就医患者对实习医生参与临床实习教学的认识与态度研究

通过调查502位患者,分析影响患者“有无义务支持实习医生的临床实习教学”的相关因素,结果显示,有显著性影响的因素包括:患者的受教育程度,对实习医生的了解程度及对实习医生参与医疗活动的态度等.深入研究这些影响因素,有助于进一步了解患者与实习医生的关系,促进实习医生的人才培养.     

内科实习医生医患沟通经历的调查分析

实习医生在医院里扮演着特殊角色,既要作为学生在临床实践中学习医学知识,又要作为医生在患者面前从事医疗工作。因此,培养医学生医患沟通能力,引导其建立和谐的医患关系,成为临床带教老师面临的一项严峻而又刻不容缓的任务。本研究针对内科实习医生在医院沟通中的典型案例进行了调查,从而了解实习医生在医患沟通中的经历,以及他们对原因的分析、处理方法及对自身的影响,进而了解实习医生对沟通技能培训的需求。     

全身体格检查标准化培训方法及评价体系在临床实习中的探讨

实习医生临床工作能力的培养是整体高等医学教育的重要目的之一,全身体格检查是最基本的内容及操作,是临床基础和技能结合的重要环节,通过体格检查规范的标准化培训及经过评价,使我们的实习医生牢固掌握体格检查的基础知识,减少因体格检查导致的临床漏诊、误诊的发生率.     

全身体格检查标准化培训方法及评价体系在临床实习中的探讨

实习医生临床工作能力的培养是整体高等医学教育的重要目的之一,全身体格检查是最基本的内容及操作,是临床基础和技能结合的重要环节,通过体格检查规范的标准化培训及经过评价,使我们的实习医生牢固掌握体格检查的基础知识,减少因体格检查导致的临床漏诊、误诊的发生率。     

腹腔镜在盆腔炎中的应用

急性盆腔炎发病率高,并发症多.是常见妇科急腹症之一,而早期明确诊断和及时处理是治疗成功的关键.本文初步探讨了腹腔镜作为一种检查和治疗的手段在急性盆腔炎的应用价值,结果提示其具有较好的临床应用价值.     

宫腔镜检查在诊断子宫内膜息肉中的价值分析

通过比较超声、宫腔镜检查与病理诊断子宫内膜息肉的结果,以及超声诊断结果阴性的病例中,宫腔镜与病理诊断的差异检出率,探讨宫腔镜检查对正确诊断子宫内膜息肉的重要性.回顾性收集连续在我院妇科行宫腔镜检查且证实子宫内膜息肉诊断的住院患者共730例.总结各病例超声诊断、宫腔镜检查及病理诊断的结果.统计分析显示,三者诊断子宫内膜息肉的检出率分别为82.7％、93.4％、90.8％.其中,由超声检查漏诊的子宫内膜息肉患者共126例,宫腔镜及病理检出率分别为96.8％、88.1％,且两者的阴性结果互不重叠,这种诊断差异在超声诊断结果示内膜增厚/内膜厚薄不均病例中尤为显著.因此,子宫内膜息肉的诊断方式中,宫腔镜诊断检出率最高,但仍有漏诊的病例由病理确诊,研究认为宫腔镜检查是确诊子宫内膜息肉的重要诊断方法.     

宫腔镜检查在诊断子宫内膜息肉中的价值分析

通过比较超声、宫腔镜检查与病理诊断子宫内膜息肉的结果,以及超声诊断结果阴性的病例中,宫腔镜与病理诊断的差异检出率,探讨宫腔镜检查对正确诊断子宫内膜息肉的重要性.回顾性收集连续在我院妇科行宫腔镜检查且证实子宫内膜息肉诊断的住院患者共730例.总结各病例超声诊断、宫腔镜检查及病理诊断的结果.统计分析显示,三者诊断子宫内膜息肉的检出率分别为82.7％、93.4％、90.8％.其中,由超声检查漏诊的子宫内膜息肉患者共126例,宫腔镜及病理检出率分别为96.8％、88.1％,且两者的阴性结果互不重叠,这种诊断差异在超声诊断结果示内膜增厚/内膜厚薄不均病例中尤为显著.因此,子宫内膜息肉的诊断方式中,宫腔镜诊断检出率最高,但仍有漏诊的病例由病理确诊,研究认为宫腔镜检查是确诊子宫内膜息肉的重要诊断方法.     

珍珠是蚌的眼泪

正1981年5月,年轻的博士马歇尔到医院做实习医生。一天,他听说患者汤姆森,吃四环素,居然把胃溃疡治好了。马歇尔比哥伦布发现新大陆还要兴奋,同时,爱思考的他想:四环素是一种杀菌剂,如果四环素是胃溃疡的克星,这是否意味着,胃溃疡是由细菌引起的?马歇尔觉得这是个很有价值的研究课题。于是,他向医院提出要做胃溃疡细菌培养实验。负责微生物实验的老教授,斜了一眼年轻的实习生,答应了。却没给他一点点支持,无     

医学生"被非法行医"的伦理学悖论及法学思考

通过回顾发生在北京某医院实习医生参与患者手术和抢救而引发纠纷的案例,分析了医学生"被非法行医"的原因以及医学生实习过程中教学医院所面临的伦理及法律问题,并提出了解决问题的思路:完善相关法律和制度,重视患者的"知情同意权"以及创新教学模式以培养医学生.     

临床实习的法律规范问题调查及对策

通过问卷对来自四川大学华西医院等6所不同层次医疗机构的475名实习医生进行调查,发现身份不合法、患者不配合、义务履行不充分、管理不规范是目前实习中的主要问题.提出在优化实习资源、加强实习生教育的基础上,通过建立《实习医师资格考试制度》、成立“临床实习管理规范委员会”,确立实习规范化的法律依据和制度框架,促进我国医学教育和卫生事业的良性发展.     

An evaluation of differential reinforcement with stimulus fading as an intervention for medical compliance

Individuals with autism spectrum disorder (ASD) often exhibit noncompliance during medical exams. One intervention used to address this concern is differential reinforcement. Although differential reinforcement includes extinction, it may not be feasible or safe to implement extinction during medical exams. In the current study, we evaluated differential reinforcement without extinction and differential reinforcement without extinction plus stimulus fading, for increasing compliance during routine medical exams exhibited by 4 individuals with ASD. An indirect assessment identified problematic medical procedures, and a functional analysis showed that participants' disruptive behavior was maintained by escape from medical tasks. Differential reinforcement without extinction was insufficient in increasing medical compliance with 3 of 4 participants. The addition of a modified stimulus fading procedure that involved gradually introducing smaller components of problematic exam steps was effective in increasing medical compliance with all exam steps.     

Striving to do Good Things: Teaching Humanities in Canadian Medical Schools

We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada's seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted - or is even desirable - given that Canadian medical humanities programs are largely shaped by individual educators' interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities - which defy easy metrical appraisal - are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches.     

Using Ecological Theory to Evaluate the Effectiveness of an Indigenous Community Intervention: A Study of Sexual Assault Nurse Examiner (SANE) Programs

In recent years, there has been renewed interest among community psychologists in indigenous interventions, which are programs created by local practitioners (rather than researchers) already rooted in their communities. Indigenous interventions have strong ecological validity, but their effectiveness is often unknown because so few are rigorously evaluated. The goal of this project was to use Kelly and Trickett’s ecological theory as a conceptual framework for evaluating an indigenous intervention and its mediating mechanisms of effectiveness. The focal intervention was a midwestern Sexual Assault Nurse Examiner (SANE) program, which provides post-assault medical care, crisis intervention, and medical forensic exams for sexual assault survivors. Prior studies of SANE programs have suggested that these interventions may help increase sexual assault prosecution rates. In this case example, we used a mixed methods design to determine if this program contributed to increased prosecution rates, and if so, why. Based on qualitative interviews with key stakeholders, we found substantial evidence for the Principle of Interdependence such that the SANE program strengthened the interconnections between the legal and medical systems, which contributed to increased prosecution. The intervention was effective in these outcomes because it promoted Cycling of Resources throughout the systems and fostered Adaptation of new roles for legal and medical personnel. Moving beyond this specific case example, this paper also examines cross-cutting advantages and struggles of using an ecological approach in the evaluation of indigenous community interventions.     

Evaluation of Student Performance through a Multidimensional Finite Mixture IRT Model

In the Italian academic system, a student can enroll for an exam immediately after the end of the teaching period or can postpone it; in this second case the exam result is missing. We propose an approach for the evaluation of a student performance throughout the course of study, accounting also for nonattempted exams. The approach is based on an item response theory model that includes two discrete latent variables representing student performance and priority in selecting the exams to take. We explicitly account for nonignorable missing observations as the indicators of attempted exams also contribute to measure the performance (within-item multidimensionality). The model also allows for individual covariates in its structural part.     

Health care utilization by low-income clients of a community clinic: an archival study

An archival study was done of 500 medical records from a community clinic serving a low income predominantly Hispanic area of Los Angeles. The data collected included demographic characteristics and presented symptoms or reasons for visit, as well as diagnosis and treatment. The greatest number of patient visits were made for family planning services. A large porportion of the patients who received initial family planning services failed to return to the clinic for follow ups or additional supplies. A total of 208 pregnancy tests were performed in 151 of the 500 cases sampled. Of these, 152 were positive. The most frequently stated reason for requesting pediatric services was for physical exams, accounting for 30% of the visits. It should be noted that the discontinuity of care and insufficient utilization of preventive care seen in these results deserve serious attention by medical clinic administrators. The rate of patients who do not return for family planning after the initial visit is worrisome. A greater effort to attract women to family planning services at the time they request pregnancy verification could reduce the need for abortion of unwanted pregnancy. The data also indicate that changes in the wording of certain questions commonly asked of clients may be needed. This study allowed service providers to obtain important information about their performance, their needs, and the future direction that their services might take. This type of analysis is relatively low in cost and can yield important benefits, espicially if done on a periodical base in a search for policy implications.     

Students' self-ratings of stress in medical school: a replication across 20 months

We replicated the essential results of a prior study on the capacity of the BAROMAS scales to reflect stress in medical school as perceived by students. As before, subjective stress was high at the start of medical school, and when facing the exams prerequisite to entry into clinical clerkships. On most measures, stress was lowest when the second year began (i.e. after having passed the first). Once again, most test-retest reliabilities (significant rs ranged from 0.24 to 0.66 for confidence ratings at 12- and 20-months after entry) were moderate.     

Caffeine enhances the physiological response to occupational stress in medical students

Caffeine (3.3 mg/kg) was tested against a placebo in 20 male medical students during periods of low (no exams) versus high (final exams) work stress. On each of 8 test days, heart rate and blood pressure were measured at baseline and over a 40-min postdrug interval; immediately afterward, blood was drawn to test plasma cortisol and serum lipid concentrations. Exams increased heart rate (p less than .005) and systolic blood pressure (p less than .02). Caffeine decreased heart rate (p less than .0001) and increased systolic blood pressure (p less than .005), diastolic blood pressure (p less than .0001), plasma cortisol levels (p less than .01), and serum cholesterol levels (p less than .02). Caffeine effects were additive with those of exams, and together they increased the number of men showing systolic blood pressures in the borderline hypertensive range. Thus, caffeine use during periods of increased occupational stress may enhance the cumulative stress response.     

Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only weak evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed.     

Delaying feedback promotes transfer of knowledge despite student preferences to receive feedback immediately

Educators and researchers who study human learning often assume that feedback is most effective when given immediately. However, a growing body of research has challenged this assumption by demonstrating that delaying feedback can facilitate learning. Advocates for immediate feedback have questioned the generalizability of this finding, suggesting that such effects only occur in highly controlled laboratory settings. We report a pair of experiments in which the timing of feedback was manipulated in an upper-level college engineering course. Students practiced applying their knowledge of complex engineering concepts on weekly homework assignments, and then received feedback either immediately after the assignment deadline or 1 week later. When students received delayed feedback, they performed better on subsequent course exams that contained new problems about the same concepts. Although delayed feedback produced superior transfer of knowledge, students reported that they benefited most from immediate feedback, revealing a metacognitive disconnect between actual and perceived effectiveness.     

The Benefits of Following Your Pride: Authentic Pride Promotes Achievement

Although the emotion authentic pride has been posited to promote achievement, it remains unclear precisely how this works. Here, we tested whether authentic pride promotes adaptive downstream achievement outcomes by motivating individuals to engage in appropriate behavioral responses to success and failure. In two longitudinal studies (N = 1,132), we measured pride emotional responses to a prior performance and subsequent changes in achievement‐oriented behavior and performance outcomes among (a) adults training for long‐distance running races and (b) undergraduates completing class exams. Authentic pride shifted in direct response to achievement outcomes, such that those who performed well felt greater pride. Furthermore, individuals who felt low authentic pride responded to these feelings by changing their achievement behavior in a functional manner. In Studies 2a, 2b, and 2c, we found that pride‐driven behavioral changes led to improved future performance among low performers. In these studies we also demonstrated that the effect of authentic pride on achievement is independent of that of self‐efficacy, which in fact works in an opposite manner. Taken together, these results suggest that authentic pride functions as a barometer of achievement, promoting behavioral responses that lead to improved performance.