How physiotherapists perceive,interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.     

基于病案的教学查房结合PACS在影像科医师培养中的应用

目的探讨在影像科医师培养中,基于病案(CBL)的教学查房结合医学影像存储与通讯系统(PACS)对医师影像诊断能力培养的价值。方法对2018年在北京大学第三医院放射科轮转CT的41名培训医师,应用PACS对其进行CBL教学查房,对照组为2017年轮转CT的39名培训医师(未进行CBL教学)。从PACS随机抽取每名医师书写的10份报告(报告时间为培训最后1个月),对开展CBL教学前后培训医师的报告书写质量评分并计算优良率。评分标准包括病灶征象描述全面准确、报告内容条理清晰规范、诊断结论逻辑清晰合理、能回答临床提出的问题、提出的下一步诊疗建议合理准确以及无漏诊。同时采用调查问卷的方式评价培训医师对CBL教学查房的主观感受,包括全面系统的认识疾病、提高临床思维能力、读片能力和学习兴趣、PACS对学习的帮助5方面,采用百分比表示。结果1)进行CBL教学查房后,培训医师报告质量评分提高(P<0.01)。2)培训医师对调查问卷5方面满意率分别为90.2%、68.3%、80.5%、75.6%和80.5%。结论应用PACS进行CBL教学查房是培养影像科医师诊断能力的有效方法。     

Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution

Diagnostic error is the most frequent cause of allegations of negligence in emergency care in the United States and is estimated to contribute to the death of hundreds of thousands of patients worldwide each year. In this special contribution, we elucidate the cognitive mechanisms that emergency physicians use to make decisions and identify how these mechanisms can become sources of diagnostic error. The discussion centers on the appraisal of proposed methods to reduce the risk of diagnostic error, including debiasing strategies and a brief discussion of the theoretical basis for interventions to improve clinician empathy.     

多模式教学在消化系统教学中的应用

目的 探讨多模式教学在消化系统教学中的教学效果.方法 选取学校五年制临床本科学生,随机抽取两个班级作为研究对象:实验组(多模式教学班),对照组(传统教学班),每组24人,随机分成3个小组,每小组8人,分组上课.实验组:在消化病学临床课间实习期间利用标准化病人和病例讨论平台、社会实践教学等多种教学模式教学.对照组:按传统教学方式授课.每组学生实习结束后进行理论考试和知识应用考试,最后对两组考试成绩进行比较分析.结果 多模式教学班的考试成绩明显优于传统教学班,结果 具有统计学意义(P<0.05).结论 多模式教学方法 对于提高学生对消化病学的理解和掌握具有重大意义.     

案例教学法在药剂科临床实习中的应用效果分析

目的研究案例教学法(CBL)在药剂科临床实习中的应用效果。方法将本院2018年1月-12月实习生252例随机分为两组各126例,其中观察组采用CBL进行教学,对照组则给予传统教学方法,比较两组实习后教学成绩和实习生学习主动性。结果干预后,观察组抗菌药物、激素类药物、抗心律失常药物、抗肿瘤药物及解毒药物考核成绩均高于对照组;观察组学习积极主动性量表学习驱动力、深入学习、控制学习、扎实学习评分及总分高于对照组,差异均有统计学意义(P<0.05)。结论CBL用于药剂科临床实习可有效提升实习生学习兴趣和主动性,从而提升其临床知识掌握水平和运用能力。     

SP联合CBL在骨外科临床实践教学中的应用研究

目的探讨标准化病人(standard patient,SP)结合案例式教学(case-based learning,CBL)在骨外科临床实践教学中的应用效果。方法选取2018—2019学年于我院骨科实习的南京医科大学2014级临床医学专业学生50人作为研究对象。随机将其均分为试验组和对照组两组,每组各25人。试验组采用SP+CBL相结合教学方法;对照组采用传统CBL授课方法。在教学结束后,请所有参与试验的学生对课程进行评价,并从理论和操作两方面对学生进行考核。结果两组学生的理论考试成绩无明显差异,不具统计学意义(P>0.05)。但试验组学生的临床技能操作考核成绩高于对照组(P<0.01)。试验组学生对SP+CBL教学在激发学习兴趣、增强解决实际问题能力及提高骨外科实践教学质量等方面的满意度显著高于对照组(P<0.01)。结论SP+CBL教学优于传统CBL教学,可以显著提高学习的积极性,有助于提高骨外科临床实践教学的效果。     

P300 and positive slow waves reveal the plausibility in inductive reasoning

Category‐based induction is an advanced cognitive function that is based on our category‐level knowledge. Previous findings have recognized the distance effect in category‐based induction: Inductive strength is affected by the hierarchical distance between the premises and conclusions. However, the neural mechanisms underlying this effect require elucidation. In the present study, we investigated the neural mechanisms of the distance effect by using EEG technology and a new experimental paradigm—category‐based induction. In this paradigm, we used three hierarchical levels of categories—the subordinate category, the basic category, the superordinate category—and an irrelevant category. We further used these categories to create four types of trial that varied in the hierarchical distance between the premise and the conclusion: the subordinate‐basic, the basic‐superordinate, the subordinate‐superordinate, and the irrelevant‐superordinate trials. In each trial, participants judged the probability that the conclusion category had the same property as the premise category. Our behavioral results revealed that people responded more slowly in the irrelevant‐superordinate trials than in the basic‐superordinate and the subordinate‐basic trials. Our ERP results showed that the irrelevant‐superordinate trials elicited smaller P300 (250–500 ms) amplitudes than did the subordinate‐basic and the basic‐superordinate trials. In addition, the subordinate‐superordinate trials elicited smaller P300 and PSW (700–998 ms) amplitudes than did the subordinate‐basic and the basic‐superordinate combinations. These findings indicate that the amplitudes of P300 and PSW may reflect the distance effect in inductive reasoning: The further the premise‐conclusion hierarchical distance, the lower the inductive strength, and thus the smaller the P300 and PSW amplitudes.