双目间接检眼镜的特点及其在眼科学中的应用

介绍了双目间接检眼镜的特点及其在眼科检查和手术2方面的应用。双目间接检眼镜因其独特的照明系统及成像原理，与直接检眼镜相比具有许多独特的优点。在双目间接检眼镜下，大多数眼底疾病可以得到正确的诊断。作者认为到目前为止，双目间接检眼镜检查法是最方便、优越的眼底检查方法，在眼底检查、眼科手术、治疗中，具有很高的应用价值。     

免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效评价

目的:探索免散瞳眼底照相仪在糖尿病视网膜病变社区防治中临床疗效。方法:本次研究对象为100例疑似糖尿病视网膜病变患者,均进行免散瞳眼底照相仪检查,随访分析此项检查在视网膜病变分期中正确率以及图像质量。结果:免散瞳眼底照相仪图像质量可以评估的有78.05%,对视网膜病变Ⅰ期诊断正确率为96.00%,对Ⅱ期诊断正确率为95.83%,对Ⅲ期诊断正确率为94.74%,对Ⅳ期诊断正确率为94.44%。同时对糖尿病视网膜病变敏感度为95.35%,特异度为92.86%,漏诊率为4.65%,误诊率为7.14%。结论:在评估糖尿病视网膜病变患者时,运用免散瞳眼底照相仪检查,可及时发现眼底病变,为后期随访提供详细参考信息。     

PUBLIC HEALTH AND EPIDEMIOLOGICAL DATABASES FOR THE ENHANCEMENT OF MEDICAL EDUCATION

The collaboration of public health education and information technology has made patient care safer and more reliable than before. Nurses and doctors use handheld computers to record a patient''s medical history and check that they are administering the correct treatment. Fortunately Public Health Informatics (PHI) is the intersecting point of technology and public health. Therefore, the inclusion of online medical and epidemiology databases in the course curriculum of budding medical professionals and postgraduate students would be beneficial in enhancing the quality of health care, extensive epidemiological research, health education, health policies, health planning and consumer satisfaction as well. The purpose of this article is to discuss and provide introduction of various databases which have huge information and it could be used to enhance the public health education.     

Telemedicine for eye care

Tele-ophthalmology has been employed mainly for patients in under-served rural areas in need of specialty care, but other applications such as telementoring have also been used. In certain populations, cost containment is a significant issue and telemedicine is a solution. Tele-ophthalmology can be performed in realtime, by store-and-forward mode, or by hybrid techniques. After appropriate modification, a range of peripherals may be used for tele-ophthalmology, including the direct ophthalmoscope, indirect ophthalmoscope, slit lamp or retinal camera. Tele-ophthalmology applications include: detecting, screening and diagnosing diabetic retinopathy; anterior segment imaging; glaucoma screening; low vision consultation; telementoring. Tele-ophthalmology shows great promise for improving patient care and increasing access to specialty care not available in under-served areas. In developing countries tele-ophthalmology may be a cost-effective method by which richer countries can assist them.     

ADEPT-CARE: A pilot,student-led initiative to improve care for persons with disabilities via a novel teaching tool

BackgroundOver one-quarter of United States adults live with a disability. Despite persistent ableism, defined as discrimination and prejudice against people with disabilities, in healthcare, disability-focused training remains largely absent from medical education.ObjectiveThe aim of this study was to pilot and evaluate a novel teaching mnemonic (ADEPT-CARE) for performing a comprehensive history and physical exam for disabled patients.MethodsIn Spring 2022, first-year medical students at a suburban Mid-Atlantic institution could electively participate in a learning module that included ADEPT-CARE. Surveys were administered to students before and following exposure to the ADEPT-CARE protocol.ResultsOf 142 eligible students, 33 and 21 completed the pre- and post-surveys, respectively. The ADEPT-CARE protocol made sense to 95.2% of students. All (100%) students reported that they will use the ADEPT-CARE protocol in the assessment of patients with disabilities. Students were more likely to agree or strongly agree that they had a consistent approach or strategy in mind when assessing a patient with a disability after exposure to ADEPT-CARE (85.7% vs. 39.4%, respectively, p = 0.002). There was no statistically significant difference in students’ perceived confidence in their ability to assess a patient with a disability after curriculum completion compared to before (85.7% vs. 81.8%, respectively, p = 1.0).ConclusionsThe ADEPT-CARE protocol has the potential to be an effective teaching tool by providing a framework to equitably care for disabled patients. Future research should assess whether students’ self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting.     

The Columbia-Harlem Homeless Medical Partnership: A New Model for Learning in the Service of Those in Medical Need

Though altruism and patient advocacy are promoted in medical education curricula, students are given few opportunities to develop these skills. Student-run clinics focusing on the health needs of the underserved can provide important health services to needy patients while providing students with career-influencing primary care experiences. The Columbia-Harlem Homeless Medical Partnership (CHHMP)—a project initiated by medical students to provide primary care to Northern Manhattan's homeless population—serves as a new model of service learning in medical education. Unlike many other student-run clinics, CHHMP has developed direct patient outreach, continuous care (stable “student–patient teams” and a weekly commitment for all volunteers), and regular internal data review. Chart review data presented demonstrate the project's success in providing care to the clinic's target population of homeless and unstably housed patients. Targeted outreach efforts among clients have increased rates of patient follow-up at each subsequent review period. Additionally, CHHMP has used review data to develop services concordant with identified patient needs (psychiatric care and social services). CHHMP has recruited a committed group of volunteers and continues to engender an interest in the health needs of the underserved among students. Not only does CHHMP provide a “medical home” for homeless patients, it also provides a space in which students can develop skills unaddressed in large teaching hospitals. This project, a “win–win” for patients and students, serves as a unique model for community health-based service learning in medical education.     

Tele-ophthalmology screening for retinal and anterior segment diseases

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera used as gold standards. Images (390 x 300 pixels x 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup-disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.     

浅谈手持式医用显示器与传统医用显示器的区别

简要介绍手持式医用显示器,对手持式医用显示系统与传统医用显示器进行对比分析,并讨论了手持式医用显示器性能评价方法。通过对比,了解其使用局限性,为实现高质量的患者护理服务,确保设备的安全使用提供指导。     

Medical students benefit from learning about patient safety in an interprofessional team

Context  Safe clinical practice is inextricably linked to team-working. Delivering patient safety education interprofessionally heightens students' awareness of the importance of effective team-working for safe care and care delivery.
Methods  We conducted a comparative study using mixed-method analysis among medical students learning about patient safety, either uni- or interprofessionally, towards the end of their training. Emphasis is placed on the detailed analysis of qualitative data relating to student perceptions of the event before and afterwards.
Results  All medical students, whether working uni- or interprofessionally, increased their knowledge across all eight learning outcomes ( P  = 0.001). Although students said they felt more comfortable when learning alongside other medical students, those who learned with other disciplines gained added value from these interactions and were able to frame their thinking more clearly within the context of safe interprofessional team-working.
Conclusions  Designing a team-based patient safety event to take place towards the end of medical education can enable students to assimilate all aspects of their curriculum relevant to safety. The link between team factors and the safety agenda is increased when students learn interprofessionally.     

A Randomized Controlled Trial on Teaching Geriatric Medical Decision Making and Cost Consciousness With the Serious Game GeriatriX

ObjectiveMedical students often lack training in complex geriatric medical decision making. We therefore developed the serious game, GeriatriX, for training medical decision making with weighing patient preferences, and appropriateness and costs of medical care. We hypothesized that education with GeriatriX would improve the ability to deal with geriatric decision making and also increase cost consciousness.DesignA randomized, controlled pre-post measurement design.ParticipantsFifth-year medical students.InterventionPlaying the serious game GeriatriX as an additive to usual geriatric education.MeasurementsWe evaluated the effects of playing GeriatriX on self-perceived knowledge of geriatric themes and the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in geriatric decision making. Cost consciousness was evaluated with a postmeasurement to estimate costs of different diagnostic tests.ResultsThere was a large positive increase in the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in the intervention group (n = 71) (effect sizes of 0.7, 1.0, and 1.2, respectively), which was significantly better for the last 2 aspects than in the control group (n = 63). The intervention group performed better on cost consciousness. Although the self-perceived knowledge increased substantially on some geriatric topics, this improvement was not different between the intervention and control groups.ConclusionsAfter playing the serious game, GeriatriX, medical students have a higher self-perceived competence in weighing patient preferences, appropriateness, and costs of medical care in complex geriatric medical decision making. Playing GeriatriX also resulted in better cost consciousness. We therefore encourage wider use of GeriatriX to teach geriatrics in medical curricula and its further research on educational and health care outcomes.     

Retinal phototoxicity: a review of standard methodology for evaluating retinal optical radiation hazards

Optical radiation (light) safety standards can be difficult to use for the evaluation of light hazards to the retina, even for persons experienced in radiometry and photometry. This paper reviews terminology and methodology for evaluating optical radiation hazards to the retina in accordance with international standard ISO 15004-2 Ophthalmic instruments-Fundamental requirements and test methods, Part 2: Light hazard protection (2007). All optical radiation safety standards use similar methods. Specifically, this paper illustrates how to evaluate the retinal hazards from various ophthalmic instruments including the following: diffuse illumination of the cornea; incident light diverging at the cornea (direct ophthalmoscope, operation microscope, fixation lamp); and incident light converging at the cornea (indirect ophthalmoscope, fundus camera, slit lamp biomicroscope). A brief review of radiometry and the use of certified optical components by manufacturers as specified by the ISO standard is also provided. Finally, the authors provide examples of the use of photometric measurements in hazard evaluation.     

An innovative examination ending the medical curriculum

There has been increasing interest in curriculum innovation in many medical schools. The pedagogic principles for learning and for assessment should be congruent. Changing the curriculum and pedagogic principles for medical education implies that the examinations should also be adapted to the new principles. At the Faculty of Health Sciences, Linköping University, we use a student-oriented programme with problem-based learning, early patient contact, multiprofessional integrated education, and integration between basic science and clinical medicine and between traditional medical subjects. We also encourage the students to adopt a scientific attitude from the very beginning. To assess the students at the conclusion of the medical curriculum, we have developed a new form for the final examination containing measurements of clinical ability based on a videotaped patient consultation, an assessment of the student's performance and presentation of a scientific project, the student's analysis of a published scientific paper and an extensive oral examination based on the students' own scientific papers. Our experience, including results from questionnaires to students and teachers, is that the method is suitable for a final examination and assesses qualities that we previously were not able to assess.     

市场经济条件下和谐医患关系的构建

医患关系紧张的直接原因是“看病贵、看病难”,深层次的原因是经济转轨后利益平衡被打破。构建和谐的医患关系需要加大卫生投入,优化资源配置,完善医院管理,加强医德医风教育,控制医疗费用上涨,改善医疗保险制度,促进慈善事业的发展。坚持“以人为本”的观点,既考虑患者的利益,又考虑医院和医生的利益;坚持正确的舆论导向,化解医患矛盾。     

加强医患关系教育培养优秀实用人才

探讨医学生实践教育.医疗卫生体制改革,使医患关系发生变化,医学院校应对医学生加强医患关系教育,使之适应市场化的医疗服务工作.     

Matching fundus photographs of classmates. An informal competition to promote learning and practice of direct ophthalmoscopy among medical students

Abstract

Purpose: To present a new approach for teaching direct ophthalmoscopy to medical students.

Methods: At the University of Bergen, four consecutive classes of fourth-year medical students complete a required 9-week ophthalmology course every year. In the present project, one fundus photograph was taken of each student. The photographs were randomly numbered, printed on A4 glossy photo paper, and displayed on the classroom wall. Each student was given a form to fill in the fellow students’ names matching the number of the fundus photographs. They were encouraged to practise direct ophthalmoscopy on their classmates outside formal teaching hours. At the end of the course, they returned the filled-in forms, and those with the highest number of correct matches between the fundus photographs and fellow students received a reward.

Results: Between 2011 and 2013, 239 students completed their ophthalmology course. Of these, 220 students (92%) voluntarily participated in the project. The mean score was 70% correct matches between fundus photographs and fellow students (range 7 ‐ 100%). The students’ course evaluations were overall positive.

Conclusions: We recommend the use of peer fundus photographs in the context of a learning competition as a simple, inexpensive, and effective way to improve teaching of direct ophthalmoscopy.     

临床医学本科学生专业思想教育的实践与体会

临床医学本科学生进入临床教学阶段后，接触社会较多，又面临毕业分配，思想比较活跃，应多加关心，注意加强与学生的思想沟通与交流。在专业教育方面：①必须重视临床实践能力培养：临床基本技能是医学生进行诊疗的基本前提和保证，是医学生素质培养和质量评价的主要内容。②必须重视培养“研究性”学习习惯和“创新性”思维方式：培养研究性学习能力，既是创新型人才的基本素质，也是创新型人才的重要标志。进行创新性思维训练主要包括求异思维、逆向思维、换位思维、发散思维和批判思维。③必须正确处理好实习与“考研”和“就业一找工作”的关系：培养学生爱岗、敬业、务实、勤奋、献身的精神，建立积极向上的学习目的，增强他们的社会责任感、使命感，树立正确的人生观、世界观、价值观。④必须加强临床医学生良好的医德医风养成：在临床实践中，规范医学生医疗行为，培养他们树立良好的医德医风，以及尊重病人，对病人负责，关爱病人的优秀品质。     

标准化病人在医学教育和卫生保健研究中的应用进展

标准化病人(SP)作为许多国家医学教育的标准组成部分,是为医学生和医生提供宝贵临床技能培训和评估机会的专业人员。作者综述了SP在卫生保健领域的应用,并分析了相关优缺点。建议在我国继续深入SP的相关研究,加快建立SP在医学教育和卫生体系应用的正式制度,以提高医疗质量。     

Preventive care attitudes of medical students

Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: the relative importance of 20 specific preventive services to the practice of medicine and the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction.(ABSTRACT TRUNCATED AT 250 WORDS)     

Developing service-based teaching in health education for medical students.

In the expanding concern about the social-behavioral aspects of health care in medical education, health education has opportunities for making itself an important part of basic medical training. The need is to actually define a physician's appropriate educational tasks and competencies as a basis for curriculum development in health education which would ideally be integrated into the whole educational program. This case study presents efforts to develop an educational service component at a rural health center which, connected to a major teaching hospital, serves as a learning base for medical students. Through trial and student feedback a program has been developed which includes patient counseling, evaluative home visits, group education sessions, exit interviews, medication counseling, community needs assessment and educational consultation with local school teachers. With this program as a foundation, the goal is to integrate health education learning throughout the rest of the medical curriculum.     

When patients decline medical student participation: the preceptors’ perspective

Patients’ receptivity towards medical student participation has been examined predominantly from the patient and/or the medical student perspective. Few studies have investigated the preceptor’s perspective. The study examined preceptors’ experience with patients declining medical student participation in clinical care and identified preceptor-related factors associated with this experience. Preceptors (n = 42) were recruited from a Family Medicine educational presentation and completed a survey assessing encounters with patients declining medical student participation, methods for obtaining patient consent, and self-rated clinical education skills. Forty-eight percent and 62% of preceptors have “sometimes” or “often” had patients decline student involvement due to student’s status and in the context of a gynecological/urological exam, respectively. Fifty-eight percent “never” or “seldom” obtain patient consent with the student outside the exam room, while 46% “often” or “always” have the student directly inform patients about his/her involvement. Being a faculty preceptor (versus resident preceptor) (r = 0.463, p = 0.026) and feeling uncomfortable talking to patients about students performing the exam (r = −0.482, p = 0.020) were associated with patients declining student participation for a genital exam. Findings indicate that preceptors encounter patients declining medical student involvement in general and sensitive exam scenarios. In addition, patients are more likely to decline student participation when preceptors are faculty members and less comfortable discussing student involvement.