Social medicine and social policy

Social medicine as a term has achieved acceptance in medical education and medical practice, although there is still some question as to its acceptance in reality. The term had its origin in the vigorous nineteenth-century efforts at both medical and social reform, combining the two in a recognition of the intimate connection between social factors and the causation of disease. Henry Ernest Sigerist, a Swiss physician and noted scholar of medical history, formulated the broadest concept in the 1930s, attracting students and a latent American reform movement toward the idea of restructuring medical education as one part of social reform, and indicating ways of restructuring medical practice as another element in improving medical care at the same time. In addition to promulgating the doctrine, he established the policy of examining and describing systems of medical education and medical care in other parts of the world, not only to assist in improving medical care in countries with well-organized systems, but to assist countries with poor resources and lesser organizational capability in meeting the goals of social medicine. Doubt as to the durability of the concept has been expressed, insofar as the recommended improvements have lagged behind the expression, and because so many changes have taken place in the nature of medical practice, medical discoveries, and advances in technology. A closer examination of Sigerist's writings on the subject and evaluation of the circumstances around present-day problems would seem to indicate that the flaw is not in the doctrine, but in the lack of social application.     

新冠肺炎疫情下开展临床医学专业课程在线教学的效果与反思

2020年新冠疫情爆发,传统教学模式被打破,网络教学作为教学手段之一承担了大部分的教学任务。在新冠疫情全球大流行新形势下,为有效保障以实践为重要载体的临床医学教学质量,通过系列教学实践,有效发挥网络教学的优势,同时利用多种手段弥补其不足。在教学实践过程中,通过开展网络教学的成效和教学反馈信息,深入思考总结教学改革中遇到的困境。对在线教学常态化工作的进一步开展;临床实践课程新思路、新模式的应用,加强公共卫生专业课程与临床医学专业课程的整合,倡导学科间发展融合;在医学教育全过程中融入思政元素,突显人文教育作用;尊重医学发展规律,践行国家有关医学教育改革的大政方针,将"大健康"理念融入医学教育全过程中等一系列问题展开深入的思考。通过系列教学实践与思考,推进教学改革进程,着力培养具有全球化视野的,多学科融合背景的,既有卓越临床医学知识技能,又具有公共卫生视野,人文情怀的,卓越医学人才。     

医学硕士研究生免疫组织化学PBL教学模式改革探索

"免疫组织化学"是医学硕士研究生前期学习的一门主要学科,为了提高教学质量,深化教学改革,我们先后在辽宁医学院2008级、2009级和2010级三个年级的硕士研究生中开展了PBL模式的免疫组织化学教学改革,对教学内容、教学方法和考试方式等都做了创新性的改革。经问卷调查,学生对本门课程的改革非常认可,教学效果良好。PBL模式的免疫组织化学教学大大提高了学生的创新能力和操作能力,为今后的科研工作打下了良好的基础。     

对医学研究生教育的实践与思考

医学研究生教育作为我国高等教育的重要组成部分,为国家培养了大批高素质医学人才。本文就我们医学研究生教育的实践,探讨医学研究生教育存在的问题。医学研究生教育应首先应加强医学专业知识的全面学习,做到博学而精深。同时,应注重科研素质和人文素质的培养。最后,医学研究生的教育国际化也是非常重要的一个问题。总之,医学院校研究生教育应更加注重创新性、科研素质、人文素质和国际视野的培养,培养具有国际竞争力的高素质专业医学人才。     

公立医院医疗服务价格调整难点及推进策略

从政策角度分析医疗服务价格的演变过程、形成机制,研究新医改以来公立医院医疗服务价格调整的进展和问题,以34家国家级试点为例,探讨调整医疗服务价格的解决策略和路径,提出推进策略。文章认为,对于医疗服务价格调整,要深刻认识价格改革在公立医院改革中的地位和作用,坚持基本原则,处理好几个方面关系,并把握好几个技术难点。     

我国现行医疗卫生政策的相关问题分析

医疗卫生是构建和谐社会的重要因素之一,也是关乎百姓切身利益的重大问题之一,近年来,医疗体制的不断改革,医疗卫生的相关政策的不断出台,已经大大地改善了我国广大人民群众的“看病难,看病贵”等问题,增加了医保的覆盖人群,减轻了城市低收入人群及农村的医疗负担,但是,我们仍面临着巨大的挑战,新的问题也不断涌现,医疗卫生政策不适应现在的医疗需求发展、经济发展不均衡、不同层次群众的医疗需求有差异等,都是医疗卫生改革中面临的问题,医疗改革的不断推进势在必行。我国的医疗保障制度覆盖率已经达到95％,但是,现行的医疗保障制度的还不能从根本上解决人民群众的“就医难,治病贵”的问题,其他医疗保险不能与现行的医疗保障制度相适应,从而,影响了我国整体的医疗水平的提高。     

《生命科学前沿》课程思政的教学改革与实践

“课程思政”融入研究生课程体系具有重要意义, “大思政”格局下的课程改革不断推进。《生命科学前沿》是湖南师范大学生物学科的研究生必修课程,致力于普及学科发展前沿。其思政元素较为丰富,是开展课程思政的优秀载体。在分析了目前课程思政教学现状和存在问题的基础上,通过树立思政理念,提升教师开展课程思政的能动性;开展课程思政教学设计,注重课程前沿性和思政元素的有机融合。采用嵌入式课程思政的教学路径,提高课程思政教学效果等具体举措进行改革实践,实现学科前沿知识普及和价值引领相结合。实践证明,将思政内容引入专业课,可以提高学生学习主动性,引导学生树立正确的价值观,实现专业课协同育人的效果。课程思政重在建设,课程内容设计是先决条件,教师是关键,课程管理是基本保障,对课程思政教学改革实践进行反思,以期为相关生物学专业课程思政教学提供参考。     

研究生高级微生物学课程教学改革与实践初探?

从研究生"高级微生物学"课程的定位、研究生学习该课程的目的、知识背景差异及教学过程中的问题等方面分析了目前研究生"高级微生物学"教学中存在的问题。通过教学内容的优化、教材建设、教学方法改革、师资队伍建设以及建立师生交流平台等方面进行教学改革实践,取得了较好的教学效果。     

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。     

A brief history of graduate medical education in Washington,Alaska, Montana,and Idaho.

Internships and hospital-based medical education preceded by more than 40 years the beginnings of a medical school in Washington State. Just after the turn of the 20th century, a few internships were begun by hospitals in Seattle and Spokane to help with the care of their sicker patients in the tradition of Eastern teaching hospitals. In the 1920s and 1930s, the number of hospitals with internship programs grew steadily as part of a nationwide effort at hospital standardization. Experiences in developing these programs and problems with intern recruitment contributed to the beginning of the University of Washington School of Medicine after World War II. Since the 1960s, intern and resident training has progressively become a cooperative effort of the school with many hospitals and clinics in Washington, Alaska, Montana, and Idaho contributing to the development of graduate medical education in this region.     

Inclusive education policy in the Hong Kong primary music classroom

An education reform policy and inclusive education policy have been implemented in Hong Kong for over a decade. As more students with special educational needs have entered the mainstream education system under these policies, Hong Kong's primary music classrooms offer a site where three policies interact—the education reform policy entitled “Learning to Learn,” the policy of inclusive education, and the undeclared “policy” of making savings in the government budget. This article seeks to explore the results of the interaction of these three policies. A qualitative study was carried out to investigate the views of Hong Kong primary school music teachers on the policy of inclusion in relation to music teaching. Insufficient support in inclusive learning in “non-core” subjects, such as music, is evidenced.     

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。     

Understand – then Criticize

In this article we propose a policy intended to alleviate the typical problems of student internships and improve the usefulness and relevancy of any partnership. We extend previous ideas about professional development schools or partnerships to eliminate the disconnect between K–12 schools and universities and add a component of multiple constituent mentoring necessary for effective music teacher and music teacher educator training. A partnership with multiple mentors—K–12 students, K–12 teachers, undergraduate students, graduate students, and university music education faculty—can provide the most benefits to the greatest number of people. The policy presented in this article will likely require the implementation of philosophical and curricular changes, but these efforts would be well worth the investment of time and resources.     

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.     

On the Outcome Project

Background: In 2001, graduate medical education in the United States was renovated to better complement 21st century developments in American medicine, society, and culture. As in 1910, when Abraham Flexner was charged to address a relatively non-standardized system that lacked accountability and threatened credibility of the profession, Dr. David Leach led the Accreditation Council of Graduate Medical Education (ACGME) Outcome Project in a process that has substantially changed medical pedagogy in the United States.Methods: Brief review of the Flexner Report of 1910 and 6 hours of interviews with leaders of the Outcome Project (4 hours with Dr. David Leach and 1-hour interviews with Drs. Paul Batalden and Susan Swing).Results: Medical educational leaders and the ACGME concluded in the late 1990s that medical education was not preparing clinicians sufficiently for lifelong learning in the 21st century. A confluence of medical, social, and historic factors required definitions and a common vocabulary for teaching and evaluating medical competency. After a deliberate consensus-driven process, the ACGME and its leaders produced a system requiring greater accountability of learners and teachers, in six explicitly defined domains of medical “competence.” While imperfect, this construct has started to take hold, creating a common vocabulary for longitudinal learning, from undergraduate to post-graduate (residency) education and in the assessment of performance following graduate training.     

Too Few,Too Weak: Conflict of Interest Policies at Canadian Medical Schools

Introduction

The education of medical students should be based on the best clinical information available, rather than on commercial interests. Previous research looking at university-wide conflict of interest (COI) policies used in Canadian medical schools has shown very poor regulation. An analysis of COI policies was undertaken to document the current policy environment in all 17 Canadian medical schools.

Methods

A web search was used to initially locate COI policies supplemented by additional information from the deans of each medical school. Strength of policies was rated on a scale of 0 to 2 in 12 categories and also on the presence of enforcement measures. For each school, we report scores for all 12 categories, enforcement measures, and summative scores.

Results

COI policies received summative scores that ranged from 0 to 19, with 0 the lowest possible score obtainable and 24 the maximum. The highest mean scores per category were for disclosure and ghostwriting (0.9) and for gifts and scholarships (0.8).

Discussion

This study provides the first comprehensive evaluation of all 17 Canadian medical school-specific COI policies. Our results suggest that the COI policy environment at Canadian medical schools is generally permissive. Policy development is a dynamic process. We therefore encourage all Canadian medical schools to develop restrictive COI policies to ensure that their medical students are educated based on the best clinical evidence available, free of industry biases and COI relationships that may influence the future medical thinking and prescribing practices of medical students in Canada once they graduate.     

高校病理生理学双语教学探析

双语教学作为蕴含着全新教育理念的教学形式,是我国高等教育改革的一项新措施,适应新时代背景下社会对高质量人才的需求。探析双语教学引入高校病理生理学中的可行意义、病理生理学双语教学中存在的问题、病理生理学双语教学的改进路径,有利于高校病理生理学双语教学的实践,对高校教育改革及医学专业人才培养起到积极的推动作用。     

The forty years of medical genetics in China

Medical genetics is the newest cutting-edge discipline that focuses on solving medical problems using genetics knowledge and methods. In China, medical genetics research activities initiated from a poor inner basis but a prosperous outer environment. During the 40 years of reform and opening-up policy, Chinese scientists contributed significantly in the field of medical genetics, garnering considerable attention worldwide. In this review, we highlight the significant findings and/or results discovered by Chinese scientists in monogenic diseases, complex diseases, cancer, genetic diagnosis, as well as gene manipulation and gene therapy. Due to these achievements, China is widely recognized to be at the forefront of medical genetics research and development. However, the significant progress and development that has been achieved could not have been accomplished without sufficient funding and a well-constructed logistics network. The successful implementation of translational and precise medicine sourced from medical genetics will depend on an open ethics policy and intellectual property protection, along with strong support at the national industry level.     

Developing medical ethics in China's reform era

The paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities and improprieties in the profession. Furthermore, the market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and education aspects of the institutionalization of medical ethics are discussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China.