A third-year family medicine clerkship based in an academic family practice center

In this paper, the authors describe the planning, curriculum, and evaluation of a five-week family medicine clinical clerkship for third-year students based in an academic family practice center. The program is an outpatient experience utilizing several innovative techniques: (a) problem-based learning that focuses on patient management tutorials, (b) consultation sessions with individuals offering specialized expertise, (c) supervised patient care in a family practice center and with a nursing home inpatient teaching service, and (d) workshops on various topics, such as office-surgical techniques, practice management, and alternative methods of health care. Evaluation of the course has demonstrated the merits of careful planning with student input, the need for flexibility, and the value of focusing on concepts in ambulatory care.     

A department of personal and family medicine.

There has been increasing, worldwide dissatisfaction with the relevance of medical education to health care. Recently, a special task group set up by The Royal Australian College of General Practitioners made a study of how a department of personal and family medicine could participate in the education of the medical student. The task was to present first steps in a research and development programme for education of health personnel to work in and near the family setting. Two academics, two nurse educators, two general practitioners, one specialist surgeon involved in medical education and a fifth-year medical student made up the group. It worked at the task during a six-day live-in teaching and leadership seminar at Leura, New South Wales, in February, 1973.     

Ethics of evidence based medicine in the primary care setting

Evidence based medicine has had an increasing impact on primary care over the last few years. In the UK it has influenced the development of guidelines and quality standards for clinical practice and the allocation of resources for drug treatments and other interventions. It has informed the thinking around patient involvement in decision making with the concept of evidence based patient choice. There are, however, concerns among primary care clinicians that evidence based medicine is not always relevant to primary care and that undue emphasis placed on it can lead to conflict with a clinician's duty of care and respect for patient autonomy. In this paper we consider the impact of evidence based medicine on primary care, and the ethical implications of its increasing prominence for clinicians and managers in primary care.     

循证医学发展与思考

循证医学自上世纪90年代以来一直成为医学界最炙手可热的话题,循证医学的诞生改变了几千年沿袭的医学实践模式.医学工作者通过应用循证医学的思路和方法指导医学研究和临床实践工作,必将有助于提高他们的专业素质,并能促进卫生决策和医疗决策的更加科学化,提高医疗质量.但是,循证医学与临床流行病学、社会医学、信息技术、数据库理论等有着密不可分的关系.这对医学工作者的知识结构和研究方法、卫生相关机构的基础设施建设和组织架构及医学教学模式等提出了新的要求.     

广州市开展全科医学教育的探索与实践

根据我市医疗卫生服务体制改革现状和社区卫生服务的需求,确立我市开展全科医学教育培训工作的指导思想、总体目标、基本原则和工作思路.与本市各高等医学院校及医疗卫生机构合作开展多形式、多层次的全科医学教育,以加强对全科医师知识与技能的培养.     

广州市开展全科医学教育的探索与实践

根据我市医疗卫生服务体制改革现状和社区卫生服务的需求,确立我市开展全科医学教育培训工作的指导思想、总体目标、基本原则和工作思路。与本市各高等医学院校及医疗卫生机构合作开展多形式、多层次的全科医学教育,以加强对全科医师知识与技能的培养。     

Teaching biopsycho-ethical medicine in a family practice clerkship

The practice of medicine is inescapably value-laden. Principles, norms, and commitments are the goals which determine the specific decisions and actions of care-givers, patients, and families. Therefore, a disciplined understanding of human values is an essential complement to the biomedical and psychosocial components of clinical training. For medical students to acquire such understanding calls for a biopsycho-ethical model for medical education. Building on a review of medical ethics teaching, the authors describe a method of systematically integrating value analysis into a family practice clerkship. By combining interdisciplinary seminars with clinical experience, both the rigor and relevance of value analysis are maximized. The specific educational and evaluational objectives and strategies are presented for a course in biopsycho-ethical education.     

家庭医生接诊服务中运用剑桥医患沟通模式的效果分析

对5名家庭医生进行剑桥医患沟通模式培训,针对培训前后接诊的各50例患者,以及专科医生接诊的50例患者的医患沟通各阶段时间及满意度进行测量、问卷调查,并进行比较.结果显示,培训后家庭医生的接诊时间比培训前延长了213 s（分别为490 s、277 s）,比专科医生（268 s）的延长了222 s,均P＜0.001.培训前家庭医生接诊患者的综合满意率为72％,培训后为88％,提高了16％,前后比较差异有统计学意义（P＜0.05）.提示,对全科医生进行剑桥医患沟通模式的培训,可以提高全科医生的沟通能力.     

The role of computers in preventive medicine in a rural family practice.

Five family physicians in a group practice in rural Quebec have introduced a computer system to improve the delivery of preventive medicine. In addition to billing, the computer is used mainly to recall specific groups of patients for preventive measures, to prompt the physicians to carry out certain procedures at the patient's next visit, to indicate which procedures are required for the family members and to generate reminder letters. The physicians are conducting a randomized controlled trial to evaluate the impact of computer-generated reminder letters on patient compliance and disease prevention among families in their practice.     

实践循证医学需要识别"循证广告"

随着循证医学(evidence based medicine)的普及,临床医生开始将循证医学的观点运用于临床决策。循证医学强调多中心随机的临床试验研究和meta分析的系统评价。但是,国际上的这类研究,相当大一部分是由制药公司资助,即使是在欧美的发达国家,公共资源在医药研究方面的科研经费也远远不及商业公司的投入。虽然是进行多中心的、随机的和双盲的临床试验,但制药公司针对自身产品的科研资助,也时常会出现系统性偏倚(biases),