The context of clinical teaching and learning in Australia

Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patient-based learning emphasising priority health concerns. The symbiotic framework provides a basis for reconstructing clinical teaching in teaching hospitals so th@they continue to play a vital role in Australian medical education, with additional clinical experience provided by primary care and community, rural and regional hospitals.     

近20年来敦煌古医方研究概况

从基础文献研究、临床价值研究、治法研究方面概述敦煌古医方的研究与应用进展。认为近20年来敦煌古医方的研究取得了可喜成绩。今后应进一步发掘敦煌医方文献．对其中有重要推广价值的古医方进行深入研究。使敦煌古医方更好地为人类健康事业服务。     

新时期地方医科院校临床实践技能培养模式改革与实践

进入新世纪以来,随着科学技术的快速发展和全球一体化的进程,医学教育面临床的形势发生了巨大的变化,高等教育大众化、多元化、国际化特点日益明显。地方医科院校如何调整临床医学人才的培养目标、知识结构、临床实践技能标准,与国际教育标准对,确保人才的培养质量,是当前地方医科院校面临的重大课题。文章总结了该校在新时期以加强临床实践技能培养为切入点,通过创建教学平台,改善教学条件,明确培养标准等一系列措施,构建了在新时期地方医科院校临床实践技能培养的新模式。为新时期地方医科院校培养合格的医学人才提供了借鉴。     

Canadian medical education: 50 years of innovation and leadership.

Over the past 50 years, many Canadian medical educators have pursued ideas and visions, as individuals in the 1950s and 1960s and later in partnership with various national bodies. Relations between universities and national medical organizations have been productive in dealing with issues of postgraduate education and clinical assessment, in particular. From 1970 to 1990, strong education offices and formally trained educators led to many successes in the areas of research in cognition, continuing medical education and clinical assessment. Canadian medical education has now achieved international recognition for its work in all aspects of the continuum of the physician's education through vision, initiative and cooperation.     

Specialty choices of male and female doctors in Malaysia

A survey of specialisation choices was conducted for two batches of medical officers applying to the local medical schools for specialisation in Malaysia. A total of 359 doctors responded, giving a response rate of 71%, with 169 male (44.4%) and 187 female (55.6%) respondents. Surgery ranked highest among the male doctors followed by orthopaedic surgery and internal medicine. Family medicine ranked highest among female doctors followed by public health and anaesthesiology. Among the other specialties, the male doctors preferred otorhinolaryngology while female doctors preferred Pathology. Both male and female doctors chose to be a clinical consultant in a general hospital as the first choice. They prefer to work in or near their hometowns.     

The global emergence/resurgence of arboviral diseases as public health problems

During the past 20 years there has been a dramatic resurgence or emergence of epidemic arboviral diseases affecting both humans and domestic animals. These epidemics have been caused primarily by viruses thought to be under control such as dengue, Japanese encephalitis, yellow fever, and Venezuelan equine encephalitis, or viruses that have expanded their geographic distribution such as West Nile and Rift Valley fever. Several of these viruses are presented as case studies to illustrate the changing epidemiology. The factors responsible for the dramatic resurgence of arboviral diseases in the waning years of the 20th century are discussed, as is the need for rebuilding the public health infrastructure to deal with epidemic vector-borne diseases in the 21st century.     

我院2009～2011年中药注射剂使用分析

目的分析我院2009～2011年中药注射剂的应用情况,为临床合理用药提供参考依据。方法对我院2009～2011年中药注射剂的用药金额、用药频度、日平均费用等进行统计分析。结果我院3年来中药注射剂消耗金额均呈逐年上升趋势,治疗心脑血管疾病的中药注射剂连续3年居临床用药之首位。结论我院中药注射剂在临床用药金额和数量增长均较快,必须加强用药管理和药品不良反应监测,保证用药安全、有效。     

科学制订评价指标体系 持续提高军医大学临床教学质量

临床教学阶段是临床医学本科生的重要培养阶段,临床教学工作是军医大学业务工作的核心内容。近3年来,军医大学先后接受了总参谋部组织的教学工作评价,通过评价,军医大学的办学思想更加清晰,人才培养目标更加明确,办学条件和教学环境进一步优化,教学管理更加规范。如何将教育评估期间好的做法和要求运用到日常的临床教学管理过程当中,从而使各附属医院对自身的临床教学质量进行动态的管控,实现教学评价的常态化,对于持续提高军医大学的教学质量有着重要的现实意义。本文在系统收集国内外相关研究进展的基础上,通过层次分析法、因果分析图法、德尔菲法等方法,对构建临床教学质量评价指标体系以及确定各层指标的考评权重,作了系统的研究和探索。     

Canadian experience with structured clinical examinations.

The use of structured clinical examinations to improve the evaluation of medical students and graduates has become significantly more common in the past 25 years. Many Canadian medical educators have contributed to the development of this technique. The Canadian experience is reviewed from the introduction of simulated-standardized patients and objective-structured clinical examinations to more recent developments and the use of such examinations for licensure and certification.     

Recent development of ischaemic heart disease in sex difference

Despite a dramatic decline in mortality over the past years, coronary heart disease is the leading cause of death and disability in the world. At the same time, with the great improvement of medical science, there is a growing population of postmyocardial infarction, postrevascularisation and heart failure survivors. Furthermore, there are rising rates of cigarette smoking, obesity, hypertension and the metabolic syndrome in the world. All the above contribute to the rising incidence rates of ischaemic heart disease (IHD) among women and men. This review highlights sex-specific issues in IHD presentation, evaluation and outcomes, with several new results published from the Women's Ischemia Syndrome Evaluation study. New evidence on traditional and novel risk markers as well as sex-specific differences in symptoms and diagnostic approaches have also been discussed.     

医学院校非直属附属医院的建立和运作体会

目的探讨扩招后解决临床教学基地面临困难的可行方法。方法对近十年来学院非直属附属医院的建立和运作情况进行回顾性分析。结果非直属附属医院的建立和临床教学质量控制体系的实施缓解了扩招与临床教学基地紧张的矛盾,保障了临床教学质量。结论高质量的非直属附属医院的建立和运作,是医学院校解决扩招与临床教学基地紧张的矛盾有效方法。     

医学影像学专业创新型人才培养模式的构建

近2年来,长江大学医学院从"课堂教学、临床实践、学生科研能力培养"等方面整体构建医学影像学专业创新型人才培养模式。为培养出基础知识扎实、临床实践技能强,具有创新精神和能力的高级医学影像学人才近进行了有益的探索和实践。     

Educational programs in US medical schools.

Trends of the past few years indicate that the 1990s will be a time of intense activity in medical education reform. A number of areas described in this annual review of medical education are grounds for optimism, tempered, however, by caution. The applicant pool has been increasing rapidly over the past 2 years and has reached the levels of the early 1980s. The average proportion of women and some minorities also has been rising. While these are positive signs, efforts to ensure diversity in the student population should not be abandoned. The number of faculty members continues to rise, especially in the clinical disciplines. The increases, occurring in the context of stable medical student enrollments, raise questions about the various roles and responsibilities of medical school faculty. Many medical schools are in the process of curriculum review and revision; while these changes respond to identified problems, they may have implications for faculty and other resources. External financial support fueled previous waves of curriculum innovation, and some of these gains could not be maintained when that support was withdrawn. The revisions in the examinations of the NBME are being well received, and the single pathway to licensure through USMLE has been initiated. This system does, however, affect graduates' options for licensure. Finally, the increased interest in program evaluation, especially the definition of goals and the measurement of educational outcomes to assess their attainment, demonstrates that medical schools are serious about educational accountability. Some schools also are being asked to address externally imposed objectives, related specifically to specialty choice, creating a potential for conflict between the objectives that the medical school sets for itself and those mandated by its external constituencies. While this analysis may imply that medical education is now in a "good news/bad news" situation, the message is that planning and careful assessment of options are perhaps even more important today than they were in the past. Change has its costs and its implications, but it must nonetheless be undertaken.     

Clozapine associated dilated cardiomyopathy

A 31-year-old white man was referred for investigation of a persistent sinus tachycardia. His only significant past medical history was of chronic schizophrenia for which he had been taking clozapine for six years. An electrocardiogram demonstrated sinus tachycardia, voltage criteria for left ventricular hypertrophy, and a prolonged QTc. Echocardiographic findings were consistent with a dilated cardiomyopathy. Serious cardiac complications of clozapine use are rare but have been reported previously. It is important to note that sinus tachycardia may be the only obvious clinical sign, and that complications can manifest months or even years (as in this case) after starting the drug. Patients on clozapine should be informed of potential cardiac symptoms and doctors should maintain a high degree of clinical suspicion throughout the duration of treatment.     

MEDICAL EDUCATION AND SOME RECENT EXPERIMENTS*

During the past ten years many changes have taken place in medical education, especially in Germany, Great Britain, and in America. Some of these changes have been significant, some very slight. At the present time interest in the problem of what constitutes a desirable programme is very great. In some quarters there is much dissatisfaction with the fesults of medical education in recent years.     

汕大医学院新教学模式毕业生执业医师资格考试成绩的比较分析

汕大医学院实施"新教学模式"已10年,该模式以系统整合为基础,基础课程与临床课程优化组合,交叉渗透。采用小班教学、小组讨论、PBL、CBL等教学方式,培养学生自主学习、终身学习能力。已有3届毕业生参加全国执业医师考试,文章通过对汕大医学院传统与新模式近6届毕业生执业医师考试成绩进行比较分析,结果,以系统整合为基础的课程体系不影响学生对学科知识的掌握,学生基本知识扎实。     

PBL教学法在医学生实习期间就控制药费比例问题中的应用

当前针对控制药费比例的各种措施主要集中在临床医生上，在校医学生虽已掌握药理学的理论知识，但对于临床合理用药尚缺乏认识。为了使医学生在毕业前对此有更深的理解，通过对近三年来在临床实习期间对这些“准医生”采用以问题为基础的学习法（PBL）就控制药费比例问题开展小组讨论会，结果发现合理用药是一个涉及社会、医疗、伦理、道德和医患关系等方面的一个复杂问题。在临床实践中应该理性看待药费比例，提倡合理用药。     

浅论全科医学教育

全科医学模式自1988年9月由世界家庭医学会组织（WONCA）介绍到中国以来,已有十年,无论从中央到地方都在为这项工作做着不懈的努力,其目的是响应阿拉木图宣言所提倡的“z000年人人享有卫生保健”的口号。我校自1992年开始开展全科医学教育至1997年已招收了五届全科医疗大专班的学生（1995年停招一届）,在全科医学的教学方法上,以临床医学教育课程为主线,增删了一部分内容,加强了全科医学的内容,并注重在基础医学教育中,从生物一心理一社会三个层面入手,对全科医学生进行培养,在临床教学阶段,加强以病人为中心、家庭为单位、社区为范畴的引导。本文还对如何搞好在职培训、师资培养及全科医学模式改革等方面做了一定的阐述。     

临床实训课程建设与教学实践

课程是实现培养目标的基本单元。“临床实训”是介于医学理论授课与临床实习之间的桥梁课程，重点加强医学生基本技能训练。设置“临床实训”课程，编写教学大纲和课程教材，开发与利用综合模拟人体的功能，进行有关师资培训，建立各项临床实训规章制度。通过近三年的教学实践，使壮床医学生按照课程的教学要求，系统掌握实习大纲规定的各项壮床技能操作的基本理论与模拟壮床实践，促进壮床医学教学的改革与发展。     

银杏果,叶及其提取物的药理作用

为了进一步推广银杏制剂在医疗卫生保健中的应用,促进银杏产业的发展,使其更好地服务于人类,大量查阅了银杏果、叶在历代本草中的不同应用文献,特别是对近２０年来国内外学者对银杏药理作用研究成果进行了综合与归纳,从而阐明银可广泛的药理活性。