ecosystem health. The Tufts program is designed to reach both the general veterinary student and the student interested in a career in conservation medicine through core teaching, elective opportunities, research opportunities, and extracurricular seminars and workshops. The core curriculum exposes every veterinary student to an ecosystem health perspective of veterinary medicine that helps them realize the impact that this approach can have on their professional lives, regardless of their chosen specialty. Committed conservation medicine students benefit from specialty courses, a wide range of experiential and field research opportunities and active mentoring. Future challenges call for development of more graduate opportunities, continued interdisciplinary collaboration with other educational institutions, and continued curricular integration of this new paradigm of health and disease into veterinary medical education.     

Referral to medical outpatients department at teaching hospitals in Birmingham and Amsterdam.

A method of comparing the referral of patients by general practitioners to medical outpatients departments at teaching hospitals in Amsterdam and Birmingham was devised. This was applied to 89 referral letters to medical specialists at the Free University Medical School Policlinic in Amsterdam and to 88 referral letters to clinics at Birmingham University Medical School, UK. The standards of referral were lower in the Netherlands than in Britain, and this may be related to differences in the health care systems, in the culture, or in the organisation of general practice. The delay between the general practitioner''s referral and the consultation to the outpatient department was four times greater in Britain than in the Netherlands.     

Medical housing "lines".

General practitioners are often asked for medical certificates (housing "lines") by applicants for council housing who claim to have medical problems requiring housing priority. The results of a survey by questionnaire showed that general practitioners in Edinburgh do not know how the housing system works and that they seem to overestimate their patients'' chances of obtaining suitable council housing. General practitioners need to know how the housing system works, and communication between general practitioners and housing departments should be improved. A comparison was also made between the number of medical points awarded by a community medicine specialist and a group of general practitioners who had written housing "lines" for their patients. The general practitioners tended to award more points than the specialist. Social priority for housing should be recognised as an independent factor and a new category of top social priority added.     

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。     

Residency training in internal medicine: program design in an era of constraint.

Directors of postgraduate internal medicine programs face many problems in program design, particularly when numbers of house staff continue to decrease. This paper examines the training requirements of a resident in internal medicine and proposes a curriculum based on set rotations in the three key areas of training--subspecialty services, critical care and the clinical teaching unit. The distribution of time in these three areas and the balance of exposure to inpatients and outpatients are discussed in detail. This program design ensures exposure to all the key elements of internal medicine in 3 years and should prevent significant gaps in knowledge at the time of certification. The implications for "service" in major teaching hospitals is discussed. Hospital departments and administrators must confront the prospect of hospital units without house staff. Most important, program directors must resist sacrificing the pedagogic essentials of a training program for service requirements.     

The language of "Circule": discursive construction of false referral in Iranian teaching hospitals

This article explores the practice of false patient out-referral by medical students in Iranian teaching hospital emergency departments. Drawing on participant-observations and interviews during eight months in six hospitals in Tehran, we investigate how discourse is appropriated to construct and legitimate out-referrals through four general strategies of sympathy, mystification, intimidation, and procrastination. Based on a critical approach to false out-referral discourse, we revisit the medical and educational functioning of teaching hospitals in Iran: Focusing on medical students involved in false out-referrals, their discursive reproduction of deception is examined along with their legitimate challenges to institutional structures. Moreover, focusing on the institution of hospital, institutional corruption is discussed along with the problematic of covert cultural defiance faced by a modernist organizational construct in a nonmainstream cultural context. Finally, we argue that the discourse of false out-referral calls for more profound public awareness in dealing with health institutions.     

乙型脑炎病毒及其疫苗的研究进展

流行性乙型脑炎是由乙型脑炎病毒引起的、经蚊虫传播的严重危害中枢神经系统的人畜共患急性传染病,其重症病死率高,易造成永久性的神经系统后遗症,严重威胁着人类的健康。目前尚无特效的治疗流行性乙型脑炎的方法,控制蚊虫传播和免疫接种是当前的主要防御手段。简要综述了乙型脑炎病毒的基因组结构、结构蛋白与非结构蛋白功能、基因分型,以及流行性乙型脑炎疫苗的研究进展。     

General internal medicine reappears in the teaching hospital: the experience of the Royal Victoria Hospital.

The internal medicine unit of the Royal Victoria Hospital in Montreal was created in 1979 to improve the training of residents and the care of patients. The practices of four internists were brought together in one part of the institution, and within 2 years there were 10 attending staff and 6 residents. The unit now provides continuing care for 2500 patients, many of whom have multisystem or potentially lethal problems. Residents and attending staff share the responsibility of providing 24-hour coverage. The group handles 5000 outpatient visits per year (20% of them being consultations) and provides a general medical consulting service for other hospital departments, with about 300 consultations per year. The creation of the unit, with highly visible role models, appears to have given new prestige to general internists in the hospital. The unit has served as a model for the reorganization of the other medical clinics and provides a base for research in health care delivery.     

General medicine in the 'eighties.

The general physician with or without an interest is directly responsible for the initial and continuing care in most acute medicine. Specialty interests cover the whole range of medicine but in most instances are subordinate to the claims of general medicine. Consultants in district general hospitals carry a bigger caseload in acute medicine than their colleagues in teaching hospitals, and this has implications for undergraduate and postgraduate training. The management of patients in intensive care units remains very much the task of the general physician. The general physician will continue to be an essential member of the hospital service in the foreseeable future.     

Undergraduate medical education.

Pressures from students and teachers, from professional bodies, and from changes in the way health care is delivered are all forcing a rethink of how medical students should be taught. These pressures may be more intense in London but are not confined to it. The recommendation the Tomlinson report advocates that has been generally welcomed is for more investment in primary care in London. General practitioners have much to teach medical schools about effective ways of learning, but incentives for teaching students in general practice are currently low, organising such teaching is difficult and needs resources, and resistance within traditional medical school hierarchies needs to be overcome. Likewise, students value learning within local communities, but the effort demanded of public health departments and community organisations is great at a time when they are under greater pressure than ever before. The arguments over research that favour concentration in four multifaculty schools are less clear cut for undergraduate education, where personal support for students is important. An immediate concern is that the effort demanded for reorganising along the lines suggested by Tomlinson will not leave medical schools much energy for innovating.