论加强当代医学生人文关怀精神的教育

医学是一门自然科学与人文社会科学高度结合的综合性学科,其本质特点是人文关怀。本文分析了当前医学教育中人文关怀精神的缺失问题,并阐述了通过转变医学教育观念、强化医学生的人文关怀意识及营造良好的校园文化氛围等方式,来加强对医学生人文关怀精神的教育。     

Creating Disability-Competent Medical Students Via Community Outreach

IntroductionMedical students often have limited exposure to providing care to physically and cognitively disabled patients. To address this gap, Involvement with Disability Education and Advancement (IDEA) was started in 2015 at Rutgers New Jersey Medical School (NJMS). The organization provides NJMS students the opportunity to visit a school dedicated to disabled students and lead educational sessions on health topics.Materials and methodsWe conducted a survey study in 2018 to compare comfort levels between IDEA members and non-members in eliciting information from and providing medical attention to nonverbal, cognitively impaired, and physically disabled patients. The survey-based study utilized yes/no questions, and a Likert scale questionnaire to determine IDEA member and non-member comfort levels in working with various disabilities. Statistical analysis was performed using SAS Enterprise Guide 7.1; p value < 0.05 was considered statistically significant.Results and discussionA total of 56 responses (19 members, 37 non-members) were analyzed. Regardless of IDEA membership, medical students of all years perceived themselves to have more comfort caring for physically disabled than cognitively impaired or nonverbal patients. IDEA members also recorded higher comfort levels with eliciting information from cognitively impaired patients and lower comfort levels with providing medical attention to physically disabled patients.ImplicationsIDEA members may have increased comfort interacting with cognitively impaired individuals due to their regular experience and lower levels of comfort providing medical attention to physically disabled patients due to awareness of complex problems specific to the population. The current results warrant continued data collection and further evaluation.     

广州地区医科大学生社会支持、自我效能感关系调查研究

目的了解目前广州地区医科大学生社会支持、自我效能感的影响因素,以及两者之间的关系。方法用肖水源的社会支持量表和王才康的大学生自我效能感量表(GSES),对广州地区3所医科大学在校本科生做调查。结果①有效问卷932份,能较好利用社会支持的人数为494人(53.00%);自我效能感较高的人数为436人(46.78%)。两者比率都接近中等水平。两者得分均值低于中国的常模水平;②不同分类亚群学生社会支持、自我效能感差异有统计学意义:女生、城镇生、学过心理知识的学生比男生、农村生、未学过心理知识学生得到的社会支持多(性别t=-5.986,P<0.001;生源地t=-2.176,P=<0.05;心理知识t=5.488,P<0.001);学过心理知识、年长生比无学过心理知识、年幼生自我效能感高(心理知识t=3.957,P=0.007;年龄t=-2.038,P<0.001);③社会支持与自我效能感两者之间呈正相关(r=0.230,P<0.001)。结论①广州地区医科大学生社会支持、自我效能感处于中等水平,低于全国常模水平;②得到的社会支持与性别、生源地、心理知识有关;自我效能感与心理知识、年龄有关;③社会支持与自我效能感两者之间呈正相关关系。     

医学生学习倦怠现状及其影响因素

目的了解医学生学习倦怠的现状,探索其学习倦怠的社会、组织和个人层面的影响因素,并提出有效可行的干预措施。方法采用大学生学习倦怠量表、领悟社会支持量表(PSSS)、青少年生活事件量表(ASLEC)和大学生专业承诺量表,对随机抽取的635名在校医学生进行调查。结果①医学生存在一定程度的学习倦怠,学习倦怠人数占总人数的41.65%;②性别方面,男生的总倦怠及各维度的得分均高于女生(t=3.030,P=0.003);专业方面,不同专业医学生学习总倦怠得分进行比较,差别有统计学意义(F=3.355,P=0.010);③学习倦怠总分与社会支持(r=-0.340,P=0.000)、学习压力(r=0.097,P=0.038)、受惩罚事件(r=0.096,P=0.040)、专业承诺(r=-0.401,P=0.000)均呈相关关系。结论多种因素影响着大学生的学习倦怠状况,改善学生的学习倦怠,需要多方面协调一致、相互配合、共同努力。     

某医学院女生进食障碍与自我接纳的现况调查

目的了解女大学生中进食障碍的发生情况及其与自我接纳的关系,为进一步对进食障碍进行研究及防治提供理论依据。方法通过随机整群抽样,抽取某医学院3个年级1062名在读女生进行现场调查,包括一般情况、进食障碍问卷和自我接纳问卷等。结果调查中有23人(2.2%)为"体重关注者",其中1人停经3个月以上;进食障碍问卷完美主义因子得分在年级(F=4.84,P=0.008)和专业(F=5.72,P=0.003)上有较大差异;进食障碍情况和自我接纳状况相关(r=-0.55,P<0.01)。结论进食障碍会引起女大学生的自我评价和自我接纳问题。     

The Life of a Black Medical Trainee in the United States: Past,Present, Future

An Introduction to the History of Black Medical TraineesIn these unprecedented times, Black medical professionals must deliver excellent medical care and uphold the highest standards of their profession while living through a devastating pandemic. They must do so in a time when the country tries to reconcile with generations of racism and injustice. The current social environment in America is particularly challenging for medical trainees such as medical students and resident physicians who must focus on their educational requirements and careers in settings that are often averse to addressing topics such as racism. This plight is not new for Black medical trainees, as they have been fighting for centuries to obtain an equitable seat at the table of medical education. Throughout the 19th century and early 20th century, Black physicians were repeatedly disenfranchised from the predominantly white medical societies, most notably the American Medical Association (AMA), which was established in 1847. Racially integrated medical organizations such as the National Medical Society of Washington D.C. (NMS), which was founded in 1870, were developed to challenge discriminatory practices of the American Medical Association against Black practitioners. The inception of the National Medical Association (NMA) in 1895 allowed Black doctors to advocate for disadvantaged patient populations and focus efforts on health issues pertinent to the underserved.The Struggles of the Black TraineeHowever, Black and underrepresented minorities continue to face challenges with medical school matriculation and retention. A 2015 AAMC report showed that Black male medical school matriculants failed to increase significantly between 1978 and 2014. From 2006 to 2018, the number of Black medical school matriculants increased from 6.7% to 7.1%.Solutions for Improving Medical Education for the Black TraineeTo improve these matriculation statistics, it is critical that institutions integrate innovative measures such as robust recruitment pipelines to expose underrepresented high school and college students to the medical field, as well as seek diversity actively in administration to dismantle the ingrained ideologies of systemic racism rooted in healthcare and medical education. To combat the institutionalized racism that has plagued medical education throughout its existence, collaboration as a unified front is essential to achieving the equity and social justice in healthcare that patients deserve.     

大学医学生心理控制源与社交焦虑的相关性研究

目的探讨心理控制源与大学生社交焦虑之间的关系,为大学生的心理健康保健提供依据,以便改善大学生的社交焦虑状况。方法采用多维度心理控制源量表(MHLC)与社交焦虑量表(IA S)对我院101名2008级医学专升本学生进行问卷调查。结果①大学生心理控制源个性因子分值均低于常模(t=-11.913,-5.847,2.258),差异有统计学意义(P<0.01或<0.05);②101例被试中,存在社交焦虑59人,占58.4%;③家庭所在地及父母文化程度不同的大学生社交焦虑情况均存在显著差异(F=5.095,3.468;P<0.01,P<0.05);④心理控制源3个变量中,内控性与大学生社交焦虑呈负相关(r=-0.220,P<0.05)。结论大学医学生普遍存在社交焦虑,社交焦虑受家庭所在地及父母文化程度的影响;社交焦虑与心理控制源内控因子呈负相关。     

广州地区医科大学生心理压力与社会支持、自我效能感相关性研究

目的 探讨广州地区医科大学生心理压力与社会支持和自我效能感之间的关系.方法 以广州地区3所医科大学在校932名本科生为研究对象,采用张林等编制的大学生心理压力量表、肖水源的大学生社会支持量表、张建新的大学生自我效能感量表(GSES)进行团体测试.结果 ①心理压力与社会支持、自我效能感有不同程度的显著性负相关关系(r=-0.177,-0.366;P＜0.01),社会支持与自我效能感有不同程度的显著性正相关关系(r=0.269,P＜0.05);②心理压力中的身体状况、人际关系、恋爱情感、经济压力因子与社会支持在统计学上差异有显著性(t=2.735,-7.941,-3.014,1.948;P＜0.05或P＜0.01);心理压力中的学习、父母期望、理想前途因子与自我效能感在统计学上差异有显著性(t =-4.644,-4.098,2.135;P＜0.05或P＜0.01);③社会支持在心理压力中的人际关系、恋爱关系、父母期望因子以及自我效能感之间有中介作用(c'/b=-0.389,-0.302,-0.390;P＜0.01).结论 可通过提高医学生的社会支持程度,提高自我效能感从而降低心理压力,促进心理健康.     

成都医学院贫困生压力源分析

目的:探讨医学院贫困生的心理压力状况及压力来源。方法:采用大学生心理压力感问卷、社会支持评定量表、特质应对方式问卷、一般自我效能感量表对成都医学院238名贫困生进行调查。结果:1医学院贫困生心理压力总体偏高;2男贫困生和女贫困生在心理压力水平上(t=2.289,P0.05)有显著性差异,尤其是在人际交往、学习、就业方面(t=2.513,3.131,2.221;P0.05);3社会支持与人际交往压力呈显著负相关(r=-0.198,P0.01);4采用消极应对方式的被试压力得分显著高于采用积极应对方式的被试压力得分(t=4.744,P0.001);5高自我效能感被试和低自我效能感被试在人际交往(t=-3.41,P0.01)、经济与地位(t=-2.587,P0.05)、学习(t=-2.583,P0.01)、就业(t=-3.189,P0.01)和心理压力总分上(t=-3.504,P0.01)呈显著性差异。结论:压力源主要包括人际交往、学习、经济与地位、就业、体能与生活、社会支持、自我效能感、应对方式。     

医学院实习生的依恋类型和社会支持对心理健康水平的影响

目的:探讨医学院实习生依恋类型,社会支持与心理健康水平之间的关系。方法:以整群抽样的方式选取正在医院实习的医学院大学生220名,用关系问卷(RQ)、亲密关系经历量表(ECR)、社会支持问卷、症状自评量表(SCL-90)进行测查。结果:220名被试中安全型依恋者占47.7%,轻视型占32.7%,倾注型占12.7%,害怕型占6.8%;在对支持的利用度指标上,安全型(8.9±1.8)和害怕型(8.8±1.9)的被试得分显著高于轻视型(7.8±1.5)和倾注型(8.0±1.7);并且在SCL-90总分上,安全型依恋的被试(109.4±23.3)显著低于轻视型(122.7±27.2)、倾注型(138.3±38.5)和害怕型(120.9±38.9);被试的心理健康水平可以通过依恋回避、依恋焦虑,以及社会支持总分进行预测。结论:医学院实习生的心理健康水平与他们的依恋类型以及社会支持之间存在密切的联系。     

医学专业女大学生心理健康状况与个性的关系研究

目的了解医学专业女大学生的心理健康状况及其与个性的关系。方法采用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)对428名医学专业女大学生进行测评。结果 1医学专业女大学生SCL-90的躯体化、偏执因子分低于全国常模青年组,强迫、焦虑、精神病性因子分高于全国常模青年组,差异有统计学意义(t=-3.692～4.232,P0.05);2医学专业女大学生EPQ的N、P因子与SCL-90各因子均呈正相关,E、L因子与SCL-90大多数因子呈负相关。结论医学专业女大学生的心理健康状况总体正常,个性与心理健康水平密切相关。     

Communication and social competencies in medical education in German-speaking countries: The Basel Consensus Statement.: Results of a Delphi Survey

Objective

To propose a comprehensive set of competencies and educational objectives for communication and social competencies in undergraduate medical education and to support the nationwide implementation of these issues in all medical schools.

Methods

Thirty experts from different medical and psychosocial disciplines participated in a 2-day workshop using the Nominal Group Technique (NGT) to develop an initial set of educational objectives. These were refined, structured, and rated according to their importance by means of a two-step Delphi Survey involving additional experts in medical education.

Results

The initial workshop resulted in 188 educational objectives assigned to 26 different topics. After the Delphi Survey, 131 objectives remained, assigned to 19 different topics. Some objectives that could be assigned to more than one topic were subsumed under a new more general category.

Conclusion

The described consensus process proved successful as one method to develop a set of educational objectives.

Practical implications

The Basel consensus statement can be used to orientate curriculum reform and development in medical education.     

心理健康教育月活动对缓解医学生焦虑抑郁情绪的效果

目的比较分析心理健康教育月活动对缓解医学生焦虑抑郁情绪的效果。方法随机选取本校三年级456名文、理科学生为研究对象,分为观察组（226人）和对照组（230人）。两组采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评分,对前组开展以人际交往的心理健康、恋爱的心理健康、应急与心理健康、心理防御的措施、常见心理健康问题处理、寻求和利用社会支持等为内容的心理健康教育月活动,后组不参加心理健康月教育。两个月后,对两组进行干预前后评定和比较分析。结果总样本焦虑和抑郁的总检出率分别为10．42％、16．72％。观察组干预后SAS和SDS的评分与干预前比较均降低有显著性差异（t=2．194,3．615;P〈005）,中度以上焦虑和抑郁的检出率也明显下降（X2=9．353,5．802;P〈0．05）。对照组各量表评分均无显著性差异。结论心理健康教育月活动对缓解医学生焦虑抑郁情绪有一定的作用。     

社团与非社团医学生的手机网络成瘾和孤独感

目的探讨网络环境下社团与非社团医学生手机网络成瘾、孤独感的状况及差异。方法采用手机网络成瘾量表、网络游戏成瘾量表、感情与社会孤独量表对人口统计学变量相匹配的社团与非社团医学生进行测查。结果①非社团医学生手机网络成瘾倾向者以及严重手机网络游戏成瘾者的比例明显比社团医学生的比例高。社团与非社团医学生手机网络成瘾、社会孤独感差异显著(F=358.99,18.13;P0.001);感情孤独感差异显著(F=33.15,P0.05);②医学生是否属于社团成员与其手机网络成瘾、社会孤独感与感情孤独感均呈显著的相关(r=0.126~0.494,P0.01);③回归分析显示,是否社团成员对医学生手机网络成瘾、社会孤独感和感情孤独感的影响作用显著(P0.001)。结论网络环境下是否是社团成员对医学生手机网络成瘾、孤独感的影响作用显著。     

医学生社会支持、心理控制源与人际关系敏感的关系

目的探讨医学生社会支持、心理控制源与人际关系敏感之间的关系。方法采用社会支持评定量表（SSRS）、内在性、有势力的他人及机遇量表（IPC）和症状自评量表（SCL-90）对150名医学生进行问卷调查。结果人际关系敏感与主观社会支持（r=-0.202,P〈0.05）、社会支持总分（r=-0.215,P〈0.01）呈显著负相关,与有势力的他人（r=0.255,P〈0.01）及机遇（r=0.254,P〈0.01）得分呈显著正相关;有势力的他人和社会支持总分能直接预测医学生的人际关系敏感因子（β值分别为0.227,P〈0.001;-0.180,P〈0.05）;社会支持完全以心理控制源为中介作用于人际关系敏感。结论社会支持通过心理控制源的中介作用影响人际关系敏感。     

Validation of the ComCare index for rater-based assessment of medical communication and interpersonal skills

ObjectivesTo develop and validate a short instrument to assess undergraduate medical students’ communication and interpersonal skills in videographed history taking situations with simulated patients.MethodsSixty-seven undergraduate medical students participating in an assessment including videographed physician-patient encounters for history taking with five simulated patients were included in this study. The last video of each participant’s consultation hour was rated by two independent assessors with the eight-item ComCare index for assessment of communication and interpersonal skills newly designed for the external rater perspective (ComCareR). We compared the sum scores of the ComCareR with ratings of the same videos with the Kalamazoo Communication Skills Assessment Form from an observational perspective (KCSAFd-video) and the Global Rating scale (GR), which also measure communication and interpersonal skills.ResultsThe ComCareR showed an excellent interrater reliability (ICC = .85). We found a small but significant correlation with the KCSAFd-video Interpersonal Competence (ρ = .34, 95% CI [.10,.54]) and a high positive correlation with the GR (ρ = .59, 95% CI [.40,.73]).ConclusionsThe ComCareR is a valid and brief index for holistic assessment of communication and interpersonal skills in physician-patient encounters.Practice implicationsThe ComCareR can be used for quick rater-based assessment of physicians’ communication and interpersonal skills.     

军医大学生心理健康教育措施干预效果研究

目的研究有效的心理健康教育干预措施。方法通过UPI,SCL-90和STAI的测查,比较某军医大学02级、03级、04级学员的心理健康状况;对04级学员进行心理健康教育措施干预后的追踪调查。结果在有效的心理健康教育干预措施影响下,04级学员心理健康水平正逐步得到提高,尤其是在半年后。结论目前已构建的心理健康教育措施体系能有效提高军医大学生心理健康水平。     

Utilizing Medical Students as Internal Assets to Enhance Gross Anatomy Laboratory Learning

Identification of cadaveric structures during anatomy summative practical examinations is a challenge for first-year medical students. To assist in cultivating this skill, we offered 12 formative laboratory activities (anatomy boot camps [ABCs]) that approximated the summative practical examination format using reciprocal and near-peer teaching. Students assisted in crafting the formative practical examination, then engaged in a self-review by scoring their individual answer sheets. Students performing below designated thresholds (≤60%) were offered laboratory review sessions led by medical student upperclassmen. Mann–Whitney U tests were used to compare the performance of participants who attended the ABC sessions leading up to each summative examination. Correlation analysis was utilized to examine the relationship between student participation in ABCs summative examinations. Voluntary surveys were administered to assess the perceived value of the experience. Mann–Whitney U tests indicated students who attended the ABC review preceding three of the four summative practical and two of the four written examinations scored consistently higher on these examinations than students who chose not to attend. Correlation analysis revealed that as the overall frequency of ABC attendance increased, students' performance on the summative practical and written examinations increased significantly (P < 0.001). These findings suggest that the provision of supplemental learning experiences, such as the ABCs, contributes to improved student learning outcomes. This sentiment was echoed in student surveys. This activity, which combines multiple peer teaching approaches, appears to be an effective strategy for guiding and enhancing student success in the anatomy practical examinations. Clin. Anat. 33:286–292, 2020. © 2019 Wiley Periodicals, Inc.     

A Web Simulation of Medical Image Reconstruction and Processing as an Educational Tool

Web educational resources integrating interactive simulation tools provide students with an in-depth understanding of the medical imaging process. The aim of this work was the development of a purely Web-based, open access, interactive application, as an ancillary learning tool in graduate and postgraduate medical imaging education, including a systematic evaluation of learning effectiveness. The pedagogic content of the educational Web portal was designed to cover the basic concepts of medical imaging reconstruction and processing, through the use of active learning and motivation, including learning simulations that closely resemble actual tomographic imaging systems. The user can implement image reconstruction and processing algorithms under a single user interface and manipulate various factors to understand the impact on image appearance. A questionnaire for pre- and post-training self-assessment was developed and integrated in the online application. The developed Web-based educational application introduces the trainee in the basic concepts of imaging through textual and graphical information and proceeds with a learning-by-doing approach. Trainees are encouraged to participate in a pre- and post-training questionnaire to assess their knowledge gain. An initial feedback from a group of graduate medical students showed that the developed course was considered as effective and well structured. An e-learning application on medical imaging integrating interactive simulation tools was developed and assessed in our institution.     

Cytokine balance and behavioral intervention; findings from the Peer Approaches to Lupus Self-Management (PALS) project

The Peer Approaches to Lupus Self-Management program sought to address the disparate impact of systemic lupus erythematosus (SLE) on African American women through a peer mentoring intervention with aims of reducing stress, anxiety, and depression. Given the association between psychological health and immune function this study examines the relationship between patient reported outcomes (PROs) in these domains and immunologic indicators of disease activity. Twenty-three African American women with SLE served as mentees in the intervention from whom PRO measures were collected at the outset, midpoint, and end of the 12 week pilot study. Blood samples were collected pre- and post-intervention. Plasma was collected from the samples and cryopreserved for subsequent analyses. The strongest correlations were between the Generalized Anxiety Disorder measure and Th1/Th2 cytokine balance. Weaker correlations existed between depression and the Th1/Th2 cytokine balance. Assessment of fresh versus cryopreserved samples revealed that changes in Th1/Th2 cytokine balance within the intervention were generally equivalent, regardless of sample type. The PALS intervention resulted in significant improvements to anxiety and depression levels which were significantly associated with positive changes in Th1/Th2 cytokine balance indicating a possible underlying mechanism of action. The nature of this relationship warrants further study.