The impact of empathy on burnout in medical students: new findings

Introduction: Research on medical students has shown they are at a higher risk for burnout and that this burnout may become more prevalent as they advance in medical school. The literature, thus far, has not explored the construct of ,emotional empathy and whether this can impact burnout in medical students. Objective: To understand the relationship between empathy (Empathic Concern [EC] and Personal Distress [PD]) and burnout in medical students. Method: Five successive classes of medical students enrolled at a new medical school were given the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index over the course of three successive years (n = 353). Two dimensions of empathy were evaluated to determine if they have an impact on three dimensions of burnout (Emotional Exhaustion/EE, Depersonalization/DP, Personal Accomplishment/PA). Results: data was analyzed using a linear mixed model for each of the three components of burnout based on gender, age, year in medical school, and two types of empathy: EC, and PD. Conclusion: It was discovered that students with high levels of EC had statistically lower scores of burnout over time while students with high levels of PD empathy showed statistically higher scores of burnout over three years. Implications for these findings are discussed.     

Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings

The discontinuation of interventions that should be stopped, or de‐implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de‐implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de‐implemented. We identify three criteria for identifying interventions appropriate for de‐implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well‐documented examples illustrate each of the criteria. We describe de‐implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de‐implementation research as a supplement. Finally, we conclude with a discussion of de‐implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de‐implementation research, especially identifying interventions appropriate for de‐implementation in a systematic manner; and highlight special ethical considerations to advance the field of de‐implementation research.     

Student Service Members/Veterans’ Mental Health: Who Is at a Greater Risk for Posttraumatic Stress Symptoms on College Campuses?

Using a cross-sectional design, this study surveyed 144 students on campus who are service members and veterans to determine whether posttraumatic stress (PTS) symptoms are significantly correlated with demographic factors (e.g., age, race and marital status), risk factors (e.g., military branch and combat exposure), and resources (e.g., social support and religiosity). The results confirm previous findings on correlates of PTS symptoms, provide new information about service members on campus that are at a greater risk for PTS and highlight resources that are associated with reduced PTS symptoms. These findings not only give institutions of higher learning insight into identifying specific demographics that are at a greater risk for PTS symptoms on college campuses, but also point to ways of supporting student service members/veterans by accurately targeting existing resources to the most affected populations.     

The Community Psychologist as Critical Friend: Promoting Critical Community Praxis

Community‐engaged researchers have a responsibility to community partners to get beyond the traditional researcher stance to take on the active role of critical friend. On the basis of my own community research experiences in the USA, in this article, I argue that there is added value in taking on the practice of critical friendship to encourage a higher degree of critical reflection and critical practice in our partners and in our work together. In the context of long‐term, trusting relationships with community partners, researchers can play the role of critical friend working together to shape critical community praxis on the basis of critical theorizing, critical reflection, and a shared commitment to working for social justice. Those trying to make a difference in communities are often isolated and can benefit from opportunities for dialogue with other community practitioners within a critical frame of reference. Although not without risks and challenges, stepping into this role allows us to put into sharper relief the gap between community practice that challenges injustice and practice that maintains it. Copyright © 2014 John Wiley & Sons, Ltd.     

医务社会工作介入的灵性视角：理论、实践与展望

灵性健康被学者视为所有健康层面中最深沉、最核心的部分,可以支持和影响其他的健康层面。不过,在当前中国的医务社会工作实践中,灵性资源相对匮乏,还没有得到应有的重视。在不同历史时期,医务社会工作中的灵性视角有着多层次、多维度的丰富内涵。在医务社会工作实践中,灵性视角的运用体现在非线性的介入策略、丰富的实务技术,重视服务对象的生命意义问题。灵性视角具有独特的意义和价值,与医务社会工作有较强的契合性。在医务社会工作实务、研究和教育中,需要加强对灵性视角的理解和自觉应用。

     

宋代医官磨勘制度初探——兼论王安石思想对其影响

磨勘是宋代对于官员进行考核迁转的制度。但宋代初期在制定官员磨勘制度之时医官并未涵盖在内,并且医官的转任也有着相当的限制。北宋历次重大改革均将医学教育作为改革的重要内容,自此培养了大批医学人才,医官转任的限制也有逐渐放松的趋势。在王安石变法思潮的影响下,宋政府出于管理的需要,于熙宁年间正式确立医官磨勘制度。至宋徽宗重新启用变法派,于国子监设立中央医学,医官磨勘制度结合中央医学的设立有了进一步的细化和发展。虽然在制度的实施过程中由于管理不善出现过种种乱象,但医官磨勘制度对后世的医学发展有深远影响。

     

记忆中枢海马体的发现与命名

海马体是大脑存储记忆的主要位置,一直是神经科学领域研究的重点。20世纪对海马体功能的揭示得益于解剖学的早期研究。海马体解剖学研究始于文艺复兴时期,但囿于大脑结构的复杂性和解剖学技术的不完善,当时对海马体的认识存在局限性。在16世纪～18世纪初期解剖学界对海马体的命名产生了分歧,出现了公羊角、阿蒙角等一系列用于描述海马体的术语,18世纪末期海马体形态学研究的突破,结束了两个世纪海马体命名的分歧。从医学史的角度出发,构建了海马体发现及命名的历史过程,旨在从中借鉴经验,更好地推动神经科学的发展。

     

医保DIP改革与医疗服务供给的伦理思考：冲突与对策

区域点数法总额预算下的按病种分值支付（diagnosis-intervention packet,DIP）是当前国内医保支付方式改革的最大热点,但尚需完善。对医疗服务供给侧结构性改革的主要目标进行了梳理,以此为基础对DIP改革的潜在伦理问题进行了分析,认为DIP多劳多得的激励机制不利于机构间协作,控费导向支付机制不利于服务行为规范,等级系数设置和低费用偏好机制不利于机构服务能力提升。从制定连续服务支付策略、提高病种分组精细程度、统一各类医保支付政策及构建能力导向支付机制等方面提出了DIP改革的优化策略。