Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

The Future of Neuropsychology in Medical Specialties

Although neuropsychology continues to grow as a valued service in most medical specialties, because of its multiple uses with diverse populations, it is necessary to evaluate the specialty critically in order to ensure continued future success. This article reviews areas in which neuropsychology is most firmly established, potential growth areas, and likely obstacles to success in the future. Suggestions are provided for ways in which neuropsychology can be improved/adapted in clinical, business, research, and training areas. On sabattical at Bebek University, Instanbul, Turkey     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

医学伦理学概念之探究

医学伦理学的概念看起来很简单,一般情况下人们便习以为常地接受了作为应用规范伦理学的一个分支的科学地位,而忽视了医学对医学伦理学所起的作用。本文认为：医学伦理学的具体内容是医学科技与伦理道德两因素相互作用的产物,对其相互作用的形式和产物的具体分析和总结便可构成这门学科的理论体系。     

合作学习对小学生同伴关系、成就动机和成就影响的研究

旨在探讨在我国开展合作学习教学的可行性,以及合作学习对小学生同伴关系、成就动机和成就水平的影响,运用自然实验和测量相结合的方法,选择了北京师范大学实验小学三年级两个班进行实验研究,其中一个班为实验班（ｎ＝３５）,另一个班为控制班（ｎ＝３７）．实验为期三个月。结果表明：合作学习在小学教学中不但是可行的,而且效果较为显著;合作学习对同伴关系的改善有着积极的影响,学生间的接纳度和被接纳度都有普遍的提高;合作学习在较大程度上激发了学生的成就动机水平,学生对合作学习的课程兴趣明显提高．成绩较差的学生表现得更为明显;合作学习对提高学生的学习成绩有一定的促进作用。     

Cooperative learning revisited

The endeavor to teach academic skills known as cooperative learningis of interest to behavioral educators due to its record of effectiveness, its use of behavioral procedures, and its relatively widespread adoption by regular educators. All forms of cooperative learning emphasize operations that encourage students to work together to achieve commonly held goals rather than competing with or ignoring the efforts of others. Despite the apparent soundness of the approach, the present commentary raises several issues. First, it states that some cooperative learning proponents fail to describe the behavioral processes underlying the approach. Second, it is pointed out that it is unclear whether cooperative learning is an independent or dependent variable. Given that cooperative learning applies group contingencies to academic behavior, the question is raised as to whether group contingencies do, in fact, produce desirable social interactions, and whether group contingencies are appropriate for academic behaviors. A concern is also raised as to whether the spontaneous peer tutoring generated by cooperative learning compares favorably with planned peer tutoring. Finally, it is claimed that the minor variations from academic group contingencies that cooperative learning proponents have introduced do not require identifying a new process.