临床思维与决策能力是医学教育的重要组成部分

临床思维与决策能力培养是医学生不可或缺的一门必修课程,临床医生实际上每天处于临床决策之中,必须为疾病提供诊断和治疗的决策.而当前临床医学生在此方面训练甚少,临床工作具有很大的不可预知性和不可确定性,尤其是在手术室繁忙、变化的环境中,进行高效的临床决策就显得尤其重要.本文阐述了临床思维与临床决策在医学教育中的重要地位及其相互关系,分析当前医学生临床实践中的思维与决策方面存在的问题.并从临床实际角度出发,探讨如何提高医学生临床思维与决策能力的方法,对促进医学教育模式改革,提高医学教育质量具有重要推动作用.     

医学教育使命的坚韧与媚俗

医学院校高大全式的多元化发展方向,式微了医学教育使命、偏离了医学专业特色、弱化了医学科研实力,得不到社会认可,给社会带来可怕后果,走向泛化与平庸是其必然的演进宿命.医学教育的使命既要坚韧于医学的专业,还要能触摸到医学的温情,这才是医学教育发展的正确方向.     

全球视野下高等医学教育面临的挑战与改革出路

医学卫生人才培养质量和高等医学教育改革备受全球瞩目.分别从体制层面涉及的四个功能和教学层面涉及的四个方面分析了目前我国高等医学教育面临的一些问题及其原因,并从全球视野出发,重新定位医学教育改革的目标,探讨在全球视野下我国高等医学教育改革的出路,提出改革构想.     

英国本科医学教育培养目标的嬗变——基于《明日的医生》报告的解读

英国医学总会在1993年、2003年和2009年先后出版了三份《明日的医生》报告,为本科医学教育提供了综合性框架,指导本科医学课程设计和评价体系的形成.从知识、技能、医学伦理和职业道德三个层面,比较英国本科医学教育人才培养目标的嬗变,发现其要求不断趋于全面、细化、深入.并进一步分析了政治、多元文化、国家医疗政策、医学领域自身及医学教育内部等诸因素对英国本科医学教育的影响,以期为我国的本科医学教育提供借鉴.     

Rejection of Darwinian Evolution Among Churchgoers in England: The Effects of Psychological Type

Rejection of Darwinian evolution (implying rejection of the common origin of all species, including humans) was assessed among 1,100 churchgoers from a range of Christian denominations in England. The main predictors of rejecting evolution were denominational affiliation and attendance. Individuals from Pentecostal or evangelical denominations were twice as likely to reject evolution compared with those from Anglican or Methodist churches. In all denominations, higher attendance was associated with greater rejection of evolution. Education in general, and theological education in particular, had some effect on reducing rejection, but this was not dependent on having specifically scientific or biological educational qualifications. Psychological type preferences for sensing over intuition and for thinking over feeling also predicted greater rejection, after allowing for the association of type preferences and general religiosity. Reasons for the association between psychological type and rejection of evolution are discussed in the light of the known characteristics of different function preferences.     

Enhancing Digital Fluency through a Training Program for Creative Problem Solving Using Computer Programming

The purpose of this paper is to propose a training program for creative problem solving based on computer programming. The proposed program will encourage students to solve real‐life problems through a creative thinking spiral related to cognitive skills with computer programming. With the goal of enhancing digital fluency through this proposed training program, we investigated its effects. Two sets of experiments were performed in which 119 typical students and 30 younger, gifted students participated. Two synthetic creative problem solving tests, which had a high correlation with logical ability, scientific problem solving ability and divergent thinking ability, were developed to measure creative problem solving ability. We provided the treatment group with a paper‐based booklet with relevant problems developed specifically for that group. ANCOVA statistical procedures were used to analyze the pre‐ and post‐synthetic creative problem solving tests. The findings of our study are as follows: with typical students, the originality of the treatment group outperformed the control group, a result that was compatible with previous research. With gifted students, the fluency of the treatment group outperformed the control group, and overall creative problem solving ability was enhanced. Remarkably, fluency increased significantly, a notable difference from the results of prior studies. In conclusion, we inferred that, given the definition of digital fluency, if creative problem solving ability is enhanced by a training program for creative problem solving based on computer programming, digital fluency will ultimately be improved. In this paper, we discuss the result of fluency enhancement that contradicts prior research. We suggest that this training program could be a new learning environment for the students who have grown up with digital media.     

Working class homosexuality and HIV/AIDS prevention some recent research from Sydney,Australia

Abstract

Surveys on gay and bisexual men in Sydney and non-metropolitan New South Wales (NSW) indicate uneven patterns of HIV/AIDS knowledge and sexual behaviour change. As a follow-up action-research study, the Class, Homosexuality and AIDS Prevention (CHAP) project pursued audio-recorded, semistructured interviews with men in western Sydney and Nullangardie, a provincial city in NSW, to investigate the relationship between homosexuality and class.

One-to-one interviews with working-class, homosexually active men revealed particular patterns of homosexual initiation and sexual relationships, and a distinct culture being slowly affected by notions of being “gay” and “gay community”. This impact of modern gay life on western Sydney was different from that in the provincial city. More prominent were the effects of class—unemployment, poor education, poverty, and cultural marginalisation—on the experience and elaboration of homosexuality. Group interviews confirmed an experience of “difference” from prominent gay communities, especially Sydney's “Oxford Street” gay quarter. Working-class men offered a critique of gay community-initiated HIV/AIDS prevention strategies, pointing toward different education initiatives involving local social networks.

Case studies are presented to argue the importance of the relation between sexuality and class, and its consequences for HIV/AIDS education.     

Early literacy among Arabic-speaking kindergartners: The role of socioeconomic status,home literacy environment and maternal mediation of writing

We explored the sociocultural context of early literacy development among Arabic-speaking kindergartners in Israel, focusing on the nature of mother–child joint writing. Eighty-nine kindergartners and their mothers participated. Mothers were videotaped in their homes while helping their children write words. Early literacy was evaluated by alphabetic knowledge, concepts about print, phonological awareness, and vocabulary. Kindergartners’ early literacy was related to socioeconomic status (SES), home literacy environment (HLE) and maternal mediation level. Hierarchical regressions indicate that HLE predicted alphabetic knowledge, phonological awareness, and vocabulary beyond SES. Maternal mediation of writing predicted all children's early literacy measures except vocabulary, after controlling for SES and HLE. We discuss maternally mediated joint writing interactions as a possible context for early literacy enhancement among young Arabic-speaking children in Israel.     

Implementing a behavioral medicine program in an internal medicine residency: A description of curriculum content,resources and barriers encountered

Abstract

Many internal medicine training programs are currently developing curricula designed to teach the psychosocial aspects of patient care and doctor-patient communication skills. However, faculty may lack expertise regarding how to accomplish new educational goals in these areas. This article is designed to assist programs by describing in detail how a comprehensive behavioral medicine program was integrated into a general internal medicine program at a university-affiliated community hospital. It describes the program goals, resources needed, content included, obstacles to implementation and potential solutions to the problems encountered.     

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Abstract

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training.

The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident.

In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation.

These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.