我国现阶段医学教育存在的问题与解决办法浅析

伴随着我国社会、经济、文化的不断发展,医学教育模式也正在逐步转变,社会各界对医学人才的综合素质也提出了更高的要求.尽管教育部推出了一系列教育改革项目,但是仍然难以改变我国医学高等教育与发达国家之间日益扩大的差异,医学教育需要更加的注重国际化和自主创新才能满足当今社会的基本需求,而我国僵化的医学教育体制已经很难适应时代的发展,因此必须针对我国的医学教育进行改革.     

把握医学模式转变与卫生服务的新特点加强医学人文教育

1992年，WHO卫生人力开发教育处Boelen．c博士提出了“五星级医生”概念，这种新概念激起国际医学教育界的强烈反响。面对与世界接轨的医学教育大改革浪潮，我国在医学人才培养模式上应该如何变革，是一个值得认真研究的课题。科技发展的新特点呼唤人才培养新式，现代生物、心理和社会医学模式的建立，要求医学教育要遵循这种医学模式组织教学、设置课程和培养未来的医生；社会发展和科技进步，卫生服务发展的特点以及未来医生应具备的能力，赋予医学教育新的任务与内涵，对高等医学教育提出了更高的要求；医学科学的人文社会属性和国外的经验表明，加强医学教育中的人文教育刻不容缓。     

我院全科医生培训工作初探

自80年代全科医学教育概念引入我国以来,全国部分地区开展了全科医学教育的探索研究与实践,积累了一定的经验.但随着社会经济的发展,人民生活水平的提高和医学模式的转变,开展融预防、医疗、保健、康复、健康教育、计划生育、技术服务为一体的社区卫生服务将成为基层卫生工作的重点.     

医学教育之人文思考——从“工具理性主义”到医学人文的融合

当前的中国医学教育未能摆脱“工具理性主义”的“单向度”发展模式.面对全球第三轮医学教育改革,我国的医学教育必须尽快实现医学与人文的融合贯通,构筑相应的医学人文训练模式.这一模式的培养需要医学教育者和学生的共同努力.     

儿科医学大众化教育的可行性

分析了儿科医学教育大众化是社会发展的必然趋势.高等教育的发展和卫生改革与发展为儿科医学教育的大众化提供社会平台,儿科医学服务对象众多,服务范围广大,儿童疾病综合管理为儿科医学教育的大众化提供具体措施,儿科医学教育的大众化有着重要意义.     

社会医学学科体系框架与战略性研究领域

社会医学是医学教育的重要学科,是健康观念与医学模式转变的必然结果.社会结构转型期社会医学教育蓬勃发展,兴旺发达,但是学科建设诸多基础性与战略性问题尚未解决,社会医学学科体系框架设计与战略性研究领域选择是关键性问题,严重影响社会医学的发展.在比较研究3本代表性教材的基础上,提出构想中的社会医学学科体系框架,确定若干亟待研究的战略性研究领域,以期完善社会医学学科体系,提高医学教育回应性和质量.     

关于发挥高等医学教育资源优势加强基层卫生人才培养

深化医疗卫生体制改革意见的出台,开启了我国新一轮卫生改革,对卫生服务体系能力建设,提出了更高的要求.人力资源的素质直接影响了卫生服务提供的质量.如何提高卫生技术队伍的素质,尤其是基层卫生人员素质,满足人们基本保健服务需求,是高等继续医学教育发展的重要任务.文章就高等医学院校继续医学教育活动的开展,如何适应社会需求的变化,进行了探讨.提出高等医学院校的继续医学教育机构,应该充分发挥高校医学教育资源优势,在教学资源组织、培训模式和内容的制定方面进行完善,为基层卫生机构提供高质量的继续医学教育服务.     

开展继续医学教育加快医院人才培养

随着科学技术的迅猛发展和医学模式的转变,新知识、新理论、新技术、新方法不断涌现,医学知识更新周期逐渐缩短,以往的"十年寒窗,终身受益"的医学教育模式已不能适应现代医学发展的需要.继续医学教育是一项新的工作领域,是以知识更新为主要内容的终身性医学教育.它既是医学教育的重要组成部分,同时又是卫生人才资源开发的主要途径和重要手段.开展继续医学教育不仅是医学科技进步和卫生事业发展的要求,也是卫生技术人员提高自身专业素质、跟上时代发展步伐的需要.     

浅淡加强预防医学教育

浅淡加强预防医学教育张建清在医学教育中，加强预防医学教育是医学本身的内在要求，是保证人们身心健康的必须，与医学发展和医学模式转变相适应，势在必行。当前医学的发展以及社会经济发展对医学提出的新的要求，使人们认识到预防医学在整个医学中的位置愈来愈重要。随...     

职业中专药物教学中基础医学课程整合的探讨

随着我国医疗体制的改革和教育事业的发展,职业医学教育在面对社会、市场的发展中面临新的要求.根据教育部的下发的意见,对于职业院校课程改革要加大力度,并且要与社会需求紧密结合.本文对药物学专业课程整合开发等方面进行了研究,为我国职业医学教育改革提供了参考.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.