以“能力与责任意识培养”为导向的药事管理学教学改革实践

目的 探索以“能力与责任意识培养”为导向的药事管理学教学改革。方法 采用案例教学法、主题探究讨论等多种方式丰富课堂教学形式，将课程思政建设有机融入到课堂教学中，提升药事管理学课堂教学的生动性、实用性和引领性，将教学目标与育人目标有机结合，锻炼学生分析理解药学事件的能力，培养学生对中国药学事业发展的责任感和担当。结果与结论 通过教学改革实践，将药事管理学的知识目标、能力目标与价值观目标相互融合，同时实现教学目标与育人目标。本教学改革实践得到了学生的认可，取得了较好的改革实践效果。     

The clinical paradox: Acting in two worlds in parallel

Background : Centred around the thesis that for those engaged in clinical practice there are two worlds present in parallel, this article defines the characteristics of the supposed second, qualitative world. Contrasting these characteristics to those of the world as seen in continuous metric dimensions of space and time, we derive the nature of the qualitative elements and their coherent interaction, as well as the rules governing these dynamic elements' interactions. Results : The second world claimed to exist turns out to be made of individual worlds centred in coherent perspectival interaction. Its polycentric agency enacts individual perspectives and mutual information uptake. This hermeneutical approach conforms with some recent developments in theory, such as that of Nobel Prize winner Elinor Ostrom, or the enactment theory of cognitive science. Conclusions : Following this theoretical process, two practical consequences are drawn. The first consists of an advanced model of biopsychosocial interaction, as extensively published throughout the years. The second presents the concept of quality-oriented self-aid groups open to all exposed to or working in care and healthcare. The corresponding training helps practitioners to consciously and deliberately move, perceive, and perform in the duplicity of worlds, the one the conventional quantifying, metric one, the other the mostly rationally unknown world emerging from qualifying interactive agency.     

Reasoning for whistleblowing in health care

Background

Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking.

Aim

This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing.

Methods

The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data.

Results

The core category of the theoretical construct, ‘The formation of morally courageous intervening’, was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning.

Discussion and conclusion

The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing.     

A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions

Introduction

Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions.

Methods

Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1–5 scale); and (4) teachers' self-perception of their ability to implement the solutions.

Results

Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50–4.85) and feasibility (3.50–4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them.

Conclusions

The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.     

抑郁性神经症和重性抑郁症的临床特征差异比较分析

目的：比较抑郁性神经症（ND）和重性抑郁症（MD）的临床特征的差异。方法：对符合CCMD－2－R诊断标准的30例ND和32例MD进行 对照分析。结果：两组患者在起病年龄、发病诱因、内向性格、阳性家族史、用药及转归方面均无显著性差异，在临床症状上的差异也仅表现在严重程度上。结论：ND具有心境障碍的性质。作者认为ND的分类学位置值得重新考虑。