临床情景教学在麻醉学医德教育中的应用

麻醉学临床教学存在临床思维培养不足和缺乏医学道德观教育等缺陷,导致学生毕业后缺乏独立应对医疗实践中的实际社会性问题的能力,产生消极情绪。为解决此问题,我们在实习早期设立课程,课堂采用临床情景结合PBL（Problem-base-learning）的教学手段,使学生应对处理临床上一些涉及技术层面和伦理道德的实际问题,再行人文知识的讲授;并建立网络课程（WBL,web-base-learning）,促使学生自习,并通过讨论与教师积极互动,达到开阔学生视野和提升医学道德情感的目的。     

Summary remarks: the implications of professionalism for medical education

Can professionalism be taught and measured? In the medical school environment, particularly with clinical encounters occurring in the first year, a focus on professionalism should begin right away. Attitudes and behavior of the students are strongly influenced during these encounters between physician-mentors, and patients and their families at the bedside or in the clinic. Careful listening and the demonstration of communication skills during these encounters are paramount. Asking questions may be better than telling students what to do. The faculty must provide thoughtful and constructive critiques and must have a mechanism for follow-up. By paying attention to how students really function, we might better teach the precepts of professionalism without adversely affecting their own well being.     

Drink and drugs: from medical students to doctors.

Drinking and illicit drug use were assessed longitudinally in a cohort of medical students who were surveyed in the second and fifth year of their undergraduate studies and after 1 year as PRHOs. Mean alcohol consumption had increased significantly (P<0.015) over the three time points; 15.2-16.0-18.8 units/week. Experimentation with illicit drugs had increased from 50 to 63 to 65%. Although education on alcohol and illicit drugs should be part of core curriculum in medical schools, support and intervention in the workplace is also needed for individuals with alcohol and/or drug problems.     

外科临床伦理学中几个基本问题的探讨

文章介绍外科临床伦理学的原则,在治疗过程中患者的同意权、参与权、隐私权的内容,以及医生如何尊重和保护患者隐私权的几个对策。     

Quality assurance and clinical pharmacy: lessons from medicine

A quarter-century of empirical work in measuring the quality of medical care has both documented serious inadequacies in care and advanced the state of the art of quality assessment. Experience with quality assurance programs at institutional, local, and national levels emphasizes that early, careful attention must be given to: specifying the purposes of a study or program, choosing the dimensions of care to be evaluated, understanding the reliability and validity of data sources and methods, and compiling appropriate evaluative criteria before projects are implemented. Superimposed on these concern are cost/benefit and cost/quality tradeoff issues. To the degree that the pharmacy profession has dealt with such conceptual and methodologic problems, it has much to offer the medical profession. To the degree that clinical pharmacy has not yet encountered them, lessons drawn from the medical experience may be helpful in implementing evaluation efforts in the future.     

The teaching of pharmacology in Italian medical schools: the point of view of Italian doctors

Objective: A survey was carried out to gather the opinions of doctors about the current method of teaching pharmacology in Italy. Methods: A questionnaire was mailed to 3860 doctors, who were asked a series of questions regarding the teaching of pharmacology to medical students in Italian universities. Results and conclusions: The great majority of those who replied considered the teaching they received to be mainly theoretical. The doctors thought that much more time and attention should be dedicated to those pharmacology subjects that are more closely connected to physiopathology and clinical practice (clinical pharmacology).     

Prescribing and the core curriculum for tomorrow's doctors: BPS curriculum in clinical pharmacology and prescribing for medical students

Prescribing is one of the commonest tasks expected of new doctors and is a complex process involving a mixture of knowledge, judgement and skills. Preparing graduates to be prescribers is one of the greatest challenges of modern undergraduate medical education and there is some evidence to suggest that training could be improved. The aims of this article are (i) to review some of the challenges of delivering effective prescribing education, (ii) to provide a clear statement of the learning outcomes in clinical pharmacology and prescribing that should be expected of all medical graduates and (iii) to describe a curriculum that might enable students to achieve these outcomes. We build on the previous curriculum recommendations of the British Pharmacological Society and take into account those of other key bodies, notably the General Medical Council. We have also reviewed relevant evidence from the literature and set our work in the context of recent trends in medical education. We divide our recommended learning objectives into four sections: principles of clinical pharmacology, essential drugs, essential therapeutic problems and prescribing skills. Although these will not necessarily be accepted universally we believe that they will help those who design and map undergraduate curricula to explore potential gaps and identify improvements.     

Translational research goes both ways: lessons from clinical studies

1. It is currently assumed that translational research goes from benchtop to bedside; that aldosterone elevates blood pressure via its effects on salt and water homeostasis; that mineralocorticoid receptors (MR) and glucocorticoid receptors (GR) share a common immediate ancestor; and that aldosterone plays a deleterious role in essential hypertension and heart failure. 2. Meta-analysis of clinical trials in essential hypertension, in which eplerenone was dose-titrated to attain diastolic blood pressure < 90 mmHg, showed no relationship between blood pressure response and electrolyte effects, as judged by change in plasma (K). 3. Reexamination of sequence data, and insights from the S810L MR mutant gene causing juvenile hypertension exacerbated by pregnancy, suggest that MR were the first to branch off the primordial ancestor for MR, GR, androgen receptors (AR) and progesterone receptors (PR). 4. In clinical trials of MR blockade in heart failure and essential hypertension baseline aldosterone levels are in the low to normal range and sodium status unremarkable. Under such circumstances cortisol appears to be responsible for MR activation, thus exculpating aldosterone in these conditions. 5. On the basis of these clinical studies, there is need to revisit the basic biology of aldosterone and MR as translational research very clearly goes both ways.     

国外药品临床试验中的伦理学现状及思考

药品临床试验为保障受试者的权益 ,必须考虑到医学伦理学问题。赫尔辛基宣言是受试者的一种保护性精神特质。参与临床试验病人的权益意识已增强 ,但宣言所规定的权利范围尚有不足之处 ,且某些方面还存在模棱两可的解释。从伦理学角度看 ,安慰剂对照还存在争议。FDA认为安慰剂对照属于“金标准”,但尚无合理科学依据。循证医学的兴起及其强调证据的可靠性对药品临床试验提出更高的要求 ,同时这种要求却触及了相关的伦理学问题。对以上问题进行讨论和分析 ,有助于管理者从伦理学角度管理好药品临床试验     

浅谈临床药理学教学中的几点体会

临床药理学是临床医学生在开始临床实践活动前所接触的一门实用课程。为了提高临床药理学教学质量,培养具有扎实理论基础和一定临床工作能力的实用型医学人才,笔者通过总结在临床药理学教学中的经验与感受,就如何提高教学质量,培养学生学习的积极性和自主性,谈谈几点教学中的体会。