Isolation, flexibility and change in vocational training for general practice: personal and educational problems experienced by general practice registrars in Australia

BACKGROUND: GP registrars, in common with other doctors, frequently experience high levels of stress; however, little is known about the nature and outcomes of personal and educational problems experienced during vocational training for general practice. OBJECTIVES: The purpose of our study was to elicit the nature, causes and effects of more severe problems experienced during vocational training for general practice from the registrar's viewpoint and put these into the context of their personal circumstances and background. METHODS: This qualitative study used detailed semi-structured telephone interviews with a selected subgroup of 33 of the 1999 entry cohort of general practice registrars in Australia who had reported serious self-defined problems during an earlier longitudinal questionnaire study. Registrars were asked about the nature, antecedents and outcomes of problems experienced during GP training, actions taken to resolve the problem, and their perceptions of what might have helped prevent or minimize the problem. RESULTS: Problems reported by registrars fell into five major themes: isolation (structural isolation, social isolation and professional isolation); flexibility and choice (administrative issues and balancing work with personal life); change and uncertainty (within general practice and training, intergenerational changes); teaching problems; and work conditions. Actions taken and effects of problems are also discussed in the light of workforce imperatives. Results have been used to develop a list of suggestions for the providers of general practice training. CONCLUSIONS: Registrars commonly experience problems during vocational training. These may be related to structural, social and professional isolation, or a lack of flexibility in training arrangements and balancing work and other commitments. Some of these problems may be amenable to relatively simple solutions involving term placements, selection of training practices and administrative adjustments.     

医护一体化训练模式在《基础护理学技能》课程教学中的实践效果

目的 探讨在《基础护理学技能》课程中医护一体化训练模式对护生临床思维能力和批判性思维的影响作用。方法 选取90名护理专升本学生,按照上课班级分为实验组和对照组,实验组加入医护一体化训练模式进行授课,对照组采用常规模式进行授课,使用批判性思维能力量表和综合技能考核进行评价。结果 医护一体化训练模式对护生批判性思维能力中寻找真理、开放思想、分析能力、系统化能力、求知欲、批判性思维能力总分有效改善,差异有统计学意义(t值=-3.695,-2.462,-2.940,-2.453,-2.468,-4.075,P值均<0.05)。医护一体化训练模式对护生综合技能中团队协作能力、操作实施过程、临场应变能力、护患沟通和人文关怀能力、技能总分的有较大提高,差异有统计学意义(t值/Z值=-5.69,2.70,-4.21,5.91,4.79,P值均<0.05)。结论 医护一体化训练模式有助于护生临床思维能力和技能的提高,可以应用于《基础护理学技能》的教学中。     

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.     

生物医学工程专业创新性人才培养的探索与实践

介绍了我国生物医学工程教育的现状,分析了创新性人才培养的必要性,从人才培养的模式、试验基地的建设、教学与教材的改革、师资培训及参加科研项目等方面,阐述人才培养模式的探索及实践。     

Why? What? and How? IT provision for medical students in general practice

OBJECTIVES: The aim of this paper is to discuss the increasing use of computers in undergraduate medical education and explore the why, what and how of providing IT facilities to undergraduate medical students when they are on placement in general practice. Adequate computing facilities are usually available within hospitals and medical schools, however, major changes are taking place in undergraduate education resulting in more teaching being undertaken in the community. Students will therefore need access to comparable facilities whilst in primary care settings in order for their training not to be compromised. SETTING: This paper describes one initiative addressing this need: the University Linked Practices (ULP) project in the Department of General Practice and Primary Care at St. Bartholomew's and the Royal London School of Medicine and Dentistry. DESIGN: We discuss the ways in which computers are currently being used in medical education and discuss some of the merits and drawbacks that are associated with this increasing drive to computerization.     

上海市专科医师培养的探索与实践

简述了专科医师培养在医学教育体系中的重要作用，概括了“3＋X”阶段性培养的专科医师培养模式的特点，分析了上海开展专科医师培养的有利条件，并对上海今后开展专科医师培养作了展望。