刍议综合性大学医学教育的发展方向

国际上一流的综合性大学都设有医学院,高水平的医学院也基本上都在综合性大学内。据此提出现阶段我国综合性大学医学教育应向研究型、国际化、现代化的方向发展,并就其发展对策提出了自己的看法。     

Serious misapplications of military research: dysfunction between conception and implementation

Researchers and technologists involved in the development of weapon systems can take their work to such extremes as to cause unplanned injury or death to others and lasting damage to the environment, reviewed here. In some cases innocent human casualties and ecological harm may actually be programmed and achieved. An analysis is proffered, attributing blame, and indicating efforts to correct the situation. The ethics involved are “complexified”, moral boundaries are exceeded, and humanity is transgressed as it develops solutions to the problem. The license to make mistakes becomes more limited with the passing of the years... Primo Levi, chemist¹ To use the term coined in 1994 by John L. Casti of the Santa Fe Institute.     

工作记忆中的部分线索效应:任务呈现方式的影响

以往研究主要在长时记忆中考察部分线索效应,很少关注工作记忆中的部分线索效应及其作用机制。本研究采用项目再认任务,考察了工作记忆中提供部分学习项目作为提取线索,对存储在工作记忆中的已有表征的影响。结果发现：有、无部分线索试次分组呈现时,相较于无部分线索条件,有部分线索条件下再认正确率和d'降低,β升高,反应时间延长;有、无部分线索试次随机混合呈现时,有部分线索条件下再认正确率降低,β升高,但反应时间并无显著延长。结果表明：工作记忆中部分线索的提供降低了目标项目的表征强度;研究结果可用提取抑制假说解释,但工作记忆中部分线索的作用可能受注意资源有限性制约。     

Improving compliance with medical fitness to drive reviews: The role of behaviourally-optimised letters

To manage the increased crash risk posed by drivers with medical conditions and impairments, many licensing authorities ask high-risk drivers to undergo medical fitness to drive assessments. Maximising drivers’ compliance and satisfaction with these assessments is an ongoing challenge for these authorities. This study tested whether drivers’ compliance and satisfaction with a licensing authority’s request to provide a medical report could be improved by incorporating two applied behaviour change principles – simplified messaging and procedural fairness – into the authority’s request letter. Drivers undergoing medical review (N = 876) were assigned to receive either a standard request letter currently used by the authority, or a revised letter that incorporated simplified messaging and procedural fairness amendments. Drivers who received the revised letter were significantly more likely to submit a medical report by the due date. Additionally, of the drivers who submitted the report, those who received the revised letter submitted the report an average of four days faster than those who received the standard letter. These findings demonstrate that optimising letters using behavioural principles can improve compliance with licensing authorities’ requests, resulting in substantial time and cost savings for licensing authorities, possible road safety benefits, and potential reductions in the number of licences suspended for failure to provide a report.     

Balint groups in undergraduate medical education: a systematic review

Objective: Though Balint groups feature increasingly in UK medical school curricula, there is no evidence-based consensus on what undergraduates might gain from participation, and how this might happen. To address this, we systematically reviewed primary research studies involving medical student Balint groups and their relationship with patient-centredness, using narrative synthesis. Data sources: Four major databases were searched from origin until 9 September 2016. The Journal of the Balint Society was hand-searched from 1971 until 9 September 2016. Study selection: English language studies reporting quantitative and/or qualitative methods examining Balint groups in medical students vs. other/no comparator. Results: Eight studies were included. Quantitative findings report statistically significant improvements to student’s empathy and intellectual interest following group participation vs. control (p = 0.03, p = 0.046, respectively). Discussion content was similar across high-income countries. There was considerable heterogeneity when students rated the efficacy of groups. All evidence had high or unclear risk of bias, or was of medium/low quality. Conclusion: Balint groups might help medical students to become more patient-centred, by increasing students’ empathic abilities and supporting their personal and professional growth. Groups are more subjectively effective when optional rather than compulsory. Discussion content is comparable to groups in continuing medical education.     

Does surrounding traffic benefit from an assisted driver with traffic light assistance system?

Traffic light assistance systems enable drivers more energy and time efficient driving behavior at signalized intersections. However, most vehicles will not be equipped with such systems in the next years. These unequipped vehicles’ drivers (UVDs) may benefit from assisted drivers, if they would adapt their behavior. This paper outlines how UVDs (N = 60) interpreted and reacted to a driver with traffic light assistance system. We used a multi-driver simulator with three drivers driving in a car-following scenario. The lead driver was not a participant, but a confederate who was followed by two UVDs. The confederate was apparently equipped either with or without a traffic light assistance system. The traffic light assistance system consisted of two functionalities: a Green Light Optimal Speed Advisory and a start-up assistance system with two different parametrizations. These functionalities aimed at preventing unnecessary changes in speed and reducing the start-up lost time after signal change. The results showed that UVDs benefited from the driving behavior of the confederate with traffic light assistance system. However, the assisted driving behavior was hardly understood and partly rated as aversive by the UVDs. We discuss how to enhance behavioral adaptation of UVDs. We also outline which negative consequences may result from encounters of driver with systems and UVDs. We assume that how UVDs react towards drivers with systems may be one factor contributing to a successful launch of such systems.     

The Balint group experience for medical students: a pilot project

Loss of empathy has been reported in medical students as they move through the clinical phases of their training. Several researchers have attempted to address this issue by exploring ways of heightening students’ awareness of the emotional, non-biomedical aspects of illness and the dynamics of the doctor–patient relationship, using a variety of reflective group discussion methods. This pilot project employed the specific group method developed by Michael Balint for general practitioners working in London after the Second World War. The pilot was based on one group of six third-year graduate students, meeting weekly over six weeks. Evaluation includes pre- and post-questionnaires, a 1000-word essay and leaders’ observations. The results suggest that the traditional Balint method needs to be modified for students at a point in their training where they have not yet been exposed to patients for long enough to develop meaningful patient relationships. Nevertheless, there was some evidence of a heightened awareness of the dynamics of doctor–patient relationships and the importance of psychological/emotional factors (including their own prejudices) when interacting with a patient. Balint-style groups could be an effective way of encouraging medical students to reflect on the importance of emotions in the doctor–patient relationship.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

How intention and monitoring your thoughts influence characteristics of autobiographical memories

Involuntary autobiographical memories come to mind effortlessly and unintended, but the mechanisms of their retrieval are not fully understood. We hypothesize that involuntary retrieval depends on memories that are highly accessible (e.g., intense, unusual, recent, rehearsed), while the elaborate search that characterizes voluntary retrieval also produces memories that are mundane, repeated or distant – memories with low accessibility. Previous research provides some evidence for this ‘threshold hypothesis’. However, in almost every prior study, participants have been instructed to report only memories while ignoring other thoughts. It is possible that such an instruction can modify the phenomenological characteristics of involuntary memories. This study aimed to investigate the effects of retrieval intentionality (i.e., wanting to retrieve a memory) and selective monitoring (i.e., instructions to report only memories) on the phenomenology of autobiographical memories. Participants were instructed to (1) intentionally retrieve autobiographical memories, (2) intentionally retrieve any type of thought (3) wait for an autobiographical memory to spontaneously appear, or (4) wait for any type of thought to spontaneously appear. They rated the mental content on a number of phenomenological characteristics both during retrieval and retrospectively following retrieval. The results support the prediction that highly accessible memories mostly enter awareness unintended and without selective monitoring, while memories with low accessibility rely on intention and selective monitoring. We discuss the implications of these effects.