PEDIATRICIAN'S POINT OF VIEW

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.”Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods.The problem of providing additional adequately equipped and staffed hospitals must receive much consideration.Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice.     

PEDIATRICIAN'S POINT OF VIEW

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of "local health councils."Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods. The problem of providing additional adequately equipped and staffed hospitals must receive much consideration.Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice.     

中外模拟医学学科发展对比与思考

模拟医学是一门将成为未来医学实践教学主流的教育学科。我国模拟医学学科建设还处于起步阶段,与国外发达国家相比明显滞后。从模拟医学专业课程、专科医师培训、理论研究、相关学术组织和学术交流等方面对国外模拟医学学科发展现状进行了分析,并对比我国模拟医学学科发展现状,提出要积极借鉴国外先进经验,勇于创新,进一步完善我国模拟医学学科体系建设,搭建更多学术交流平台,扩大模拟医学理论体系的内涵和外延,以构建具有中国特色的模拟医学学科体系。     

The Medical System in Ghana

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women’s health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.     

Universities and medical schools: reflections on a half-century of Canadian medical education.

After 50 years of accelerated development, universities and medical schools have entered a period of uncertainty and instability. The Flexnerian paradigm of medical education, rooted in biomedical science and conducted under the aegis of a university, reached its apotheosis by the late 1960s and the early 1970s. Fuelled by the introduction of comprehensive, government-sponsored health care insurance and advances in technology, the demand for health care professionals and for access to facilities increased sharply. Medical education, research and advanced clinical services expanded dramatically aided by the emergence of academic health sciences centres and accompanied by a wave of medical curriculum reform. Now medical schools must strike a dynamic balance in responding to the continued expansion of knowledge and technology, the demand for social equity and the exigencies of prolonged fiscal constraint. They must also balance the biological and sociological approaches to medicine in establishing the foundations for the future development of Canadian medical education.     

Medical physics practice and training in Ghana

Medical physics has been an indispensable and strategic stakeholder in the delivery of radiological services to the healthcare system of Ghana. The practice has immensely supported radiation oncology and medical imaging facilities over the years, while the locally established training programme continues to produce human resource to feed these facilities. The training programme has grown to receive students from other African countries in addition to local students. Ghana has been recognised by the International Atomic Energy Agency as Regional Designated Centre for Academic Training of Medical Physicists in Africa. The Ghana Society for Medical Physics collaborates with the School of Nuclear and Allied Sciences of the University of Ghana to ensure that training offered to medical physicists meet international standards, making them clinically qualified. The Society has also worked together with other bodies for the passage of the Health Profession’s Regulatory Bodies Act, giving legal backing to the practice of medical physics and other allied health professions in Ghana. The country has participated in a number of International Atomic Energy Agency’s projects on medical physics and has benefited from its training courses, fellowships and workshops, as well as those of other agencies such as International Organization for Medical Physics. This has placed Ghana’s medical physicists in good position to practice competently and improve healthcare.     

Islamic medical ethics: a primer

Modern medical practice is becoming increasingly pluralistic and diverse. Hence, cultural competency and awareness are given more focus in physician training seminars and within medical school curricula. A renewed interest in describing the varied ethical constructs of specific populations has taken place within medical literature. This paper aims to provide an overview of Islamic Medical Ethics. Beginning with a definition of Islamic Medical Ethics, the reader will be introduced to the scope of Islamic Medical Ethics literature, from that aimed at developing moral character to writings grounded in Islamic law. In the latter form, there is an attempt to derive an Islamic perspective on bioethical issues such as abortion, gender relations within the patient-doctor relationship, end-of-life care and euthanasia. It is hoped that the insights gained will aid both clinicians and ethicists to better understand the Islamic paradigm of medical ethics and thereby positively affect patient care.     

Issues and Challenges in Research on the Ethics of Medical Tourism: Reflections from a Conference

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight.     

我院康复医疗服务体系建设的做法与体会

哈尔滨医科大学附属第一医院积极探索新的服务体系,充分整合和利用黑龙江省康复资源和医疗卫生资源,在康复医疗服务体系建设、康复机构功能定位、双向转诊制度、康复人才培养等方面进行了积极的探索,康复医疗服务网络化管理模式初具雏形。     

The benefits of privatization.

The promise of a universal, comprehensive, publicly funded system of medical care that was the foundation of the Medical Care Act passed in 1966 is no longer possible. Massive government debt, increasing health care costs, a growing and aging population and advances in technology have challenged the system, which can no longer meet the expectations of the public or of the health care professions. A parallel, private system, funded by a not-for-profit, regulated system of insurance coverage affordable for all wage-earners, would relieve the overstressed public system without decreasing the quality of care in that system. Critics of a parallel, private system, who base their arguments on the politics of fear and envy, charge that such a private system would "Americanize" Canadian health care and that the wealthy would be able to buy better, faster care than the rest of the population. But this has not happened in the parallel public and private health care systems in other Western countries or in the public and private education system in Canada. Wealthy Canadians can already buy medical care in the United States, where they spend $1 billion each year, an amount that represents a loss to Canada of 10,000 health care jobs. Parallel-system schemes in other countries have proven that people are driven to a private system by dissatisfaction with the quality of service, which is already suffering in Canada. Denial of choice is unacceptable to many people, particularly since the terms and conditions under which Canadians originally decided to forgo choice in medical care no longer apply.     

Lessons from Lithuania: rethinking public health training.

Lithuania faces stark problems that are familiar to most countries in the former Soviet Union: high morbidity and mortality rates, pollution, an unstable economy, and rapid changes in the financing and organisation of health care. In this environment Moore and Dixon visited Kaunas Medical Academy to help identify how training in public health medicine could contribute towards improving the health of the population. Although over 200 hours are devoted to public health training for medical undergraduates, teaching is unfocused, fragmented, and includes little epidemiology--the core subject for public health physicians. Teaching is mainly through long lectures with few group discussions. Student participation and motivation are low. As well as recommending redesign of the curriculum, Moore and Dixon suggested training in teaching methods for teachers. They also suggested that postgraduate training in public health should begin and should be targeted at hospital managers, teaching staff, and existing public health physicians.     

Transfer of medical technology from a developed to a developing country

Medical care is increasingly dependent on technology, but what are the problems involved in the transfer of technology from a developed to a developing country? What are the administrative, personnel and engineering problems? We address these questions in the context of our experience of transferring the medical technology and knowledge necessary for the development of nuclear medicine facilities in Kuwait.     

Heart-Alert: emergency resuscitation training in the community

One approach to reducing avoidable mortality from coronary artery disease is to provide resuscitation capability in the community. In Manitoba this is the function of the Heart-Alert program, sponsored by the Manitoba Heart Foundation. The program is based on public and professional education dealing with the recognition and immediate care of cardiac emergencies, including cardiopulmonary resuscitation (CPR). The three components to the program are (a) training in basic CPR for all health care and community rescue groups; (b) training in definitive CPR for physicians, critical care nurses and advanced emergency medical technicians; and (c) education of the public to recognize the signs of impending or actual cardiac emergencies and to take appropriate action to summon quickly an emergency rescue team.The initial emphasis of the program has been on developing an organizational structure and a training network for basic CPR. A corps of instructor-trainers and instructors has been certified to implement CPR training in the medical and community target groups. Developmental problems include problems of quality control, of providing for self-sustaining and continued expansion, and of evaluation of the overall results.It is suggested that widespread implementation of CPR training is facilitated by the incorporation of CPR into existing training activities, particularly those of the medical, nursing and other health care disciplines, those of community protection agencies such as police, fire and ambulance departments, and those of volunteer groups concerned with rescue work and first-aid. If the impetus, organizational structure and instructor training are provided by a strategic agency, wide dissemination of CPR training is then possible at relatively modest cost.     

Poverty in the United States as Defined by Federal Standards—Report of the Bureau of Research and Planning

The subject of this Socio-Economic Report is of tremendous importance to the medical profession because physicians should be aware that future programs for the expansion of health care services will be based and, in fact, are being based upon information which this Report contains. The relationship between poverty and accessibility of health care services is therefore quite direct. So, too, will be the impact upon the profession and the organization of medical practice.The 1966 amendments to the Poverty Act are concerned with neighborhood health centers and a vast array of other programs which will touch every physician and every community which can be identified by the standards indicated in this Report as low income, poor, or near poor. For this reason the California Medical Association Committee on Welfare Medical Programs, among several others concerned with aspects of this problem, is trying to alert every county medical society of developments as well as of the responsibilities they should assume in working with the Office of Economic Opportunity and other community organizations in providing guidance and leadership in structuring programs compatible with the interests of the public and the health care professions.This Report on poverty presents a current and prospective view of the problems and issues to be faced. Unless physicians see the relationship and join in a community effort to aid in resolving an issue which underlies public policy, we shall be looking back five or ten years from now to point out that we failed to take advantage of opportunities to assist in the development of a rational system of medical care for low-income groups.Individual physicians, component medical societies on a grass-roots level and CMA as a state organization should all be concerned with and aware of the facts.     

Older Russian emigrés and medical care.

Although emigration from the former Soviet Union is dramatically increasing nationwide, little information has been reported on the medical problems of these emigrés. For older emigrés in particular, the medical realities of aging, in combination with cultural expectations, make the United States'' medical system an arena where the stresses of emigration are expressed and help is sought. We describe the influences of culture and aging on older emigrés'' health and interaction with the American medical system. A qualitative, exploratory study was done of problems and issues in health care use by older Russian emigrés at the ambulatory medical clinic of Mount Zion Medical Center, San Francisco. Cultural expectations and beliefs about health, adaptive health behaviors learned in the former Soviet Union, the stresses of emigration, and the medical realities of aging can result in serious problems in the care and treatment of older Russian emigrés. Recommended solutions include educating emigrés and health care professionals, integrating mental health services into the primary care setting, and expanding supportive services in the community such as adult day health care.     

虚拟仿真技术助力下的“医学微生物学”实验课程教学方案设计和实践

近年来,虚拟仿真技术在实验教学中获得了广泛的应用,取得了令人瞩目的成绩。由于学科特点,"医学微生物学"实验课程特别适合通过虚拟仿真技术丰富实验教学内容,从某种意义上说虚拟仿真技术重新构建了"医学微生物学"实验课程的教学体系。本文以"医学微生物学"实验课程教学局限性为着眼点,重点阐述基于虚拟仿真技术在加强生物安全教育、重构教学内容、创新教学手段等方面的有益实践和探索。相较于传统实验教学,该教学方案极大地丰富了教学内容,能够更好地培养学生的综合实验能力和职业责任感,切实提高实验教学质量,有望为虚拟仿真实验建设及基础医学实验教学改革提供借鉴参考。     

Systems-based practice: education in plastic surgery

The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Plastic surgery is a specialty that is intimately involved with the economics, coordination of care, and real-life experience of resource allocation. It should be avant-garde in the development of a systems-based educational experience and be in the forefront in creating an appropriate and well-thought-out teaching agenda for graduate medical education. The authors explain and expand this definition to include objectives for plastic surgery training, programs, and individual learning goals. A series of didactic lectures, small group discussions, and grand round presentations are suggested to fulfill and facilitate the educational objectives. A potential time allotment and method of objective and subjective evaluations are offered.     

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。     

浅析临床专业影像学教学现状与改革

医学影像学是一门新兴学科,同时也是一门发展迅速的学科。目前影像学技术已进入全新的数字影像时代,代表着临床医学发展中的热点潮流,同时也推动了医学的发展。医学影像学是医学高等教育中的重要内容,涉及到人体各个系统、各种疾病,内容多、范围广;然而近年来,随着各种影像设备的不断更新,影像技术的迅猛发展,医学高校的影像学教育明显滞后于该学科的发展速度,传统影像学教学模式也已经很难满足学习的需要。本文根据已有的研究资料及师生反馈的信息,分析临床医学专业影像学的教学现状与改革方向,以期提高对其教学方法的认识,适应医学影像学的快速发展,提高教学质量。     

关于临床医学专业学位硕士研究生教学与培养的几点思考

随着医学科学技术的发展和社会需求的扩大,医学界对高层次人才的需求持续增长。为推进我国医疗卫生系统的可持续发展,医学院校适应时势变化,积极调整和优化研究生教学类型结构,大力发展专业学位研究生教育。专业学位研究生教育以培养临床思维和提高临床技能为重点,同时注重基本科研素质的培养。随着专业学位研究生招生人数的增加,如何保证研究生的"质"和"量"的同步提升成为高校和教育者研究热点。本文通过借鉴临床医学科学学位硕士研究生的教学与培养模式,结合临床医学专业学位硕士研究生的特点及培养要求,对以往教学经验与教训做一总结,着力于探索一条适合临床医学专业学位硕士研究生的教学与培养模式,为建立标准化的临床医学专业学位硕士研究生的教学与培养模式提供参考。