生物化学的教与学

在医学院校中,生物化学被认为是一门最难学的学科。传统的观念认为学习是一件“非常辛苦”的事情,从这种观念出发,导致我们的教学方式完全成为一种强迫性的任务,教师辛苦,学生辛苦。由于突出了这种“苦”字,而将学习的乐趣掩盖起来了。实际上教和学并非是一件很辛苦的事,本试图分析在生物化学的“教与学”中,从“寓教于乐”和“晓之以理”方面,浅谈几点教学体会。     

美国加州大学旧金山分校医学院课程改革对我国医学教育改革的启示

美国加州大学旧金山分校医学院于2001年秋季首次使用新课程计划.本文首先介绍了该课程计划的目标、具体内容、各学科内容整合方针、课程预评估及管理机构;然后论述了加州大学旧金山分校医学院课程改革对我国医学教育改革的四点启示:①在学科内容整合上,应当遵循认知科学、学习理论的基本原理,充分考虑学生毕业后的工作情境和社会情境,面向学生毕业后的实际工作需要.②在教学方法上,提倡以课堂讨论(小组)为主、以问题为基础学习(PBL),兼而采用床边教学、案例教学等方式,充分利用信息技术,提倡师生"互动式教学".③在学生评价方式上,强调能力培养,重视诊断性评价和过程性评价,重视临床实际操作能力,学生在见习期间要通过客观结构化临床考试(OSCE).④课程计划改革要有制度上的保证.     

Health care reform in Russia: a survey of head doctors and insurance administrators

In keeping with the introduction of market-oriented reforms since the collapse of the Soviet Union, Russia's health care system has undergone a series of sweeping changes since 1992. These reforms, intended to overhaul socialized methods of health care financing and delivery and to replace them with a structure of competitive incentives to improve efficiency and quality of care, have met with mixed levels of implementation and results. This article probes some of the sources of support for and resistance to change in Russia's system of health care financing and delivery. It does so through a national survey of two key groups of participants in that system: head doctors in Russian clinics and hospitals, and the heads of the regional-level quasi-governmental medical insurance Funds. The survey results demonstrate that, on the whole, both head doctors and health insurance Fund directors claim to support the recent health care system reforms, although the latter's support is consistently statistically significantly stronger than that of the former. In addition, the insurance Fund directors' responses to the survey questions tend consistently to fall in the shape of a standard bell curve around the average responses, with a small number of respondents more in agreement with the survey statements than average, and a similarly small number of respondents less so. By contrast, the head doctors, along a wide variety of reform measures, split into two camps: one that strongly favors the marketization of health care, and one that would prefer a return to Soviet-style socialized medicine. The survey results show remarkable national consistency, with no variance according to the respondents' geographic location, regional population levels or other demographic or health characteristics, age of respondents, or size of health facility represented. These findings demonstrate the emergence of well-defined bureaucratic and political constituencies, their composition mixed depending on the particular element of reform under discussion, for and against specific avenues of continuity and change in Russia's health policy. As Russia struggles to devise policy strategies and tactics that balance access, equity, quality, and efficiency, it confronts not only policy choices but also political challenges that look not dissimilar to those faced by health reformers elsewhere in the world.     

Intensive short courses in biostatistics for fellows and physicians

At both of our universities we teach (with colleagues) introductory courses in statistics for fellows and physicians. We do not expect that those taking these courses will be able to do their own statistical work, but rather the intention is for them to 'learn the language' and to facilitate future collaboration. Basic principles of study design are introduced in the courses, as well as some of the most common statistical procedures. We will discuss the factors (what works and what does not) that may contribute to a successful course, a comparison to other courses, and our self-evaluation strategy. Finally, we will cover the financial arrangements that we have made when teaching these courses.     

Teaching of occupational medicine to undergraduates in UK schools of medicine

OBJECTIVES: To assess any recent change in the commitment to teaching of occupational medicine in UK undergraduate medical curricula. DESIGN: A questionnaire survey of the teaching of occupational medicine to undergraduates in all medical schools listed in the UK Universities and Colleges Admissions Service prospectus for 1999-2000 (n = 24). RESULTS: Nineteen UK medical schools returned a completed questionnaire, giving a response rate of 79%. A comparison of results from this survey with previous surveys of teaching of occupational medicine to undergraduates in the UK shows that fewer schools now provide lectures, project work or ward-based tuition in the subject. Workplace visits were not undertaken by any institution. Only two of the schools setting an examination question also had a syllabus. CONCLUSION: Despite the prominence given to issues related to occupational health in recent UK government policy, this study suggests a declining commitment to occupational medicine on the part of UK medical schools. Urgent action needs to be taken to address the lack of training in occupational medicine in UK medical schools.     

Factors influencing prescribing: an intern's perspective

OBJECTIVES: To examine the self-reported influences on intern prescribing practice. DESIGN: Qualitative interviews with a cross-sectional cohort. PARTICIPANTS AND SETTING: Ten interns practising in two urban teaching hospitals in New South Wales, Australia. RESULTS: The interns identified a number of factors that improve their confidence and perceived competence and allow them to extend their existing skills. These were approachable, available and up-to-date teachers (most often registrars and subspecialty nurses and pharmacists); timely, relevant and practical teaching (such as interactive bedside teaching); concise and widely accepted resources (such as prescribing pocket guides); and a constructive manner on the part of senior staff for dealing with prescribing errors. Interns also identified influences that are detrimental to confidence, conflict with their perceptions of appropriate prescribing and inhibit learning and skills acquisition. These were unapproachable, physically and mentally remote teachers (most often consultants); theoretical, inconsistent and irrelevant teaching (such as grand rounds or didactic education sessions); inconsistent and inaccessible resources; and a confrontational and accusatory way of dealing with prescribing errors. The added pressures of time, hospital hierarchies and the indirect influence of drug company promotion also impeded acquisition of good prescribing habits. CONCLUSIONS: At a critical time in skills development, interns encounter many forces that can potentially impact on prescribing practices in both positive and negative ways. Our data contribute to the understanding of the multifaceted learning environment of interns and may be useful in providing a foundation for prescriber education programmes tailored to the specific needs of junior doctors.     

Testing learning theories: the NUL hypothesis

INTRODUCTION: In the spirit of Scrooge and the Grinch, I describe the nasty unpalatable learning (NUL) hypothesis as a new theory of learning. This is an exercise to explore how difficult it would be to develop a new learning theory by reversing the social and altruistic tenets of most existing learning theories. THE NUL HYPOTHESIS: The NUL hypothesis has four propositions. These are: (1) the value of rote learning; (2) the usefulness of authority figures in teaching within a clear hierarchy; (3) the use of fear in teaching, and (4) the value of internal consistency without any necessary connection to the outside world. CONCLUSIONS: The NUL hypothesis may promote reflection not only on the construction of learning theories, but also on the design of critical experiments. It also seems to imply that efficiency may be a better measure of learning success than effectiveness.     

中药饮片改革的研究

中药饮片现代化是中药现代化的重要组成部分。中药饮片改革作为学术问题的讨论,不能因“中药配方颗粒”已获批准而结束,在简述中药饮片改革研究的概况后,提出中药饮片改革尚需深入探讨的问题是非常必要的。     

循证医学与儿科临床工作的教与学

目的探讨循证医学干预在儿科学中的应用,并对此教学模式的效果做出评价。方法在循证医学教育观指导下,以临床医学七年制学生为研究对象,采用无记名问卷调查形式,内容包括对教师授课的评价以及对学生学习的评估,通过自身前后对比,了解学生对教师在理论课讲授、见习课及日常学习中循证医学方法应用的评价。结果调查显示大多数学生对于循证医学教学模式给与肯定评价(P<0.05),能将基础理论与临床问题相联系,提高临床实践、自学能力;多数学生认为能较好激发自己的学习兴趣,提高主动学习能力,培养临床思维及创新意识(P<0.05)。结论循证医学教育有利于帮助学生学会学习,学会独立思考,从而达到培养其终身学习能力的目的。