Medical education in the public versus the private setting: a qualitative study of medical students' attitudes

Public hospitals serve as primary training sites for medical students. Public patients may therefore bear a disproportionate burden of medical student education. The purpose of this study was to critically examine the ethics of medical education in the public setting. Attitudes of first- and fourth-year students towards the role of public patients in medical education were elicited in focus groups. Inductive qualitative analysis was utilized to organize data into conceptual groups, which were then analyzed within an ethical framework. All patients have an equal obligation to participate in medical education. Students identified modifying factors that could affect a patient's obligation to educate future physicians. Available data highlight a concern that public teaching hospitals may provide a lower quality of care. If true, then the public teaching setting is creating an unfair burden upon that patient population who would then have a weakened obligation to participate in medical education.     

Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators

There has been recent increasing interest in reflective practice within physiotherapy education as a method for reducing the 'theory-practice gap' and as a means of articulating, exposing and developing knowledge embedded in practice. Several contrasting theories have been developed to explain the role, place, purpose and definition of reflection in learning and teaching; however, much of the research to date has relied on theoretical debate rather than high quality empirical evidence. The aim of this paper was therefore, to report how a group of United Kingdom (UK) based physiotherapy Professional Practice Coordinators (n = 33) with their unique insight into the concept from both the academic and clinical perspective viewed and interpreted the use of reflective practice within their physiotherapy curriculum. Consent for the study was obtained via the professional body (The Chartered Society of Physiotherapists) (CSP) and data was collected via postal questionnaire. Results indicated a diversity of experience in respondents both in terms of their role as Coordinator and their training in reflective practice. There was also no clear consensus regarding facilitative models or assessment methods even though the majority of coordinators believed that reflective practice should be considered to be a central component of physiotherapy teaching strategies. The results of this survey provide a focus for further empirical research into reflective practice as part of the physiotherapy curricula, while advancing the understanding of reflective practice from a broader perspective and clarifying the benefits to students, teachers, patients and practitioners.     

Medical students' attitudes to gender issues in the role and career of physicians: a qualitative study conducted in Sweden

There is an increasing awareness of the importance to address gender issues during medical studies. This qualitative study is aimed at exploring students' attitudes to gender issues in the career of physicians, and identifying questions important to consider in medical education about gender. At Ume? University in Sweden, third-term medical students write an essay about 'being a doctor' and they also reflect on gender issues their future career. In 2002, the essays of 41 men and 63 women (75%) were analysed using open coding and repeated comparisons to elaborate categories. Four main attitudes towards gender were identified. Important and interesting (men 22%, women 63%), meaning gender was regarded as a crucial consideration in a physician's working life. Interested women expressed personal worries about their future, while interested men's reflections were more intellectually focused. Relevant with doubts (54%, 27%) represented a positive stand while simultaneously reducing the significance of gender. In Irrelevant and irritating (20%, 8%), gender was seen as over-talked and politics. Irritated students challenged the teachers and questioned gender as a field of scientific knowledge. Neglecting denoted avoidance of gender (5%, 3%). To avoid reinforcing stereotypical ideas about men and women, teachers and physicians need more knowledge about gender.     

Medical curriculum reform in Sun Yat-sen University: implications from the results of GMER evaluation in China

Created by interlocking economies, a global language, the informatics revolution and rapid travel, globalization has penetrated all aspects of human life including science, environment, public health and medicine. Physicians are now members of a global community. The global physician should possess universal core essential competences required for medical practice throughout the world. The Institute for International Medical Education (IIME), created by the China Medical Board (CMB) of New York, has developed the " global minimal essential requirements" (GMER) that define the knowledge, skills, professional behavior and ethics that all physicians must have regardless of where they received their general medical education and training. The IIME initiated a pilot project in China in October, 2003, to evaluate the graduates of the 7- or 8-year track program of eight leading medical schools, including Medical School of Sun Yat-sen University. The results of GMER evaluation indicated strengths and areas for improvement of our school in relation to international standards, which greatly re-invigorate our enthusiasm on medical curriculum reform on the new 8-year track program in Medical School of Sun Yat-sen University. The modifications of our medical curriculum for the new 8-year track program based on the results of GMER evaluation are discussed in this paper.     

The ‘exotic other’ in medical curricula: Rethinking cultural diversity in course manuals

Abstract

Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of ‘cultural diversity’. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula.

Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments.

Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic.

Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of ‘problematic stranger’ can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.     

Francis Bacon's natural history and civil history: a comparative survey

The aim of this paper is to offer a comparative survey of Bacon's theory and practice of natural history and of civil history, particularly centered on their relationship to natural philosophy and human philosophy. I will try to show that the obvious differences concerning their subject matter encompass a number of less obvious methodological and philosophical assumptions which reveal a significant practical and conceptual convergence of the two fields. Causes or axioms are prescribed as the theoretical end-products of natural history, whereas precepts are envisaged as the speculative outcomes derived from perfect civil history. In spite of this difference, causes and precepts are thought to enable effective action in order to change the state of nature and of man, respectively. For that reason a number of common patterns are to be found in Bacon's theory and practice of natural and civil history.