Graduate Medical Education for Rural Physicians: Curriculum and Retention

The chronic shortage of rural physicians prompts further consideration of the educational interventions that have been developed to address this issue. Despite rural admission strategies and a variety of undergraduate, graduate and postgraduate curricular innovations, the recruitment and retention of family physicians into many rural areas has not kept pace with the retirement of older general practice physicians. This paper reviews the 1994 American Academy of Family Physicians' rural training recommendations in the light of several recent educational needs assessments. These studies affirm the need for rural residency rotations and the need to maintain and better implement the established rural clinical training guidelines. However, although preparation for rural medical practice has been addressed and is being adequately accomplished in the clinical knowledge and procedural skills areas, instruction and experiences relating to the "realities of rural living" need to be enhanced to increase the retention duration of rural physicians. This can be accomplished with more curricular emphasis on developing community health competencies, including community-oriented primary care (COPC). Physicians who know how to collaborate with community members on health improvement projects have skills that can also facilitate integration and, hence, retention.     

大数据时代我国高等医学教育挑战

随着计算机互联网信息技术的发展,社会进入大数据时代,传统的医学教育模式已经无法适应社会发展的需求.在大数据时代背景下,探讨我国高等医学教育面临的困境与矛盾,从改革理念、培养模式、课程设置、信息素养、人文素质等五个方面提出对策与建议.     

Catalyzing a Reproductive Health and Social Justice Movement

Objectives The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women’s reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. Methods This paper synthesizes three current, interrelated approaches to addressing MCH challenges—life course theory, preconception health, and social justice/reproductive equity. Conclusion Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.     

Blended Learning: Strengths, Challenges, and Lessons Learned in an Interprofessional Training Program

This field report outlines the goals of providing a blended learning model for an interdisciplinary training program for healthcare professionals who care for children with disabilities. The curriculum blended traditional face-to-face or on-site learning with integrated online interactive instruction. Credit earning and audited graduate level online coursework, community engagement experiences, and on-site training with maternal and child health community engagement opportunities were blended into a cohesive program. The training approach emphasized adult learning principles in different environmental contexts integrating multiple components of the Leadership Education in Neurodevelopmental and Related Disabilities Program. This paper describes the key principles adopted for this blended approach and the accomplishments, challenges, and lessons learned. The discussion offers examples from training content, material gathered through yearly program evaluation, as well as university course evaluations. The lessons learned consider the process and the implications for the role of blended learning in this type of training program with suggestions for future development and adoption by other programs.     

社会医疗保险公平性与政府保险政策建议研究

针对社会医疗保险实施过程中存在的各种不公平现象,从社会医疗保险制度内部保险经费筹集方法、保险资源的利用与费用补偿机制以及社会医疗保险制度之间、社会医疗制度属性等角度,对造成这些不公平的原因进行分析,查找原因,提出从医疗费用精算、提高人群覆盖率和积极借鉴国外医疗保险经验3个方面提出提高社会医疗保险公平性的措施。     

Social Justice in Pandemic Preparedness

Pandemic influenza planning in the United States violates the demands of social justice in 2 fundamental respects: it embraces the neutrality of procedural justice at the expense of more substantive concern with health disparities, thus perpetuating a predictable and preventable social injustice, and it fails to move beyond lament to practical planning for alleviating barriers to accessing care.A pragmatic social justice approach, addressing both health disparities and access barriers, should inform pandemic preparedness.Achieving social justice goals in pandemic response is challenging, but strategies are available to overcome the obstacles. The public engagement process of one state''s pandemic ethics project influenced the development of these strategies.Historically, socially disadvantaged groups have fared the worst of any population during influenza pandemics.1–3 They will most likely continue to do so; this certainly held true for the 2009 influenza A (H1N1) pandemic. Although that pandemic was relatively mild, its disparate impact on certain populations raises significant ethical concerns. The US Centers for Disease Control and Prevention (CDC) acknowledges,

[I]t''s clear that minority groups have consistently had higher rates of serious 2009 H1N1 disease, including hospitalizations, than non-minority groups. In fact, hospitalization rates among minority groups have consistently been more than double those of White, non Hispanics.4

Preliminary data analysis in Minnesota indicates that “non-whites represented an astonishing 31% of hospitalized cases,”5 although they consititute only 11% of the population of the state.6 American Indian/Alaska Native populations in the United States had a death rate 4 times as high as all other racial/ethnic groups combined.7 We focused on pandemic preparedness in the United States, but similar disparities span the globe. For example, in Australia, New Zealand, and Canada, rates of hospitalization and death for 2009 H1N1 were 3 to 8 times as high in indigenous as in general populations.8 Murray et al. contend that if a severe (1918-type) pandemic occurred today, “96% (95% CI 95-98%) of the estimated number of deaths would take place in the developing world.”9^(p2215)CDC maintains that the reasons for racial/ethnic differences in hospitalization rates are unknown but suggests they may be attributable to socioeconomic factors such as “access to care, preponderance of underlying health conditions among certain ethnic or minority groups, and self care or care seeking behaviors.”4 Blumenshine et al. suggest1 and Quinn et al confirm10 that differences in exposure, susceptibility, and access to health care account for influenza-related health disparities. Socially disadvantaged persons are more vulnerable to illness, less able to protect themselves through preventive strategies, and more burdened than relatively privileged populations by public health response interventions. Inadequate access to health care impedes effective intervention when members of underprivileged populations fall ill. Structural inequalities underlie all of these factors.In the context of public health, Farmer et al.,11 Parker,12 Kelly,13 Keshavjee and Becerra,14 Mukherjee,15 and others have identified large-scale social forces such as poverty, racism, gender inequality, and other social determinants of disease as components of what they call structural violence: “[S]tructural violence remains a high-ranking cause of premature death and disability.”11^(p1690) The paradigm of structural violence was introduced by Galtung in the context of peace studies in the 1960s.16 He discriminates between tripartite forms of violence: personal, cultural, and structural. For Galtung, structural violence conveys a systemic inequitable social arrangement involving, for example, economic or political power. It is perpetuated by institutions and social structures that prevent individuals or populations from meeting their basic needs.

There may not be any person who directly harms another person in the structure. The violence is built into the structure and shows up as unequal power and consequently as unequal life chances.16^(p171)

These structural inequalities constitute the core of structural violence.To counter the social injustice of structural inequalities and adequately meet the needs of vulnerable groups, pandemic preparedness efforts must address both health disparities and access barriers. Here we outline challenges inherent in eliminating injustice and delineate strategies to meet those challenges. These strategies offer pragmatic ethical guidance, moving beyond the identification of abstract moral principles or the creation of broad ethical frameworks for pandemic planning. In part, our analysis arose from our work on the Minnesota Pandemic Ethics Project (MPEP), the primary aim of which was to offer ethical guidance to the Minnesota Department of Health concerning the rationing of scarce health resources during influenza pandemics. MPEP''s public engagement process involved representatives of several vulnerable communities and specifically sought guidance on meeting the needs of those groups.17–19 We undertook further analysis, developed independently from MPEP, that focused on social justice—and not on the other concerns about fairness that garner a great deal of attention in the literature on pandemic preparedness, such as prioritization of key workers or of certain age groups for access to resources during pandemics.     

Self-Esteem and Health Instruction: Challenges for Curriculum Development

A review of literature on self-esteem and its role in health education raises questions about the extent to which health education can influence student self-esteem through direct and indirect instruction. This article operationally defines self-esteem, discusses the role of health education in developing self-esteem through direct and indirect instruction, interprets evidence that self-esteem is affected by health education curricula, and discusses challenges facing health educators in curriculum development, instruction, and evaluation of self-esteem as a realistic component of health education curricula.     

构建和谐社会视野下的医疗公正与宏观卫生政策

医疗卫生保健关系到人的最基本需求，是社会起点公平的保障，对健康投入是政府不可推卸的责任。在经济发展的基础上不断提高群众健康水平，是实现人民共享改革发展成果的重要体现，是促进社会和谐的重要举措。在今后的深化改革中，必须强调医学目的，贯彻以人为本的指导思想，加大政府的投入，围绕公正目标，建立覆盖全民的医疗保障体制。     

对医务人员强化社会医学教育的思考

强化社会医学教育研究,对医务人员转变思想观念、改善知识结构、提高综合素质具有重要的作用.本文分析了当前落后工作模式存在的问题及原因,提出以现代医学模式指导工作的对策,并对强化社会医学教育增强医务人员综合素质进行了深入的思考.     

军医研究生体育课程开设现状及合理构建策略研究

目的构建合理的军医研究生体育课模式,以达到最佳的教学训练效果和终身体育意识的培养。方法通过专家访谈、问卷调查等方法,从教学理念的设计到教学内容的制定、从教学方法的多变到考核模式的多元等方面人手进行研究。结果目前军医研究生体育课的教学理念相对滞后、教学内容不完善、教员队伍比例不合理。结论先进的教学理念、合理的教学内容、灵活的教学方法、自由的选课方式、适宜的考核模式5大措施,是军医研究生体育课的理想模式。