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。     

医学微生物学课程思政改革的实践与思考

专业课程是课程思政建设的基本载体,课程思政建设是课程教学改革的根本任务.医学微生物学是医学生的一门专业基础课程,教学内容涉及与人民生活息息相关的病原微生物,实用性强.紧密结合医学微生物学课程内容和人民健康需求,开展课程思政教育资源体系建设,强化学生知识学习和思想教育,达到"立德树人"的培养目标.文章介绍了围绕医学微生物...     

PBL 教学模式在八年制《医学导论》教学中的应用

《医学导论》课对于八年制临床医学专业学员的学习非常重要,将PBL教学模式应用到《医学导论》教学中,从课程设计、问题筛选、团队精神培养等环节进行实施,有利于培养学员自主学习和解决实际问题的能力,圆满完成了《医学导论》的教学任务。     

McGill makes Canada's first attempt to put medical curriculum in computerized format.

A member of McGill University''s Faculty of Medicine wants Canadian medical schools to collaborate to create a central repository for the best teaching materials. Dr. David Fleiszer fears that many individual efforts are being undertaken without an overall plan being in place. For its part, McGill is putting its medical-school curriculum on line over the next 2 years, and is collaborating with industrial partners to develop clinical simulations.     

Curriculum change needed at Yale

The United States Congress has recently passed an important bill entitled, The Health Professionals Assistance Act of 1976. It seeks to right physician maldistribution in the country and curtail the over specialization of medical practitioners. Quotas have been set in terms of the number of medical school graduates who must enter primary care training programs over the next few years. Failure to comply risks loss of the federal capitation grant of twenty-one hundred dollars per student or about one million dollars a year in Yale''s case.The causes of physician maldistribution are discussed. Partial blame is ascribed to the medical schools themselves and recommendations are made for curriculum changes which if adopted may achieve better physician distribution without further government inroads into medical school affairs.     

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。     

Can medical students teach? A near-peer-led teaching program for year 1 students

The General Medical Council states that United Kingdom graduates must function effectively as educators. There is a growing body of evidence showing that medical students can be included as teachers within a medical curriculum. Our aim was to design and implement a near-peer-led teaching program in an undergraduate medical curriculum and assess its acceptability among year 1 students. Students received six tutorials focusing on aspects of cardiac, respiratory, and blood physiology. Tutorials ran alongside standard module teaching. Students were taught in groups of ～30 students/group, and an active teaching approach was used in sessions where possible. Using anonymous evaluations, student feedback was collected for the program overall and for each tutorial. The program was voluntary and open to all first-year students, and 94 (of 138) medical students from year 1 at Brighton and Sussex Medical School were recruited to the study. The tutorial program was popular among students and was well attended throughout. Individual tutorial and overall program quantitative and qualitative feedback showed that students found the tutorials very useful in consolidating material taught within the module. Students found the small group and active teaching style of the near-peer tutors very useful to facilitating their learning experience. The end-of-module written examination scores suggest that the tutorials may have had a positive effect on student outcome compared with previous student attainment. In conclusion, the present study shows that a near-peer tutorial program can be successfully integrated into a teaching curriculum. The feedback demonstrates that year 1 students are both receptive and find the additional teaching of benefit.     

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。     

传统教学与PBL结合的教学模式在老年医学教学中的应用

传统的医学教育主要强调学科的系统性和完整性,注重知识的广度及其深度。采用的主要方式是:教师讲、学生听。以问题为导向的教学方法 PBL(problem based learning,PBL)提倡在教学相关环节中以问题为中心展开讨论,促进师生间的互动交流,激发学生的兴趣。两种教学模式相结合,既可以将医学知识系统、完整地传授给学生,又能够调动学生们学习的主动性,提高了学生综合分析问题以及解决问题的能力。在老年医学的教学活动中,我们尝试传统教学与PBL结合的教学模式,认为采用这2种教学方式相结合的方式,可以弥补各自的不足。     

构建融合医学人文教育的新型医学遗传学教学模式

医学遗传学是广泛涉及基础与临床学科的综合性课程,对于医学生是至关重要的必修课程。现代医学已由传统的生物-医学模式向生物-心理-社会医学模式转化,医学诊疗模式从最初的以"疾病为中心"到"以病人为中心"的方式转变,医生不仅精通医术,更要理解患者的心理,与其进行良好的沟通,因此现代医学成为了一门具有自然科学、人文社会科学双重属性的综合性科学体系。长期以来,我国医学院校的教学仍然是生物医学知识和技能占据主导地位,人文课程不受重视。因此,必须加强医学人文知识的学习和技能培训,只有这样才能在未来的医疗工作中掌握良好的医患沟通技巧,建立和谐的医患关系,对处理好日渐增多的医疗纠纷、维护医患双方的共同利益具有重要意义。     

“新工科”背景下“生物分离工程”课程创新改革

“生物分离工程”是生物工程专业本科生的一门重要的专业必修课,是生物工程专业建立“新工科”课程体系的重要组成部分。本教学团队坚持“以学生发展为中心,以创新思维为核心”的教育理念,以“学习成果”为导向的创新理念,针对课程长期存在的“理论教学与实验课脱节,学生不能及时地将理论知识内化为实践能力”、“课程内容陈旧,与行业需求脱节”、“授课和考核方式相对单一,学生的专业能力和素质未能有效培养”等痛点问题开展教学改革,重构课程内容。打通理论课和实验课的界限,开展“线上+线下”混合教学,通过科研反哺教学,使课程内容紧跟行业发展前沿,充分利用现代信息技术手段开展更丰富的课堂教学活动,并对学生进行全程化、动态化和多样化的考核,全面提升学生的能力。     

中国首批国家公园体制试点的经验与成效、问题与建议

建立国家公园体制是建设生态文明制度的重要内容,是解决我国自然保护地发展过程中存在的重叠设置、多头管理、边界不清、权责不明、保护与发展矛盾突出等问题的重大举措。根据国家统一部署,2020年要设立一批国家公园,分级统一的管理体制基本建立。在跨时2年的资料收集、实地考察基础上,全面总结首批10个国家公园体制试点的经验与成效,梳理试点过程中存在的问题,并提出针对性建议,以期全面展现国家公园体制试点的最新进展,为国家公园深化建设提供参考和依据。结果显示,各试点区基本建立起分级统一的管理体制,创新了运行机制,保护力度持续加强,资金投入不断加大,科研合作不断深化,社会参与逐渐扩大。体制试点产生了明显的生态成效,民生改善初步显现,社会效益充分彰显。但是,仍然存在管理机构级别和类型参差不齐,法律制度不健全,资金保障长效机制未建立,人才队伍建设滞后,保护与发展的矛盾突出,空间范围不合理等问题。建议采取必要措施改进存在的问题,积极推广有效经验,加快健全国家公园体制。     

Medicolegal audit in the West Midlands region: analysis of 100 cases.

One hundred medicolegal cases were analysed to obtain quantitative data about diagnoses and the causes of litigation that affect hospital doctors in the National Health Service. Sixteen actions concerned minor problems that are an unavoidable risk of treatment, and 39 were due to natural causes. In other cases it was debatable whether a medical accident or negligence was responsible. At the end of three years 73 actions had been withdrawn, 12 settled out of court, and one lost in court by the plaintiff, and 14 were pending. Of these 14, nine were likely to reach court on charges of negligence. Contributory causes were failure of communication in 27 and matters connected with the patient''s attitude or personality in 20. Because much time and money are spent on cases that should never have started a doctor should sit on the legal aid panel to give advice for medical cases. Also, solicitors should obtain an independent medical opinion when a complaint is first received from a patient. Consent forms should be more informative and give details of what can reasonably be expected from treatment and its possible risks.     

A student-centred,problem-based curriculum: 5 years' experience.

In 1987, the University of Sherbrooke''s school of medicine implemented a student-centred, problem-based learning (PBL) curriculum. The experience of the first 5 years is reviewed; program goals, the schedule of learning activities, the instructional format and assessment of student learning are described. The new program is more demanding of teachers and requires better faculty training in pedagogy. No new financial resources have been available. The preclinical reform has led to revision of the clerkship, where sessions on clinical reasoning are now based on the PBL philosophy. Student reactions to the program are reported. The Sherbrooke experience has demonstrated that it is both possible and feasible to shift from a traditional to a problem-based curriculum.     

A History of Orthopedics in San Francisco and the West

The unique development of early medical specialization in the West can be traced to California''s geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford''s Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time.     

Auditing sex- and gender-based medicine (SGBM) content in medical school curriculum: a student scholar model

Background

Sex- and gender-based medicine (SGBM) aims to (1) delineate and investigate sex- and gender-based differences in health, disease, and response to treatment and (2) apply that knowledge to clinical care to improve the health of both women and men. However, the integration of SGBM into medical school curricula is often haphazard and poorly defined; schools often do not know the current status of SGBM content in their curricula, even if they are committed to addressing gaps and improving SGBM delivery. Therefore, complete auditing and accounting of SGBM content in the existing medical school curriculum is necessary to determine the baseline status and prepare for successful integration of SGBM content into that curriculum.

Methods

A review of course syllabi and lecture objectives as well as a targeted data analysis of the Curriculum Management and Information Tool (CurrMIT) were completed prior to a real-time curriculum audit. Subsequently, six “student scholars,” three first-year and three second-year medical students, were recruited and trained to audit the first 2 years of the medical school curriculum for SGBM content, thus completing an audit for both of the pre-clinical years simultaneously. A qualitative analysis and a post-audit comparative analysis were completed to assess the level of SGBM instruction at our institution.

Results

The review of syllabi and the CurrMIT data analysis did not generate a meaningful catalogue of SGBM content in the curriculum; most of the content identified specifically targeted women’s or men’s health topics and not sex- or gender-based differences. The real-time student audit of the existing curriculum at Texas Tech revealed that most of the SGBM material was focused on the physiological/anatomical sex differences or gender differences in disease prevalence, with minimal coverage of sex- or gender-based differences in diagnosis, prognosis, treatment, and outcomes.

Conclusions

The real-time student scholar audit was effective in identifying SGBM content in the existing medical school curriculum that was not possible with a retrospective review of course syllabi and lecture objectives or curriculum databases such as the CurrMIT. The audit results revealed the need for improved efforts to teach SGBM topics in our school’s pre-clinical curriculum.

     

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.     

新形势下医学课程整合的现状与建议

随着医学教育方式不断被创新与改善,单一的医学课程教育模式已经不能满足于新形势下医学生的培养。医学课程整合可以将学科知识串联在一起,形成有机的融合。其具有综合性、多元化的特点,便于医学生对所学知识的理解与应用。目前,在实行医学课程整合中存在着师资力量薄弱、学生素质参差不一、医学院校课程设置不合理、教学资源缺乏以及缺少统一的课程整合的评价标准等现状问题。因此有效的实施医学课程整合,仍需各医学院校因地制宜采取相应措施,通过调整课程结构、提升师生素质,建立起有效的评价措施等手段来促进与改善医学课程整合。     

Reference-based pricing: Will other provinces follow the BC lead?

REFERENCE-BASED PRICING has had a major impact on medical practice in British Columbia. Anne Mullens discusses the new system''s first 2 years. She says physicians outside BC should pay attention, because RBP may be heading their way. It is set to land in Australia next month.