叙事医学在生殖医学临床教学中的应用探讨

生殖医学具有社会和心理的人文特性,现实中,医疗技术手段不能解决所有的生殖医学问题,因此,在生殖医学的临床教学中,教师不仅要教授学生理论和临床操作的专业技术知识,更要注重加强人文关怀精神和人际沟通能力的培养。将叙事医学引入生殖医学教育是回归生殖医学人文属性的要求,叙事医学在生殖医学教学中的应用,将为单靠专业技术知识无法解决的生殖医学"难题"另辟蹊径。生殖医学教学中,培养医学生的叙事能力,有助于医学生把叙事模式作为医疗实践活动的重要部分,建立和谐的医患关系、师生关系、伙伴关系,具备关爱病人、尊重他人、尊重师长、尊重伙伴、团队合作的良好职业素养,以适应社会对高层次生殖医学人才日益增长的需求。     

生殖医学专业临床带教探讨

生殖医学作为一门新兴的比较前沿的综合性学科,带给医学生的是新鲜、好奇而又陌生,作为临床带教老师,如何针对生殖医学中这一特殊的学科进行科学的带教值得探讨。本研究就生殖医学的特点、生殖医学中的医疗服务、生殖医学中的伦理以及笔者近几年来的带教经验进行总结,希望对生殖医学专业的临床带教起到一定的参考价值。     

生物医学前沿中的伦理问题

本文在讨论科学技术与伦理学关系、生命伦理学基本原则以及道德与伦理学之间的异同后,探讨了人的克隆和干细胞研究、基因治疗、生殖遗传学、异种移植、生物医学和临床研究中的伦理问题。     

提高生殖医学研究生临床技能的探讨

生殖医学作为妇产科学一门重要分支学科,近年来随着胚胎学、遗传学、男科学的不断发展,其发展迅猛。尤其在国家二胎政策放开后,辅助生殖技术的需求显著增加。因此,在对妇产科学研究生的培养,更应该重视对生殖医学人才的临床技能的提升和培养。生殖医学尚无统一的教材,患者的个体化情况复杂,传统教学手段单一,这为生殖医学教学带来了一定困难。本研究就目前比较流行的教学模式进行对比,并对优缺点进行评估,从而得出如何优化教学模式。教学模式的综合优化,有助于促进生殖医学研究生临床技能、临床思维及主动学习能力提升。     

欢迎订阅《中国医学伦理学》杂志

《中国医学伦理学》杂志是中国目前惟一的关于医学伦理学、生命伦理学的大型刊物。现为国家科技部中国科技论文统计源期刊(中国科技核心期刊)。开设的栏目有:院士论坛、名家访谈、新能源与生命伦理、构建中国生命伦理学、医德评价、医疗职业人格、医学专业精神、医改伦理、医疗诚信、学术争鸣、生命     

重视医学研究中的伦理学问题

2004年2月在杭州举办了第一期“中美生物医学科研伦理研修班”。研修班是由美国纽约中华医学基金会资助、北京大学医学部医学伦理学教研室主办、中华医学会医学伦理学分会、卫生部医学伦理学专家委员会协办。涉及内容为：伦理学的基本理论、原则；医学科学家的行为与道德责任；医学科研中的利益冲突；人体实验中的知情同意；医学科研中的随机对照；人体实验中弱势人群的保护；     

国家卫生计生委医学伦理专家委员会成立

<正>原卫生部医学伦理专家委员会自2000年成立以来,对推动我国生物医学研究伦理审查、传播伦理理念、开展重大医学伦理问题研究、组织伦理学培训交流等发挥了重要作用。为了满足新形势下卫生计生工作和医学科学技术发展对医学伦理管理的要求,根据《涉及人的生物医学研究伦理审查办法》,决定组建国家卫生计生委医学伦理专家委员会。国家卫生计生委医学伦理专家委员会的主要职责为:对涉及人的生物医学研究中重大伦理问题进行研究,指导和督促省     

提高生殖医学研究生培养质量的探讨

生殖医学专业人员的培养往往通过研究生教育来完成,从业人员需要较全面的基础知识和临床专业知识。生殖医学研究生教育目前没有统一的教材,患者的治疗又呈现个体化,增加了学习和教学难度。研究生教育工作中应该积极引导学生塑造敬业、奉献精神,建立完整的理论知识体系和过硬的临床技能,加强科研能力的培养,不断提高素质教育的质量,才能培养出高素质的生殖医学人才。     

辅助生殖中心的伦理关怀在护理工作中的体现

结合实际工作体会,从伦理学角度探讨辅助生殖中心的护理工作的伦理因素及其重要性从而更好的更合理的为病人实施人性化的护理。     

高仿真模型在妇产科临床技能教学中的应用

临床技能操作是妇产科教学中的重要组成部分,目前由于医患诊疗意识的提高、医学伦理学的发展、近年来高校招生规模的不断扩大等诸多因素使临床技能教学面临越来越多的困难.妇产科学习包括理论及实践学习2个部分,要学好妇产科理论及实践学习二者均不可偏废,缺一不可[1].医学作为高风险行业,又涉及到诸多社会伦理道德问题,随着各项模拟技术应用于医学教育,仿真模型模拟教学也正被越来越多的临床教学工作者所接受并迅速推广应用,是目前妇产科临床技能教学的新途径[2].我院在210名临床医学生妇产科临床技能教学中应用高仿真模型,取得了满意效果,现报告如下.     

Medical ethics education: where are we? Where should we be going? A review.

PURPOSE: The authors' primary goal was to provide a comprehensive and current review of the literature surrounding ethics education for medical students. Following this review, the authors summarize the deficits in the current literature and provide recommendations for future inquiries on medical ethics education. METHOD: In 2004, the authors searched MEDLINE and PubMed using the following search terms: ethics, ethics education, medical ethics education, curriculum, undergraduate medical education, virtue, role model, philosophy of medicine, and outcomes research. No limit was placed on dates for this literature search. Articles whose primary focus was professionalism were excluded because the professionalism literature tends to focus on competencies and postgraduate education, whereas the primary focus of this study was on undergraduate education. Literature on physicians as role models to medical students as a form of teaching medical ethical ethics was excluded as well because the current discussion examines the formal undergraduate medical ethics curricula. Also excluded were reports from foreign countries (unless there were no equivalent studies in the United States). The authors found almost no literature exploring students' backgrounds (cultural, religious, socioeconomic, etc.) and the teaching of medical ethics in medical schools. Otherwise, the authors reviewed everything they could find, regardless of imperfections in individual reports such as small sample size or poor research methodology. RESULTS: The review, which encompassed articles from 1978 to 2004, revealed that deep shortcomings exist in the literature on medical ethics education. Deficits exist in all areas of the literature: (1) theoretical work done on the overall goals of medical ethics education; (2) empirical studies that attempt to examine outcomes for students; (3) studies examining teaching methods in medical ethics education, and (4) studies evaluating the effectiveness of various teaching methods. CONCLUSIONS: There are substantial opportunities for contribution to the literature on medical ethics education in all of the areas where deficits exist. The literature suggests that two points of view exist regarding the purpose of teaching medical ethics: (1) that it is a means of creating virtuous physicians; and (2) that it is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. This dichotomy made it difficult to arrive at a consensus regarding the goals of medical ethics education. The field would benefit from further theoretical work aimed at better delineating the core content, core processes, and core skills relevant to the ethical practice of medicine. The time has come to organize an effort to improve and validate medical ethics education. In the end, effective medical ethics education will further the goals of medicine in dramatic and tangible ways.     

Internal medicine residents' preferences regarding medical ethics education

Three hundred and twenty-three residents in six internal medicine programs in three states were surveyed concerning what they wanted to learn about medical ethics and how they would prefer to learn it; they were also asked to indicate what medical ethics education they had already received. Specifically, the residents were given a list of 35 medical ethics topics and asked to indicate whether they would like more attention to a topic, or whether it had received enough or too much attention. (They could also indicate that they though the topic was inappropriate for attention during residency.) The residents were also given a list of 17 teaching methods for medical ethics and asked to indicate whether each method was very useful, somewhat useful, or not useful. Sixty-one percent of the residents responded. Approximately three-fourths of these had had some formal teaching about medical ethics in both medical school and residency, and nearly all indicated that they wanted more ethics training on specific topics. Certain topics were chosen as particularly suitable or unsuitable for such training; many of those judged as deserving more attention concerned legal issues and end-of-life issues. Most of the responding residents regarded standard clinical teaching formats as very useful for learning about medical ethics but regarded several other methods are not useful. The authors discuss the implications of these and related findings.     

Teaching medical ethics during residency

Because practicing physicians are poorly prepared to resolve many ethical issues that arise in patient care, this article proposes that residencies include practical training in medical ethics. Training in medical ethics helps physicians recognize ethical issues in patient care and resolve those issues wisely. Furthermore, such training has its maximum impact during the professionally formative years of residency. The article specifies key ethical concepts residents should know, including knowing how to obtain informed consent, knowing what to do about incompetent patients, knowing when to withhold or disclose clinical information, and knowing how to use resources properly. The article also points out that the success of residency training in ethics depends on strong commitments from the department: endorsement by the chairman and the residency program director; recruitment of several dedicated faculty; support for adequate ethics training for these faculty; dedication of conferences, rounds, and consultations to teaching ethics; and allocation of sufficient funds.     

Development of a teaching program in clinical medical ethics at the University of Chicago

The University of Chicago Pritzker School of Medicine has developed and evaluated an extensive teaching program in clinical ethics coordinated primarily through the Center for Clinical Medical Ethics. The program provides medical students with a foundation in medical ethics during the four years of medical school and augments the clinical ethics knowledge and teaching skills of the housestaff and clinical faculty at the University of Chicago. Together, medical student teaching and clinical faculty development have made clinical ethics an integral part of medical education at the University of Chicago. Through these efforts, the teaching program aims to incorporate clinical ethics considerations into medical decisions and in this way contribute to improving patient care. (A detailed overview of all clinical ethics instruction at the school is provided.)     

Ethical considerations for biomedical scientists and engineers: issues for the rank and file

Biomedical science and engineering is inextricably linked with the fields of medicine and surgery. Yet, while physicians and surgeons, nurses, and other medical professionals receive instruction in ethics during their training and must abide by certain codes of ethics during their practice, those engaged in biomedical science and engineering typically receive no formal training in ethics. In fact, the little contact that many biomedical science and engineering professionals have with ethics occurs either when they participate in government-funded research or submit articles for publication in certain journals. Thus, there is a need for biomedical scientists and engineers as a group to become more aware of ethics. Moreover, recent advances in biomedical technology and the ever-increasing use of new devices virtually guarantee that biomedical science and engineering will become even more important in the future. Although they are rarely in direct contact with patients, biomedical scientists and engineers must become aware of ethics in order to be able to deal with the complex ethical issues that arise from our society's increasing reliance on biomedical technology. In this brief communication, the need for ethical awareness among workers in biomedical science and engineering is discussed in terms of certain conflicts that arise in the workaday world of the biomedical scientist in a complex, modern society. It is also recognized that inasmuch as workers in the many branches of bioengineering are not regulated like their counterparts in medicine and surgery, perhaps academic institutions and professional societies are best equipped to heighten ethical awareness among workers in this important field.     

Responsibly managing the medical school--teaching hospital power relationship.

The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.     

“互联网+精准医疗”推动医学课程整合与信息化

在医学高等教育与信息深度融合的大背景下,依托毕博网络教学平台开展医学课程混合式教学。以"精准医疗"理念为导向,按照学生专业特点不同个体化教学设计;同时定位于培养学生整体性思维模式,通过混合式学习引导学生通过分析临床病例资料来整合医学各学科相关知识;并制定学生考核方案,运用大数据综合分析学生考核结果。以此推动以学生个体为中心的"精准教学"信息化发展进程。     

Ethical issues

Key concepts which should be recognized to understand today's medical ethics required for information management regarding clinical research are privacy protection, use limitation, individual participation, and accountability. Special attention should be paid to concepts other than privacy protection, because they are fairly new to medical professionals. Furthermore, in laboratory medicine, we have real problems, for example, how to protect privacy concerning specimens gathered from patients. Therefore, there have been many kinds of rules or guidelines established recently. Although we tend to strictly follow these guidelines, it is not always clear which guidelines should be applied to certain cases, or they do not always exactly correspond to a specific case. The full understanding of the principles of medical ethics represented by these guidelines is essential. In this paper, a clinical research document reviewed by an ethical review board is shown as an example.     

医学物理学与医学课程相结合的研究

目的：从目前医学物理课程教学的现状出发,阐述在医学专业的课程设置和教学中加强医学和理工课程相结合的必要性。分析医学物理学与医学课程之间的关系,结合多年的教学实践探讨医学物理学与医学课程教学相结合的教学思想和方法,以期解决教学中实际问题,提高医学物理教学质量,提高物理学应用能力,培养具有扎实理工基础的创新医学人才。方法：采用理论分析和实践相结合的方法。医学物理学与医学课程教学相结合通过教学内容相融合、专题教学、医学案例讨论、医学拓展练习等形式具体实现。实践中分别对设立的两类班施行传统教学和医学与物理相结合的不同教学方法,然后进行比较。结果：医学物理学与医学课程相结合的教学能够提高学生学习《医学物理学》的积极性和效率,加深对医学课程内容的理解,增强医学应用能力,促进综合能力提升。结论：应当促使教学管理部门、教师、学生充分认识到物理学与医学课程存在紧密关联,意识到物理课程在医学生培养中的重要作用,通过医理结合教学提高课程的教学质量,提高医学生的医理结合能力。     

The incremental value of internet-based instruction as an adjunct to classroom instruction: a prospective randomized study.

PURPOSE: Computer-based methods of instruction offer the possibility of helping medical students to learn clinical skills and professionalism. Without rigorous documentation of its pedagogic advantages, the utility of Internet-based teaching is not solidly grounded. The authors carried out a prospective, randomized study of educational outcomes, comparing a traditional classroom course in clinical ethics with the same course supplemented by Internet-based discussion. METHODS: Introduction to Clinical Ethics is a sophomore medical school course that teaches a specific method for analyzing clinical ethical problems. One sophomore class was randomly assigned to either classroom teaching alone (traditional group; n = 65) or classroom teaching supplemented with Internet-based discussions of cases illustrating ethical issues (Internet component group; n = 62). A final case analysis comprehensively evaluated students' understanding of the analytic method taught in the course. Grades for both groups on the final case analyses, which were rated by two external reviewers, were compared. RESULTS: The students' understanding of ethical analysis, as measured by grades of external reviewers on the final paper, was significantly higher for those in the course with the Internet component than it was for those in the traditional course (3.0 +/- 0.6 and 2.6 +/- 0.7, respectively; p <.005). CONCLUSION: The study documents the incremental value of Internet-based teaching of clinical ethics to sophomore medical students.