Reconsidering "good teaching" across the continuum of medical education.

There is no shortage of sustained inquiry into the nature and evaluation of teaching in medical education. For the most part, however, this growing and respectable body of inquiry has uncritically adopted a single model of effective teaching that is assumed to be appropriate across variations in context, learners, and teachers. This article presents five alternative views of "good teaching" and challenges the trend toward any single, dominant view of what constitutes good teaching. Based on 10 years of research, in five different countries, studying hundreds of educators in adult and higher education across a wide range of disciplines, contexts, and cultures, we have evidence of five different perspectives on good teaching: transmission, developmental, apprenticeship, nurturing, and social reform. Each perspective represents a philosophical orientation to knowledge, learning, and the role and responsibility of being an educator. A "snapshot" of each perspective is provided, including an example from continuing medical education (CME), a set of key beliefs, primary responsibilities, typical strategies, and common difficulties. Readers are encouraged to use the five perspectives as a means of identifying, articulating, and revisiting assumptions and beliefs they hold regarding their view of effective teaching. They are also encouraged to resist a "one-size-fits-all" approach to the investigation, improvement, or evaluation of teaching in CME.     

什么是"好"的卫生政策

医药卫生体制改革已进入攻坚和关键阶段,宏观、前瞻、科学的卫生政策指导与深厚社会关怀、社会健康理论支持已成为继续深化卫生体制改革发展战略措施和战略议题。如何科学民主决策,如何创造性地制定优秀的卫生政策框架,是卫生改革发展成功的前提。     

妙心搞定"好男人"

她们自视清高,她们神情冷漠,她们匆匆走过的孤单身影是都市美丽的风景,单薄的身子没有强健的他的呵护,都市的白领在等待中蹉跎,为什么放眼望去,身边就没有一个顺眼顺心的男人?为什么“好男人”都娶了别人?     

"Good help" in St. Petersburg

Founded in 2001 by representatives of seven local organizations, the Refugee Healthcare Partnership (RHP) provides necessary health services and meaningful employment opportunities for refugees in the Tampa Bay, FL, area. Spearheaded by Catholic health care organizations and Catholic Charities of the Diocese of St. Petersburg, the RHP was made possible initially by funding from the Bon Secours Mission Fund of Bon Secours Health System, Marriottsville, MD. Florida leads the nation in granting lawful permanent resident status to refugees and asylum seekers. Like the rest of the country, Florida has a shortage of long-term care nursing personnel. RHP leaders believed that by training refugees to become certified nursing assistants (CNAs) they could ease the local CNA shortage and provide refugees jobs with health insurance. Soon thereafter, RHP leaders recognized that to be successful they would have to provide services to teach refugees English. The RHP worked with the Pinellas Technical Education Centers (PTEC) to form the Pinellas Refugee Education Program (PREP). Funded by the Florida Department of Children and Families and the U.S. Department of Health & Human Services, PREP assists refugees to learn English and to train for jobs, including careers outside of health care. To help RHP clients prepare for CNA classes at PTEC, a "medical orientation" course was developed to give refugees familiarity with medical terms and with long-term care practices in the U.S. In less than four years, the RHP has served more than 260 clients. The RHP continues to offer its clients needs assessment; placement in health-care related, entry-level training programs; mentoring programs; and referrals to medical services. The original seed funding from Bon Secours has now been superseded by a substantial grant from the state.     

民国时期离婚现象再探讨——以20世纪20年代的山西省为个案

中华民国成立后,中国社会的各个方面都发生了重大变化。青年知识分子高呼婚姻自由。在结婚自由成为社会风气的同时,离婚自由也成为人们的诉求。当时地处内陆的山西人的婚姻观念也发生了转变,离婚、再婚事件屡有发生。通过分析20世纪20年代山西离婚的文献资料,我们可以洞察到当时山西离婚现象的特点。     

Reconsidering scholarship.

Following the publication of Scholarship Reconsidered in 1990, debates began on many campuses regarding the expansion of the definition of scholarship. These debates focused on the appropriateness of the scholarship of discovery, the scholarship of integration, the scholarship of application, and the scholarship of teaching. These conversations were enriched by the six standards for assessment proposed in Scholarship Assessed, published in 1996. Now these concepts prosper on many campuses as individual institutions find their own interpretations and adaptations of enriched and expanded scholarship.     

Divorce and sex

Studies on the sex lives of the divorced are relatively few and somewhat dated. Although they give a rather optimistic view of the subject, this research is flawed by high respondent refusal rates and poor representativeness of samples. Further, a major gap in this literature is that the possible predictors of sexual activity of the divorced remain largely unexplored. The present study, using national data on 340 divorced people, indicates a much lower level of sexual activity than found in past research. Regression analyses find that both number of partners and sex frequency are related to religiosity, education, and political liberality. Future research can explore the impact of low sexual activity among the divorced on indicators of emotional well-being.The Interuniversity Consortium for Political and Social Research provided the datatape containing the data used in this paper.     

Reconsidering the moral hazard-risk avoidance tradeoff

The received model for optimal demand-side cost sharing trades off moral hazard and risk avoidance. This model appears to lie behind recent increases in initial cost sharing, such as those embodied in Health Savings Accounts and Health Reimbursement Accounts. At the same time there is evidence that lower cost sharing for certain drugs can reduce future total health care costs and/or improve future health, and this may be true of other medical services as well. To the degree that individuals remain in the same common insurance pool, lower cost sharing that induces increases in certain services that reduce total costs, including future costs, represents a classic case for a subsidy and will minimize an employer's labor costs. Even if total costs increase, the value of a change in health could increase more. In that case such a subsidy is consistent with recent work in behavioral economics for those with self-control problems.     

Reconsidering the age limits on pill use

This article reports on an advisory committee of the US Food and Drug Administration (FDA) which recommended the removal of age limits on the use of oral contraceptives by healthy nonsmoking women. The factors that weighed on this "judgement call" which is unusual for the FDA were: previous studies that set an upper age limit for nonsmoking women of 40 years were done in the mid-1970's with high dose oral contraceptives which are a much higher health risk than today's low dose pills; women older than 40 often choose sterilization and the committee felt that their decision was affected by the lack of highly effective alternatives; the ability to conceive is a very real possibility for women 35-49 (e.g. 86% for women age 35-39, 78% for ages 40-44, and 69% for ages 45-49), and pregnancy for this age group is believed to be much more dangerous than the low dose pill's health risk. The committee did consider evidence of the pill's implications in increasing breast cancer and cervical cancer but found the data inconclusive or not an added health burden when considering the potential health benefits of a lowered risk of ovarian and endometrial cancer. The FDA committee urges further research on the risks and benefits or oral contraception. The evidence of increased risk of cardiovascular disease from pill use among smoking women, especially those over 40, was incontrovertible and the committee adhered to an upper age limit of 35 years for using oral contraceptives for smoking women.     

Reconsidering HIV testing--consent is still the key

The high quality and easy accessibility of HIV testing in Australia has been one of the reasons for Australia's effective response to the epidemic. However there have been a number of changes in the epidemiology of HIV and new technologies and treatments have emerged since the last Australian HIV policy was released in 1998. Antenatal testing to prevent vertical transmission, the licensing of rapid, point-of-care test kits in the United States and the problem of late diagnosis of infection in some populations are important issues to consider in the context of the drafting of a new HIV testing policy. The terms 'pre- and post-test counselling' are seen, by some, as barriers to HIV testing in the broader community. Reframing the process with a focus on the desired result (i.e. informed consent for voluntary testing) rather than on the process (i.e. pre-test counselling) could be one way to increase the rate of appropriate testing.     

Divorce in clinical practice

The family physician today has many families in his/her practice who have decided on divorce and who turn to the family physician for guidance. The effect of divorce for children from infancy to age three years is primarily related to the mother's emotional adjustment to the divorce. Preschool and school aged children are most at risk for personality disturbances because of their emerging sense of identity and need for both parents as figures of identification. The adolescent is initially the most painfully distressed by the divorce but, in fact, is in time the least affected of all the age groups. An intervention aimed at helping reduce the pathological effect on the child's development is outlined, which includes an emphasis on the parents working together for the benefit of the children, the suggestion that the children be allowed as much continuity in their lifestyle as possible, and the need for each parent not to deprecate or blame the other so that the child may have a positive image of both parents.     

Barriers and Supports to Divorce for Victimised British-Indian Mothers and Consequences of Divorce: Narratives of British-Indian Adult Children of Divorce

Divorce or separation is one route towards addressing high conflict in marriages and may be a key route out of situations of significant domestic violence for women and children. However, divorce has been associated with feminisation of poverty and other negative outcomes which can be further exacerbated for victimised women. While there has been research as to what prevents women from leaving violent marriages, there is little research on what prompts women to leave and separate or divorce. This literature is particularly limited for minority ethnic women, for whom both the contexts of domestic violence and divorce may be additionally complex due to the superimposition of several oppressive structures such as race, patriarchy, gender and immigration that render them particularly vulnerable and limit their help-seeking approaches. However, victimised minority ethnic women do make strategic choices to seek help in domestic violence situations and even to divorce. This paper address this gap in literature by presenting a study that explores the narratives of British-Indian adult children who experienced and witnessed parental domestic violence and parental divorce. The paper presents the perspectives of these children to highlight the context, barriers and supports that participants believed their mothers had to address domestic violence and to divorce, the decisions their mothers made and the consequences of these decisions. The analysis suggests that barriers and supports towards help-seeking for domestic violence and to divorce and the consequences of divorce are embedded in the community contexts for British-Indian women. The implications towards informing appropriate support to victimised and divorced women within their communities are discussed.