Clinical attitudes to the autopsy

An enquiry into the attitudes of clinical consultants to autopsies was conducted by questionnaire. Responses indicate that most of the consultants accept that the autopsy is important in hospital practice and in teaching. There are, however, marked differences of view on the reasons for doing autopsies, and on the results of autopsies (e.g. in altering diagnoses or revealing unsuspected pathology), differences which influence the freqeuncy with which autopsies are requested. Some clinicians believe that increasing resistance by relatives to granting permission contributes to the falling rates, but this is a minority view. Clinicians also vary in their reactions to the falling rate, some regarding it as worrying while others are not concerned.     

Management of voice disorders

Voice disorders are commonly seen in general medical practice. In some cases voice disorders represent the presenting symptom for serious underlying disease. It is important for clinicians from internal medicine, pediatrics, and family practice to be able to identify those factors in the history or observed vocal symptoms which suggest need for referral for comprehensive voice evaluation as well as to understand the distinct but complementary roles of the specific disciplines (otolaryngology and speech-language pathology) involved in diagnosis and treatment of patients with voice disorders.     

Entering and navigating academic medicine: academic clinician-educators' experiences

Medical Education 2011: 45 : 497–503 Objectives Despite a recognised need for richer narratives about academic medicine, much of the literature is limited to an analysis of the enablers and barriers associated with recruitment and retention, and focuses on analysing the development of research career pathways. We explored academic clinician‐educators’ experiences of entering into and navigating academic medicine, with a particular focus on those who privilege teaching above research. Methods Data were collected through interviews and focus groups conducted across a medical school at one Australian university. We used socio‐cognitive career theory to provide theoretical insight into the factors that influence academic clinician‐educators’ interests, choice and motivations regarding entering and pursuing a teaching pathway within academic medicine. Framework analysis was used to illustrate key themes in the data. Results We identified a number of themes related to academic clinician‐educators’ engagement and performance within an academic medicine career focused on teaching. These include contextual factors associated with how academic medicine is structured as a discipline, cultural perceptions regarding what constitutes legitimate practice in academia, experiential factors associated with the opportunity to develop a professional identity commensurate with being an educator, and socialisation practices. Conclusions The emphasis on research in academia can engender feelings of marginalisation and lack of credibility for those clinicians who favour teaching over research. The prevailing focus on supporting and socialising clinicians in research will need to change substantially to facilitate the rise of the academic clinician‐educator.     

The scope of naturopathic medicine in Canada: an emerging profession

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for 'new' groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners' perception of their training and their current scope of practice. Two thirds (n = 315) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners' scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.     

The conventional autopsy in modern medicine

In many countries, including the UK, where relatives' consent is required, clinical autopsy rates (i.e. autopsies other than those required by law) have been declining since the 1950s. In the UK, even in teaching hospitals, the clinical autopsy rate has fallen to only 10% of deaths or less. At this rate of decline, clinical autopsies - and the pathologists who perform them - face extinction. The future practice of medicine will be blind to the many adverse consequences of clinical actions or omissions. The reasons for this decline are manifold and these have to be addressed if autopsy is to stand a chance of survival. The future of autopsy lies in promoting public support for autopsies, in some cases adapting the autopsy to address specific questions, thus making more effective use of information from autopsies. Only by ensuring that the next generation of doctors have experienced the powerful educational benefit of examining the body after death will the importance of autopsy to modern medicine be understood.     

协同创新下中医高层次人才培养教学改革试验建设新探索

在协同创新情景下,为适应我国对高层次应用型人才的迫切需要,应遵循中医人才成长特殊规律,培养具有国际竞争潜力中医学人才,结合PBL教学等新手段,探索"中医经典回归临床的案例"教学方法;构建全新中医专业学位创新人才教学试范建设区,培养适应医学新模式需要的高层次创新型人才;贯通以临床基地带动经典课程学习、理论提高和素质养成,构建课程学习与临床实践综合考核制度,基础训练、技能强化、名师指导三段一体,以推动中医高层次人才培养教学改革试验区建设,培养高素质中医人才.     

大宁社区家庭病床患者护理需求调查

目的了解家庭病床患者对医疗和护理的需求情况。方法采用问卷调查方式，对闸北区大宁路街道112例家庭病床患者进行中西医治疗和各类护理需求的调查。结果112例患者中，78．57％希望得到中西医结合治疗及护理，需求西药治疗的人数比例仅为37．50％。结论中医的简、便、廉特点受到患者青睐，中医居家护理模式在家庭病床患者中有较大需求。     

Clinical teaching: maintaining an educational role for doctors in the new health care environment

CONTEXT AND OBJECTIVES: Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. METHODS: Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. RESULTS: The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can 'teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. CONCLUSION: Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers.     

A new advanced studies program for faculty development in primary care

To meet the growing demand for more innovative teaching in primary care medicine and simultaneously to improve the overall quality of family practice, McGill University and The Montreal General Hospital, with the cooperation of the McGill School of Nursing, have inaugurated a faculty development center offering a program for advanced studies in primary care medicine and nursing. This program is offered to physicians and nurses who are already members of, or plan to join, a university faculty to teach primary care medicine. The program is diverse and interdisciplinary. Advanced courses are offered in teaching methods, investigative principles, biomedical communication, and management. In addition, each student Fellow participates in academic activities in fields of education, clinical practice, research, and community health care. All Fellows and faculty of the center rotate periodically to several satellite community-based teaching practice units in urban and rural areas of Quebec and to a region of northern New Brunswick. This activity enriches the medical manpower of the various regions, and the urgan physicians acquire an increased awareness of the particular problems and challenges of practicing medicine where full hospital and laboratory services are not always available.     

Clinical standards to assist audit in medical rehabilitation

The professional need for audit has been acknowledged and the discipline of rehabilitation medicine is now included in training programmes in general medicine and surgery. In rehabilitation medicine the data which would allow medical audit to take place have not always been recorded in routine clinical practice. However, the measurements required are not difficult, and have been validated by extensive research in academic units. This paper describes a series of simple, reliable measures and tests which can be used as baseline measures of progress in patients following rehabilitation programmes. It is essential that rehabilitation specialists are familiar with, and use, these basic tools, so that the usefulness of different treatments can be assessed, and their value accurately audited.     

Clinical teachers and problem-based learning: a phenomenological study

AIM: To explore how clinicians perceive their roles in problem-based medical education, and how closely those perceptions link to the curriculum they teach. METHOD: All 14 general physicians in a teaching hospital took part in 6 semistructured discussions, which were analysed phenomenologically. RESULTS: Third year clinical teaching was described in terms that bore little relation to problem-based learning (PBL). Teachers placed great importance on the social dimension of professional learning. They expressed strongly positive affects towards learners and their learning that they found hard to express as PBL tutors. Their narratives of education were remarkably divorced from modern day clinical practice. CONCLUSIONS: Problem-based method lacked some important conditions for professional teaching and learning. Traditional apprenticeship is unsustainable under present day conditions of practice. There is a need for new educational methods that help the learner to build a professional identity through social interaction with practitioners.     

Making the links between domestic violence and child safeguarding: an evidence‐based pilot training for general practice

We describe the development of an evidence‐based training intervention on domestic violence and child safeguarding for general practice teams. We aimed – in the context of a pilot study – to improve knowledge, skills, attitudes and self‐efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two‐stage consensus process with a multi‐professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co‐ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi‐agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice‐based domestic violence training.     

The wireless Web and patient care

Wireless computing, when integrated with the Web, is poised to revolutionize the practice and teaching of medicine. As vendors introduce wireless Web technologies in the medical community that have been used successfully in the business and consumer markets, clinicians can expect profound increases in the amount of patient data, as well as the ease with which those data are acquired, analyzed, and disseminated. The enabling technologies involved in this transformation to the wireless Web range from the new generation of wireless PDAs, eBooks, and wireless data acquisition peripherals to new wireless network protocols. The rate-limiting step in the application of this technology in medicine is not technology per se but rather how quickly clinicians and their patients come to accept and appreciate the benefits and limitations of the application of wireless Web technology.     

Interrelationships of general internal medicine and preventive/community medicine

Clinical preventive medicine, efforts by clinicians to prevent disease in individual patients, is an important component of preventive medicine as a whole. Yet clinicians, including internists, apparently do not provide many preventive services of established effectiveness. This paper describes one approach to improving the practice of clinical preventive medicine: increased cooperation between general internists--one of the nation's largest groups of primary care physicians--and specialists in preventive/community medicine. The paper summarizes a larger report prepared by two societies representing these disciplines: the Society for Research and Education in Primary Care Internal Medicine and the Association of Teachers of Preventive Medicine. It was found that the two disciplines have many common goals, and much to offer each other, but do not often collaborate. The report concludes with 14 recommendations for improving the practice of clinical preventive medicine, which suggest that such improvement can be achieved in part through strengthening working relationships between general internists and preventive/community medicine specialists.     

高职高专临床专职教师临床实践的必要性及途径

临床医学是一门专业性、实践技能性很强的学科,高职高专院校临床专职教师参加临床实践是高职高专教育的要求,也是临床医学不断发展的要求,是双师型队伍建设需要,也有利于教师教学能力的提高。可以通过深入临床、现场观摩学习,积极参与医疗机构举办的临床实践项目培训,鼓励参与医疗机构科研项目,实行顶岗实践等多种途径,促进临床专职教师参加临床实践。     

全科医师职业教育认知调查分析

目的：通过对全国部分省市临床工作者在全科医师职业教育方面的认知开展调查研究和分析,为完善全科医师职业教育体系提供科学建议。方法以文献回顾法和专家访谈法,设计调查问卷,调查83名全科医学教学者和109名全科医学执业者,调查教、学双方对我国全科医师职业能力、职业教育的认知。结果被调查者认为患者对全科（社区）医师服务能力满意程度并不高（31．2％）。超过50．0％被调查者认为在本科学历教育中专门开设全科医学专业、毕业后开展医学继续教育项目作用较大。对全科医师培训基地的运作效果满意的仅有17．7％。在需求方面,超过90％的被调查者期望提高全科医师待遇和社会地位,77．1％认为要增加临床实践和技术操作。教学者对教材、临床技能评估方法、带教能力提出更高要求。结论提升教学者的带教能力和全科医师实践能力,健全全科医师职业教育体系,创造全科医师职业发展的有利环境。     

Clinical exposure during clinical method attachments in general practice

BACKGROUND: There has been a significant decline in medical students' clinical experience in hospitals. Hospital-based teaching is struggling to provide medical students with sufficient experience of the common health problems of our industrialized ageing society. Hence, general practice has become an important locus for medical education. Published evidence, however, that students can access appropriate clinical experience in general practice is sparse. OBJECTIVE: To determine students' clinical exposure during clinical and method attachments based in general practice at two medical schools. EDUCATIONAL INITIATIVE: Students were attached to general practice tutors to learn clinical method in internal medicine. METHOD: General practice tutors from two medical schools collected data on age, gender, diagnoses, symptoms and signs of the patients they invited to teaching sessions. RESULTS: The frequency of diagnoses, symptoms and signs seen by medical students are recorded. Students mostly saw patients with chronic illnesses; the commonest diagnoses were ischaemic heart disease and angina. DISCUSSION: Our study has recorded the largest published database of clinical diagnoses, symptoms and signs encountered by students learning clinical method in general practice. It shows that students obtained a wealth of experience with patients with common chronic diseases. Students must also learn in the hospital setting, to experience the presentation of acute illness. The combination of teaching in these two settings is likely to provide the most effective technique to ensure that students encounter the common, acute and chronic conditions that affect patients in the 21st century.