临床医学导论实习对医学生职业素质培养的引入作用

医学生职业素质培养是一项重要的工程,要始终贯穿于医学专业教育和人文素质教育的全过程。医学生职业素质教育要与医学基础理论知识学习、临床实习过程相结合。临床医学导论是一门专门针对低年级的医学生开设的课程,是临床医学专业课程体系的重要组成部分,是临床医学专业整个本科教育的引导环节,目的是早期引导医学生认识医学和医学的责任,为培养未来具有良好职业素养的医师打下良好的基础。     

责任指数对口腔医学专业学生职业精神考核的设想

医学生的责任心体现在其一定行为表现上，是医学生职业精神培养的重要内涵，因此对影响医学生责任心的负向行为进行一定的干预具有重要意义。分析国内外医学院校应用责任指数考核在医学生行为督导养成的评价研究，遵循我国口腔医学专业人才培养的规律，结合口腔医学生成长的特点，借鉴职业精神考核的相关指标——责任指数考核法，试设计口腔医学生行为责任指数测评方案，并预设可行性，为拓宽口腔医学生职业精神的培养提供思路。     

医院治理结构改革与医院管理职业化

通过对当前两种医院治理结构的六个要素比较，认为这两种改革模式的主要问题在于不能很好地解决委托人(或董事会)人员来源和委托人的所有权约束和激励以及代理人的约束和激励等两个问题。并据此提出政策建议，认为解决委托人与经营者的约束和激励问题是医院治理中非常关键的一环，国资委应在医院经营中培育一个专业化、职业化的委托人和代理人阶层。     

Conceptualizing Professionalism in Dietetics: An Australasian Qualitative Study

BackgroundProfessionalism is a vital aspect of health care and multidisciplinary teamwork. Although there is substantive professionalism literature in medicine and an expanding health care professions literature, there is a significant gap in understanding professionalism in dietetics. There are very few research papers in the dietetics literature on this issue compared with other health professions. Given the multidisciplinary nature of health care, it is important to understand what professionalism means within each profession to develop shared understandings across health care teams.ObjectiveThe study aim was to explore how dietetics professionalism is conceptualized by dietetic practitioners/preceptors, faculty, and new graduates.DesignA constructionist exploratory qualitative interview study was conducted.Participants/settingOne hundred participants (dietetics graduates, faculty, and practitioners/preceptors), associated with 17 universities across Australia and New Zealand and from diverse geographical and work settings, participated in 27 group and 24 individual interviews from March 2018 to June 2019.Statistical analyses performedThematic framework analysis was used to examine participants’ understandings of professionalism.ResultsTwenty-three dimensions of dietetics professionalism were identified, with the most common being communication and including four novel dimensions of professionalism (generational, emotion management, cultural capability, and advocacy) not previously described in other professions. Professionalism as emotion management and generational adds new insights to the professionalism literature, expanding understandings of this vital aspect of health care. Although high levels of consistency in professionalism understandings existed across the three stakeholder groups, some interesting differences were found. The profession of dietetics shares similarities with other professions in the ways professionalism is conceptualized.ConclusionsUsing these dimensions of professionalism as a framework for teaching and learning about professionalism will help in clarifying expectations and expand shared understandings about professionalism for dietitians, other health professions, and across multidisciplinary teams.     

基于结构方程模型构建护理本科生人文关怀对职业精神态度的影响模式

目的 应用结构方程模型构建人文关怀对职业精神态度的影响模式,了解人文关怀、社会支持及职业精神态度之间的关系。方法 采用分层随机整群抽样法从南京和南通两所高等护理院校抽取全日制在校护理本科一年级至三年级在校学生450名进行问卷调查,应用AMOS 21.0构建人文关怀对职业精神态度的影响模式。 结果 人文关怀对职业精神态度影响模式的结构方程模型最终模型适配度指标分别为RMSEA = 0. 066、GFI = 0. 951、AGFI = 0. 918、NFI = 0. 901、ＲFI = 0. 860、IFI = 0. 932、TLI = 0. 903、CFI = 0. 931、PGFI = 0. 573、PNFI = 0.641、PCFI = 0. 663、χ_²/DF=2.965,说明模型拟合效果较好；人文关怀对社会支持的直接效应为0.571,社会支持对职业精神态度的直接效应为0.778,人文关怀对职业精神态度的总效应为0.554。结论 此模型可用于护生职业精神态度评价与干预工作,进一步提高护生人文关怀能力、社会支持水平及职业精神态度水平。     

Luxury primary care,academic medical centers,and the erosion of science and professional ethics

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed.