Changes in undergraduate attitudes toward medical ethics.

To detect any change in medical students'' attitudes toward medical ethics, students from the same class were given a questionnaire on their first day of medical school and again near the end of their fourth year of study. The results showed a strong shift away from the students'' initial expectations that they would rely on specialists or scholarly sources in the future; the need for a medical ethics course in the curriculum, while still felt, was less important to them by the fourth year. The reasons for these changes were not apparent, for the students'' levels of knowledge and perceptions of the role of ethics in medicine in the first and fourth years did not differ. It is recommended that medical school faculty actively reinforce the initially positive attitudes of students during clinical supervision.     

" 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。     

International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of S?o Paulo School of Medicine in Ribeir?o Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.     

提高临床实习教学质量的实践与体会

临床实习是医学生大学教育阶段的重要组成部分,是医学生向临床医生转型的过渡时期。临床实习质量的高低直接关系到医学生的培养质量。在实习期间培养出扎实的临床基本功、科学的临床思维和高尚的医德医风对于医学生而言是非常重要的。同时,临床实习教学也是医学院校及教学医院的工作重心。作为教学医院,我院多年来积极推进教学改革,不断探索提升临床实习质量的方法,部分科室率先开展了PBL等新的教学模式,并取得了卓越的成效。我院领导阶层也通过抓好教学准备、提升带教质量、严格实习考核等方面的工作,全面提升了临床实习教学质量,从而提高了医学生的综合素质,也为提高执业医师考试通过率打下了坚实的基础。     

Euthanasia, ethics and economics

The financial aspects of legalizing active euthanasia rarely have been discussed. H?yry and H?yry argue that there are no good grounds for ignoring the connection between euthanasia and the need to conserve medical resources. Their paper is intended to offer a rough sketch of how ethics and economics may legitimately work side by side in the debate over euthanasia.     

医学生早期教育阶段综合能力培养之探索

现代医学模式要求医务工作者必须是高素质的人才。基础医学教育阶段是医学生培养过程中的基础环节和重要阶段,与临床教学阶段相比,基础教育阶段更有利于学生综合能力培养和开展素质教育。医学生综合能力的培养在医学教育中具有重要的地位,它的实现要靠教育者在教育教学的各个环节中主动施行,积极探讨医学生综合能力培养的有效实施途径和方法。我们课题组根据多年从事医学生人才培养的教育教学经验,针对医学生早期教育阶段的心理、生理、环境、知识结构特点,围绕综合能力培养这个核心课题,强化创新性人才培养,系统有序地按学生学习时间和课程进行各种能力的逐一培养,从学习能力,思维能力,观察能力,动手能力,合作能力,分析问题和解决问题能力,判断是非能力,语言表达能力,写作能力,创新开拓能力等,探索医学生早期教育阶段综合能力培养模式。     

An Ethical Fa?ade? Medical Students' Miscomprehensions of Substituted Judgment

Background

We studied how well first-year medical students understand and apply the concept of substituted judgment, following a course on clinical ethics.

Method

Students submitted essays on one of three ethically controversial scenarios presented in class. One scenario involved a patient who had lost decisional capacity. Through an iterative process of textual analysis, the essays were studied and coded for patterns in the ways students misunderstood or misapplied the principle of substituted judgment.

Results

Students correctly articulated course principles regarding patient autonomy, substituted judgment, and non-imposition of physician values. However, students showed misunderstanding by giving doctors the responsibility of balancing the interests of the patient against the interests of the family, by stating doctors and surrogates should be guided primarily by a best-interest standard, and by suggesting that patient autonomy becomes the guiding principle only when patients can no longer express their wishes.

Conclusion

Students did not appear to internalize or correctly apply the substituted judgment standard, even though they could describe it accurately. This suggests the substituted judgment standard may run counter to students'' moral intuitions, making it harder to apply in clinical practice.     

Innovations in human genetics education. Alternative methods of instruction in medical genetics

A course in medical genetics for first-year medical students was developed with the use of alternative methods of instruction, including audiovisual materials and computer-assisted instruction. The use of this methodology enabled students to consider many significant areas of medical genetics, without a dependency on the traditional lecture-based instructional format. Seventy-eight percent of the students identified the alternative instructional methods as an enhancement to their education. These students performed a mean of 6% better on class examinations.     

医德视域下医学生医学精神的建构

近些年来,我国十分重视医学生职业道德教育,然而,在医德教学实践中仍存在着观念落后、内容失衡和方法单一等多方面问题。同时,随着我国多元结构社会的形成,医学生的思想状况和价值观趋于复杂化,从业时职业道德水平出现滑坡。针对目前医学生医德教育存在的种种问题,试图从加强和改进医学生医德教育的角度,探索医学生医德教育改革,增强医学生医德教育的实效性。     

Medical student perceptions of a behavioural and social science curriculum

Background In 2006, Oregon Health & Science University began implementing changes to better integrate mental health and social science into the curriculum by addressing the Institute of Medicine''s (IOM''s) 2004 recommendation for the inclusion of six behavioural and social science (BSS) domains: health policy and economics, patient behaviour, physician–patient interaction, mind–body interactions, physician role and behaviour, and social and cultural issues.Methods We conducted three focus groups with a purposive sample of 23 fourth-year medical students who were exposed to 4 years of the new curriculum. Students were asked to reflect upon the adequacy of their BSS training specifically as it related to the six IOM domains. The 90-minute focus groups were recorded, transcribed and analysed.Results Students felt the MS1 and MS2 years of the curriculum presented a strong didactic orientation to behavioural and social science precepts. However, they reported that these principles were not well integrated into clinical care during the second two years. Students identified three opportunities to further the inclusion of BSS in their clinical training: presentation of BSS concepts prior to relevant clinical exposure, consistent BSS skills mentoring in the clinical setting, and improving cultural congruence between aspects of BSS and biomedicine.Conclusions Students exposed to the revised BSS curriculum tend to value its principles; however, modelling and practical training in the application of these principles during the second two years of medical school are needed to reinforce this learning and demonstrate methods of integrating BSS principles into practice.     

Development and evaluation of a community based,multiagency course for medical students: descriptive survey

Objective: To develop and evaluate an effective, community based, multiagency course (involving doctors, nurses, non-health statutory workers, and voluntary organisations) for all Leicester medical students, in response to the General Medical Council’s recommendation of preparing the doctors of tomorrow to handle society’s medical problems. Design: Survey evaluating a task oriented, problem solving course, designed by medical students in partnership with the University of Leicester and the local community. The students, staff, and participating agencies and patients all helped in the evaluation of the first course. The students’ performance on the course was also individually assessed. Setting: Inner city housing estate with Jarman index 64.1 in Leicester. Subjects: All third year medical students at Leicester University. Main outcome measures: Results of the student assignments and students’ responses to a questionnaire. Results of feedback questionnaires distributed to the patients and agency representatives. Results: In a two month period, 168 students completed the first course. 163 students passed the criterion referenced assignment, 50 of whom achieved an “excellent” grade. 166 completed the questionnaire, with 159 wishing to see the course continue in the present format and 149 saying that the course linked theoretical teaching with the practical experiences gained in the community. Conclusions: The University of Leicester has a viable mechanism for providing a community based, multiagency course for all its medical students. Many of the principles applied in the development and implementation of the course could be transferred to other medical schools.

Key messages

• Health policy increasingly emphasises the need for multidisciplinary service provision and training
• A new course for third year medical students provides practical and reproducible multiagency learning in the community
• Medical students and local community organisations participated in the development of the course
• Students received quality experiences with minimum inconvenience to agencies
• The structure of the course could be used in other medical schools

     

The effect of a compulsory curriculum on ethical attitudes of medical students

The purpose of the present study was to assess the influence of a compulsory curriculum on first-year medical students. The ethical attitude study was performed at the School of Medicine, University of Rijeka, Croatia. The samples consisted of 171 medical students (68 males and 103 females) interviewed at the beginning of the first year of studies. Some of them, namely 143 (56 males and 87 females) were interviewed again at the end of the same academic year. Data were analysed by applying factor analysis under principal component model and varimax criterion as the rotation model. The results clearly show that the current compulsory curriculum without formal ethical education has a limited influence on first-year medical students. That points to the obvious necessity to implement the medical ethics in the course of medical education.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

TK3 eBook software to author, distribute, and use electronic course content for medical education

The methods for authoring and distributing course content are undergoing substantial changes due to advancement in computer technology. Paper has been the traditional method to author and distribute course content. Paper enables students to personalize content through highlighting and note taking but does not enable the incorporation of multimedia elements. Computers enable multimedia content but lack the capability of the user to personalize the content. Therefore, we investigated TK3 eBooks as a potential solution to incorporate the benefits of both paper and computer technology. The objective of our study was to assess the utility of TK3 eBooks in the context of authoring and distributing dermatology course content for use by second-year medical students at the University of Utah School of Medicine during the spring of 2004. We incorporated all dermatology course content into TK3 eBook format. TK3 eBooks enable students to personalize information through tools such as "notebook," "hiliter," "stickies," mark pages, and keyword search. Students were given the course content in both paper and eBook formats. At the conclusion of the dermatology course, students completed a questionnaire designed to evaluate the effectiveness of the eBooks compared with paper. Students perceived eBooks as an effective way to distribute course content and as a study tool. However, students preferred paper over eBooks to take notes during lecture. In conclusion, the present study demonstrated that eBooks provide a convenient method for authoring, distributing, and using course content but that students preferred paper to take notes during lecture.     

基于“以学为中心”的医学微生物学课程教学改革与实践

“医学微生物学”是临床医学专业的核心课程,理论性和实践性较强。面向国家对医学人才培养目标的变化、如何在教学过程中以学为中心,以及注重学生能力素质的培养是本课程教学改革的重要环节。我们依据学情分析结果,通过翻转课堂、挖掘课程思政元素、基于问题的学习(problem-based learning,PBL)讨论课、虚拟仿真实验及临床见习课、开放性实验等教学手段综合运用进行课程的教学改革。实践证明,该教学改革体系使课程教学与医学人才培养挂钩,能够充分调动学生积极性、提高创新能力及服务意识,实现了师生共赢,圆满完成教学目标。     

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。     

Publication: an ethical imperative.

Publication of medical research is both a monitor of the researcher''s ethics and an audit of the local or regional ethics committee that approved it. Selectivity of publication or of the intention to publish lessens this audit. Opinions differ about what is ethically allowable in clinical and benchtop medical research. Ethical permission and ethical monitoring of medical research are subject to a hierarchy of pyramidal controls, starting in hospital and ending with the local, institutional, or regional ethics committee. Currently, such committees function with widely varying degrees of efficiency and quality of output, and with differing viewpoints on many ethical issues. Without an a priori insistence by institutional ethics committees that there be an intention to publish all medical research involving human subjects, ethics committees cannot routinely be subject to the scrutiny or audit which they themselves demand of researchers.     

全球化背景下医学伦理学教学改革的探索

医学伦理学理论和实践根植于一定时期的社会经济、文化和教育,并随之发生改变和发展。随着全球经济一体化的进展完善,不同国家的文化和教育已在全球范围内互联互通并进而影响异乡本土医学文化。从目前我国医学伦理学教育和实践看,医学伦理学教学及评价体系已不能满足日新月异的全球化医学发展进程。本文从传统医学文化和医学伦理学的理论渊源入手,针对我国医学伦理学教学实践中存在的德性培育重视不足、临床决策能力培养缺失、标准化评价体系缺失等主要问题,探析教学改革的路径,以促进医学伦理学教学理论和实践的发展。     

Hybrid lecture-online format increases student grades in an undergraduate exercise physiology course at a large urban university

Hybrid courses allow students additional exposure to course content that is not possible in a traditional classroom environment. This exposure may lead to an improvement in academic performance. In this report, I describe the transition of a large undergraduate exercise physiology course from a traditional lecture format to a hybrid lecture-online format. A total of 658 final grades (traditional = 346, hybrid = 312) was used to evaluate the effect of course format on academic performance. The hybrid online portion was delivered using WebCT Vista, enhanced with various instructional technologies. The hybrid lecture portion was enhanced with an in-class response system. PowerPoint files were used to distribute in-class lectures in both formats of the course. Final student grades were 9.9% higher (83% of the increase due to an increase in the exam grade) when the course was administered in a hybrid format (P = 0.01), which translated to a one letter grade increase on a standard grading scale. Transition from a traditional lecture format to a hybrid format significantly enhanced student learning; presumably, this increase is due to the fact that students were able to increase their exposure to course content via access to material on WebCT.