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。     

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.     

Medical schools seeking new ways to cope with funding cutbacks

Cuts in government funding mean that Canada''s medical schools have to seek new ways to raise funds. Susan Thorne examines some of the ways faculties of medicine are coping with change. In the brave new world of medical education, schools are combining classes for medical students and other health professionals, seeking business alliances, encouraging attendance by full-tuition students from other countries and diversifying revenue bases through new programs, such as McGill''s new 5-year MD-MBA degree.     

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。     

Another Look at the Medical “Generation Gap”—Second Triennial Survey of Attitudes of Medical Students and Recent Graduates

A 1969 survey of attitudes held by medical students and recent graduates was repeated in 1972, using the same samples of respondents and adding a new freshman group. Findings from both surveys showed that a “generation gap” existed on many issues.Furthermore, a comparison of the two studies suggested that two kinds of attitude change are occurring simultaneously. On some issues, the next generation of physicians will probably continue to differ from their predecessors. Perhaps the primary thread woven through this cluster of attitudes is that today''s medical students and young physicians perceive themselves as members of a larger structure for providing health care.However, many of the students'' attitudes held early in their medical careers appear to have been modified in the process of becoming physicians. It appears that medical education continues to convey many traditional professional values to students, and it seems likely that tomorrow''s physicians will retain a core of those values.     

Effect of Supervised Students' Involvement on Diagnostic Accuracy in Hospitalized Medical Patients �� A Prospective Controlled Study

Background

During internships most medical students engage in history taking and physical examination during evaluation of hospitalized patients. However, the students'' ability for pattern recognition is not as developed as in medical experts and complete history taking is often not repeated by an expert, so important clues may be missed. On the other hand, students'' history taking is usually more extensive than experts'' history taking and medical students discuss their findings with a Supervisor. Thus the effect of student involvement on diagnostic accuracy is unclear. We therefore compared the diagnostic accuracy for patients in the medical emergency department with and without student involvement in the evaluation process.

Methodology/Principal Findings

Patients in the medical emergency department were assigned to evaluation by either a supervised medical student or an emergency department physician. We only included patients who were admitted to our hospital and subsequently cared for by another medical team on the ward. We compared the working diagnosis from the emergency department with the discharge diagnosis. A total of 310 patients included in the study were cared for by 41 medical students and 21 emergency department physicians. The working diagnosis was changed in 22% of the patients evaluated by physicians evaluation and in 10% of the patients evaluated by supervised medical students (p = .006). There was no difference in the expenditures for diagnostic procedures, length of stay in the emergency department or patient comorbidity complexity level.

Conclusion/Significance

Involvement of closely supervised medical students in the evaluation process of hospitalized medical patients leads to an improved diagnostic accuracy compared to evaluation by an emergency department physician alone.     

PBL+LBL教学模式在留学生医学微生物学教学中的实践

由于留学生的特殊性导致他们对传统教学模式的不适应,医学微生物学的课程特点使留学生学习掌握相关知识较困难,有必要探索好的教学方法,提高教学质量。我国传统的LBL教学模式和国际上流行的PBL教学模式各有优缺点,我们融合PBL和LBL的优点,互补其缺点,对留学生医学微生物学课程采取PBL+LBL教学模式,既发挥PBL教学法打破学科界限,容易调动学生学习积极性,注重培养学生自主学习和团结协作能力的特点,又结合LBL教学法传授知识系统、完整,培养学生基础理论扎实等优势。教学实践证明,PBL+LBL教学法运用于留学生医学微生物学教学,能激发留学生学习兴趣,在增强留学生对医学微生物学基础理论和基本技能掌握的同时,培养留学生知识整合的能力及创新思维的医学综合能力,提高教学质量。     

The ethics of learning from patients

Is it ethical for medicine to use patients as learning tools for medical students if these patients have not been given a chance to provide truly informed consent? Dr. Caroline Shooner raises this question in the following article, which claimed second prize in CMAJ''s 1996 Logie Medical Ethics Essay Contest. She considers the case of a patient whose trust was shaken when a medical student performed a chest-tube insertion. Shooner concludes that psychologic harm could have been avoided had the patient''s right to informed consent been respected. She also argues that few patients will turn down a chance to help students learn if the request is made properly and openly.     

建立住院医师规范化培训管理体系的探索

住院医师规范化培训是医学生向医生转变的必修科目,也是住院医师向高层次医师迈进的必由之路,对于提高住院医师临 床技能及完善医疗水平极为重要。目前,我国住院医师规范化培训存在很多弊端,相关管理体系缺乏统一、完善的评价标准。因 此,建立一个完善的住院医师规范化培训管理体系是我们应该重视的问题。本文结合医院临床教学实习所积累的经验,并学习借 鉴发达国家及地区对住院医师规范化培训管理制度的优点与长处,探索建立住院医师规范化培训管理体系的新方法,旨在促进 住院医师规范化培训工作的持续发展。     

医学专业学生确立自主学习观的必要性和重要性

目前,高等医学教育的主要任务是培养学生的综合能力,对于医学院校的学生来说,掌握扎实的医学基础知识至关重要。然而,大多医学专业的学生习惯于被动接受老师传授的知识,而严重缺乏主观能动性。医学知识涉及的内容广、难度大,初学者很难迅速掌握其精髓之处,因此确立一种高效的学习模式帮助医学生更好的理解并掌握专业理论是医学院校教育改革的重点。自主学习能力是现代教育学所提倡的相对于传统学习模式的一种现代化学习理念。自主学习的主体是学生,自主学习的过程要求主体发挥其主观能动性,自我督促、自我激励,以独立自主的方式完成高效的学习,帮助学生牢固地掌握专业理论,同时又可以灵活的运用在临床实践中。本文通过对自主学习的含义进行阐述,分析医学生确立自主学习观的必要性和重要性,并对如何确立自主学习观提出相应的建议,以推进我校教育体制改革的进度,进一步完善医学教育教学的质量。     

Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

Ethics,jurisprudence, and economics in the medical school curriculum.

Medical ethics, medical jurisprudence, and medical economics are recognized as important components of a medical school curriculum. These subjects were introduced through a course given at the University of California, Davis, School of Medicine. Four aspects of the format and content of the course were instrumental to its success. Teaching principles of medical ethics within the context of jurisprudence and economics permitted the students to gain an understanding of the institutions and processes that act as positive and negative constraints on physicians'' clinical and professional behavior. The course was offered during the fourth year following required clinical rotations so that all aspects of the course could be based on the clinical experiences of the students. It was presented in a continuing medical education format away from the normal teaching environment of first- and second-year classrooms and third-year clerkships. Finally, the course was designed by a multidisciplinary, multidepartmental planning group that included students.     

Taking care of patients--does it matter whether the physician is a woman?

Researchers have recently begun to compare male and female physicians'' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians'' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians'' communication styles to identify these behaviors and inculcate them into all physicians.     

The Social Background and Finances of Medical Students at Dalhousie University

Factors that may affect the supply of physicians in the Atlantic Provinces were examined by studying the social and financial background of Dalhousie medical students. In contrast to the regional population, they were predominantly of city origin and from well-educated, well-to-do families. Their median annual costs were $1915 for single and $4420 for married students. Earnings and family contributions each furnished about a third of the single student''s funds. The wife''s earnings constituted one-third, and the largest single source, of the married student''s funds. Loans accounted for 18% and 12% respectively of their income. Twenty-two per cent of students had had some interruption of their pre-medical studies for financial reasons.The major unknown factor in the problem is the number of qualified and aspiring students who do not reach medical school.Direct governmental subsidization of the medical student may well be necessary if the increasing need for physicians is to be met.     

医学院校本科生进行基础科研能力培养的意义

随着我国科学技术的迅猛发展,生命科学领域对专业人才的需求愈加迫切,要求亦愈加严格。部分医学院校为适应目前我国对基础科研工作者的需求现状,积极调整医学与生命科学专业本科生专业设置,改善完善课程设置,在本科生中有计划的进行科研训练,对学生毕业后的选择就业去向或者进一步深造具有重要指导作用,培养具有科研能力的高素质的医学从业人员,有助于推动医疗卫生事业的发展。     

Do students' attitudes toward women change during medical school?

BACKGROUND: Medical school has historically reinforced traditional views of women. This cohort study follows implementation of a revitalized curriculum and examines students'' attitudes toward women on entry into an Ontario medical school, and 3 years later. METHODS: Of the 75 students entering first year at Queen''s University medical school 70 completed the initial survey in September 1994 and 54 were resurveyed in May 1997. First-year students at 2 other Ontario medical schools were also surveyed in 1994, and these 166 respondents formed a comparison group. Changes in responses to statements about sex-role stereotypes, willingness to control decision-making of female patients, and conceptualization of women as "other" or "abnormal" because they are women were examined. Responses from the comparison group were used to indicate whether the Queen''s group was representative. RESULTS: Attitudinal differences between the primary group and the comparison group were not significant. After 3 years of medical education students were somewhat less accepting of sex-role stereotypes and less controlling in the doctor-patient encounter. They continued, however, to equate adults with men and to see women as "not adult" or "other." Female students began and remained somewhat more open-minded in all areas studied. INTERPRETATION: A predicted trend toward conservatism was not seen as students became older, more aware and closer to completion of medical training, although they continued to equate adults with male and to see women as "other." Findings may validate new curricular approaches and increased attention to gender issues in the academic environment.     

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.     

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。     

Medical Students in Canadian Universities: Report of Statistics, 1963-64 and 1964-65

Recognizing Canada''s urgent need of physicians Canadian medical faculties have continued to increase first-year enrolment for the sixth successive year. Returns from the 12 medical schools showed that 1133 students began medical studies in 1964 compared with 1086 the previous year. Firstyear female students showed a decrease for the first time since 1959: 124 compared with 146 in 1963. Every tenth graduate is a woman; six years ago this ratio was one in 20. Loss of students from withdrawals and dismissals in 1963-64 occurred chiefly in the first year (9.2% as compared with 8.7% in 1962-63). Almost half of the loss in all four years of the course was for non-academic reasons. A decrease in American and a slight increase in Commonwealth and foreign first-year students was noted. Total foreign student enrolment continued to decline from a high of 485 in 1959-60 (13.7%) to 400 in 1964-65 (10.3%).     

Improving the preregistration experience: the New Zealand approach.

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students'' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer''s salary for their clinical work, which is supervised by the firm''s registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.