临床医学人才培养目标的探讨

通过复阅文件资料、问卷调查,从历史回顾、现状研究等着手,对新世纪医学本科人才培养目标进行了探讨。提出临床医学专业本科人才的总体培养目标是：面向现代化、面向世界、面向未来,具有较高的医学人文素养、较宽的医学基础理论、较强的医学实践能力,具有创新创业精神,融医疗、预防、保健、康复为一体的应用型医学人才。本研究对于进一步整体优化课程结构和改革教学内容具有十分重要的意义。     

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.     

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.     

Were the “Pioneer” Clinical Ethics Consultants “Outsiders”? For Them,Was “Critical Distance” That Critical?

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field.     

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.     

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.