The changing perceptions of junior medical students about the current U.S. health care system after a seminar series

In the last few years dramatic changes have occurred in the way health care is delivered and financed in the United States. Academic medical centers have been slow in helping students understand what these changes will mean. We developed a series of student-run seminars and attempted to study what effect these seminars had on the students' attitudes towards many aspects of the current health care environment. We used recent journal articles as the basis for a student-led seminar series addressing many issues in the current health care environment. A previously developed 33-item survey was administered to the students before and after the seminars to evaluate any changes that occurred in their attitudes towards the evolving health care system. The students' responses showed significant changes on eight of the items surveyed. These included a more negative feeling about non-physician health care providers, a greater appreciation of the need for physicians to become more actively involved with social issues, and a greater understanding of the financial aspects of medicine. After a student-led seminar series there were significant changes in students' attitudes regarding several aspects of the changing health care environment in the United States.     

Trainee health care professionals'' knowledge of the health risks associated with obesity

BACKGROUND: Trainee nurses, doctors and dietitians will direct the future of obesity treatment and prevention. To do so effectively, they must have sufficient knowledge regarding the health risks associated with obesity and feel that part of their professional role is to counsel obese patients regarding these risks. METHODS: An online survey collected data on professional roles, training needs and the Obesity Risk Knowledge-10 (ORK-10) scale from 38 dietetic, 88 nursing (Diploma), 74 nursing (Masters) and 389 medical students. RESULTS: Final-year dietetic students demonstrated higher ORK-10 scale scores than final-year nursing (Dip), nursing (MSc) and medical students (P < 0.001). The majority of students agreed that part of their profession's role was to counsel obese patients about the health risks associated with obesity. Dietetic students were more satisfied with the teaching they had received than each of the other student groups (P < 0.05). CONCLUSION: Future health care professionals recognize their responsibility to communicate health risk information to obese patients. Dietetic students have a sound knowledge base to support them in this. Educators of trainee nurses and doctors may like to respond to their students' lower levels of knowledge and desire for more training.     

Abortion and physicians in training: the opinion of medical students in Mexico City

This research project explores doctors' views regarding induced abortion. Abortion's penalization in Mexico greatly conditions its relevance as a social and public health problem. Physicians constitute a professional sector that can play an important role in reforming current laws on abortion. As a professional group, they have taken a conservative stance towards abortion. Their attitudes are to a great extent influenced by the medical training they receive. In this article we present results from a survey of 96 medical students from the Universidad Autónoma Metropolitana Xochimilco, in Mexico City. Data were processed with the SPSS program. Simple frequencies show that students have limited knowledge concerning the legal status of abortion and that they tolerate it with restrictions and in limited situations. Women students apparently take a more conservative stance, but statistical analysis with the c-square test did not show significant differences by gender. The article poses the need to modify doctors' training in the reproductive health field, allowing future doctors to acquire a broader view of health problems related to sexuality and reproduction. In the long run, this should also promote a kind of comprehensive health care practice in medical services, thus responding more satisfactorily to women's needs.     

Changes in primary health care centres over the transition period in Slovenia

BACKGROUND: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. METHODS: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. RESULTS: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. CONCLUSIONS: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.     

Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes

Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today’s health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral “teams;” (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.     

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.     

Impact of interprofessional training on medical students'' willingness to accept clinical responsibility

Interprofessional training has been suggested as a means of preparing medical students for team health care, but the effects of such training have not been carefully studied. A multidisciplinary training programme in ambulatory diabetes care was developed to promote positive attitudes towards team care. Programme effects were assessed by a questionnaire which asked medical students to indicate their willingness to delegate or share 25 specific clinical tasks with a nurse. Following programme participation, students' willingness to share responsibility increased significantly for seven of the 25 tasks. To test the hypothesis that this effect resulted from the assignment of a teaching role to nurses, selected seminar content was taught by doctors or nurses on a random basis. No differences in willingness to share responsibility were related to which professional taught the seminar content. However, students were more willing to share responsibility with a nurse when they thought they had learned that topic from a nurse, suggesting that their experience in observing nurses at work may have been important in influencing attitudes towards team care.     

The emerging need for transformational leadership in health information management

The prospect of national healthcare reform, new clinical and information technologies, and the need to cut the cost of health care delivery are contributing factors in the restructuring of the health care system. In light of these rapid changes and great uncertainties, health information management (HIM) leadership must radically change its style. The appropriate new styles will move the HIM practitioner from the specialized medical records department to a larger, more professional role. The successful transformational leader will help HIM emerge as a central function in the new health care industries.     

口腔专业学生对艾滋病的知识与态度

口腔疾患是HIV/AIDS患者重要和早期的临床表现之一,口腔医疗服务不仅有利于治疗患者的口腔疾患,改善患者的生活质量,而且可以降低HIV的传播.口腔专业医学院校的学生是未来提供HIV/AIDS患者口腔医疗服务的重要卫生资源,他们的HIV/AIDS认识和态度对未来提供的服务具有重要的影响.此文对口腔专业医学院学生的HIV...     

School-Based Prenatal and Postpartum Care: Strategies for Meeting the Medical and Educational Needs of Pregnant and Parenting Students

Adolescent pregnancy is not a new phenomenon, but it is a source of concern to U.S. educators because of the many young women choosing to become parents and the profound effect early childbearing has on the educational and vocational careers of many young Americans. Strategies for addressing the unique medical, educational, and psychosocial needs of pregnant and parenting students will be examined. Documented physical and psychosocial risks associated with adolescent childbearing will be reviewed, and data related to the effect of young maternal age on pregnancy outcome and the effect of pregnancy on the life course development of adolescents will be emphasized. Specific elements of comprehensive, adolescent-oriented prenatal and postnatal care will be discussed, as well as the effectiveness of existing prenatal and postnatal programs at preventing the most serious sequelae of adolescent childbearing. The role of school-based services will be examined, and ways will be discussed for educators and health care providers to collaborate in providing medical, educational, and social services for adolescent parents and their children. In addition, topics for future research will be suggested.     

Researching patient-professional interactions

This paper explores the nature and future of social research on patient-professional interactions. It first sketches the historical background to such research and notes that in the UK and US this was characterised by a focus on the doctor-patient relationship. This research embodied a sceptical view of the power of the medical profession in sustaining and promoting social inequalities, and a critique of 'medical dominance' over other health care professionals and patients. The paper then goes on to outline changes occurring in the nature of professional practice that suggest a fundamental shift in the social relations of health care and the role of medicine. These include a putative loss of public confidence in the medical profession and the authority of science, an increased role of the media in informing patients, and a change in the state's relationship with health care professionals. Finally, the paper outlines some items for a future research agenda, including the need to understand better patient preferences about changes in health care delivery, including a willingness to engage in 'partnership', and the possibilities and barriers to change in professional practice.     

Effects of performance-based reimbursement on the professional autonomy and power of physicians and the quality of care.

The key question addressed in this study is whether performance-based reimbursement in health care affects the professional power and autonomy of physicians, and if so, whether this has any consequences for the quality of care. This cohort study examines the period 1994-98 in 11 Swedish county councils. Four hundred and eighteen physicians were studied in Stockholm County Council, which has a performance-based reimbursement system, and in ten councils without such a system. The results show that professional power and autonomy are considered to be very limited in all councils, and that they have decreased during the period studied. Professional autonomy is, however, more limited in Stockholm. The limitations in Stockholm are more related to financial considerations, whereas the limitations in the other councils are more due to guidelines and lists of recommended drugs. Professional autonomy and power were found to be important determinants for quality of care, and the physicians in Stockholm estimated the quality of care lower than their colleagues in the ten other councils. Thus, our study suggests that the performance-based reimbursement system might fail to reach the desired results due to its negative impact on professional power and autonomy.     

Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students

CONTEXT: Doctors are often reluctant to seek health care through the usual channels and tend to self-diagnose and prescribe. Medical students learn attitudes and values from clinician role models and may also adopt behaviour patterns that lead them to seek help for physical and mental health problems from informal sources. OBJECTIVES: This study aimed to explore the behaviour of students in seeking health care for physical and mental health problems, comparing medical with psychology students, and to understand what barriers to conventional routes of seeking health care may affect this. METHODS: We administered a questionnaire asking for demographic details and responses to 2 vignettes in which a student from the respondent's discipline was experiencing firstly symptoms of a mental health problem and secondly symptoms of a physical health problem. Data were analysed with spss and univariate anovas to examine differences between respondents. RESULTS: A total of 172 students at the psychology and medical schools at James Cook University in Australia participated. We identified a number of barriers affecting student behaviour in seeking help, which included worries about knowing the doctor they could consult at the university health centre or having future dealings with him or her, and cost of treatment. There were differences between the 2 groups of students. DISCUSSION: There are several barriers for both psychology and medical students to accessing appropriate professional mental health care. Medical students also experience barriers to attaining appropriate physical health care when needed. Psychology and medical students were more likely to seek advice informally from friends and/or family with regard to mental health care.     

Physicians’ attitudes toward aging,the aged,and the provision of geriatric care: a systematic narrative review

As the number of older adults in the population increases, the rate of medical care use is expected to rise. As a result, geriatricians and gerontologists are researching predictors of medical care in later life, which includes ageism. Ageism within health care has been widely and frequently reported and it is thought to be a product of negative attitudes toward aging. The current review systematically explores the existing literature in this area and establishes seven themes within the research. From a predominantly American population of papers, themes that emerged were the following: physicians’ attitudes toward aging are complex and mixed; mixed associations among attitude, knowledge, and medical care; aging and disease symptom attributions among physicians; attitudes, knowledge, and exposure to older adults; the role of role models; the influence of the health care culture; and the influence of the health care system. These themes were considered separately and in tandem in order to explore avenues for future research that will clarify the influence that these psychosocial factors have on health care provided to older adults.     

基于区域信息平台的公立医疗机构政府监管机制研究

目的剖析闵行区政府监管机制的特点与变化,为公立医疗机构监管机制改革提供参考。方法采用政策分析和现场观察法相结合的方法。结果闵行区成立了“闵行区卫生监管中心”,运用区域信息平台工具,以绩效考核和专题监管活动为主要形式,开展了医疗机构运行监管、医疗质量监管等七个方面的监管工作。结论绩效考核监管形式有助于引导医疗机构实现公益性目标。区域信息平台在很大程度上提高了政府的监管能力。未来工作中需进一步完善监管制度和监管指标体系,强化专业监管能力,并建立信息公开制度和奖惩制度。     

完善知识结构,转变医学模式--论引入“社会流行病学”课程的意义

医学模式的转变和“大卫生观”的提出要求医学工作者具备相应的知识结构,能够从整个社会甚至整个生态系统视角做好生理、心理和社会方面的预防、健康指导服务。“社会流行病学”是研究人群健康的社会分布及社会因素对人群健康影响的一门课程,在国外很多大学受到广泛关注。但在我国该课程还未引入。引入该课程在完善现代医学生知识结构、促进医学模式转变和提高卫生服务水平等方面有着重要作用。     

Medical education,palliative care and moral attitude: some objectives and future perspectives

CONTEXT: Adequate medical education has 3 interrelated aspects: theoretical knowledge, practical skills and the personal attitude of the doctor. The current emphasis on medical science diverts attention from the importance of the attitude aspect of medical education. We argue that the integration of palliative care into medical curricula can correct this imbalance between knowledge, skills and attitude. In our view, incorporating palliative care into medical training not only improves the quality of palliative care, but also contributes to the moral quality of the doctors being trained. To support our argument we emphasise the moral aspects of attitude. Moral attitude focuses on the capacity to respond to others in a humane manner and can be compared with the way a virtuous doctor acts. We show the crucial role this moral attitude plays in palliative care and the surplus value palliative care education can have in general medical training. PERSPECTIVES: We suggest that clinical experience in palliative care, supplemented by reflection on narratives about chronically ill or dying patients and mourning or ageing processes, offers prospects for developing palliative care education. These perspectives can contribute to the transformation of the present 'hidden curriculum' of contemporary medical education, which implicitly shapes the student's moral attitude, into a future more explicit enculturation into the medical realm. Ultimately, this will improve health care as a whole.     

The case for educating health care students in professionalism as the core content of interprofessional education

BACKGROUND: Professional teams are becoming more central to health care as evidence emerges that effective teamwork enhances the quality of patient care. Currently, health care professionals are poorly prepared by their education for their roles on the team. In parallel, there are increasing demands from consumers for health care professionals to serve the interests of society and patients through engaging in effective professional partnerships. Professionalism for health care providers is now being defined as a commitment to standards of excellence in the practice of the profession that are designed primarily to serve the interests of the patient and to be responsive to the health needs of society. Yet, there are multiple barriers impeding the development of professionalism beyond a uni-professional frame of reference. METHOD: Incorporating teamwork and professionalism into health care professional curricula at pre-registration level is proving to be challenging. These 2 areas of learning are brought together in this paper through a discussion of the role of interprofessional education in preparing all health care professional students for the workforce. CONCLUSION: Interprofessionalism is presented as a pre-registration curriculum framework that includes values shared by all health care professionals, which should be learned in order to more adequately prepare students for working in health care teams. It will be argued that interprofessional education provides appropriate methods by which to learn interprofessionalism, and that this will ultimately contribute to overcoming uni-professional exclusivity.     

医疗保险与卫生服务发展研究

医疗保险与卫生服务是辩证统一的关系。医疗保险的推行,对医疗机构既是挑战也是机遇,要求医疗机构转变观念,增强竞争意识和竞争能力,做好监督控制、审核评价工作。成本核算、定额补偿是医院乃至医疗保险发展的核心问题。医疗保险制度的建立和完善有助于优化卫生资源配置,完善医院内部科学管埋体制,提高医疗质量,促进医院发展。社区卫生服务应纳入医疗保险范畴,医疗保险管理邯门从效率角度出发,也应首先选择社区卫生服务机构承担医疗保险任务。社区卫生服务的发展对医疗保障体系的建立和完善将起到重要的推进作用,而医疗保障体系的建立,必将促进社区卫生服务的深入发展。     

老年医疗照护人才培养实践中强化全科医学理念

目的 探索卫生职业类高职高专院校的基层人才培养模式.方法 建立实践实训基地,采用SOAP格式编写老年医疗照护实训教材,强化全科医学理念;遴选临床医学专业学生到基地老年病区参加床旁教学,结束后发放调查表,对收集的数据进行分析.结果 编写了一本实用的教材;100％的学生对所提供的教材满意;97.44％学生认为教学效果好;92.95％的学生掌握或熟悉全科医生的基本技能,74.36％的学生建档与SOAP病历质量优秀.结论 全科医生是老年医疗照护团队的骨干,床旁教学中强化全科医学理念,使学生在基于行业的情境实践中,得到全科医生思维能力及各项基本技能的训练.