知识管理在医学生培养中的作用

随着知识经济时代的到来和发展,各行业竞争日益激烈,医疗工作作为知识密集型行业也不例外。高新科技迅猛发展和医患关系日趋紧张,医师除需要熟练掌握专业知识和技能外,还要具备沟通、组织、协调等多方面的能力。本文结合医学院校教育教学中学生运用知识管理的现状,提出几点建议,为提高人才培养质量提供参考。     

Do we need a strong programme in medical sociology?

Medical sociology has traditionally been concerned with the ways in which medical knowledge is applied. Less work has been done on the construction of knowledge in the laboratories of the basic medical sciences. This paper aims to extend the field of interest of medical sociology by introducing some recent developments in the sociology of science and technology (the ‘strong programme’).     

Sexuality,aging, and the education of health professionals

Expansion of medical personnel's knowledge of sexuality, especially for the aged, has progressed minimally from 1950s' tendencies toward avoiding the topic or fatalism in reflecting on it. Some progress has been made from past emphases on “plumbing” and most medical schools now provide at least some course work on sexuality. A reality of inconsistent content and teaching methodology persists, however, and its product is still widely viewed by sexuality educators as inadequate. This paper reviews research on academic programs preparing medical and health professionals for dealing with issues of sexuality.     

新型冠状病毒肺炎疫情下发热门诊医务人员心理健康状况和知信行调查与防控研究

目的 了解发热门诊医务人员的心理健康状况及工作过程中的薄弱环节,以完善发热门诊流程,帮助发热门诊医务人员做好个人防护,降低院内感染发生的风险.方法 以甘肃省收治确诊新型冠状病毒肺炎患者的定点医院发热门诊医务人员为调查对象,于2020年2月23日-3月21日,采用手机问卷星的方式调查267名发热门诊医务人员,了解其在进入...     

COMMENTARY: RSI AS A SOCIAL PROCESS

Since 1982 there has been an ‘epidemic’ of repetitive strain injuries in the workplace. Its recency, widespread incidence and threat to industry make RSI an important medico-social phenomenon of the 1980's. This paper considers RSI in a process framework, one with important sociopolitical dimensions. Drawing upon the parallel historical example of the occupational injury of miners' nystagmus, two aspects of the sociopolitical process are developed. The first is the mediation of the social relations of work by RSI. Using labour process theory it is argued that the injury must be understood in the context of the gradual dehumanisation of work, as involving a form of resistance which is transforming the industrial relations of occupational health and safety. The second aspect to be addressed is the sociology of medical knowledge about RSI; the role of medical practitioners as arbiters in the mediation of social relations and the location of medical knowledge about RSI in the medico-legal process. An attempt is made to account for the controversial nature of the medical knowledge about RSI. Finally, some implications of RSI for future industrial relations are considered.     

Users' understanding of medical knowledge in general practice

Much emphasis is now being placed on the quality of medical care, and various ways are being developed to assess the medical knowledge of general practitioners. It is increasingly recognised that the users perspective on health care is important, and that the views of health care professionals do not and cannot represent patients' views. In order to explore whether or not a large-scale survey, which asked people to rate their doctors' medical knowledge, yielded meaningful results, this paper draws on findings from a study involving in-depth interviews with 26 lay people who had already completed the General Practice Assessment Survey questionnaire. When completing the questionnaires, patients had been asked to consider the 'technical care' provided by their general practitioners and to make a judgement about their doctors' medical knowledge. When interviewed at a later date, some people explained that they defined medical knowledge as knowledge of 'disease and treatments', while others defined it as knowledge of the 'whole person', and some defined a knowledgeable doctor as one who would acknowledge uncertainty. Patients appeared to have made judgements about their general practitioners' medical knowledge based on many factors, such as their experience of illness, perceptions of professional training, contact with other health care professionals in both primary and secondary care, and exposure to the media. The paper discusses the nature of medical knowledge, and concludes that although patient surveys are useful for the evaluation of interpersonal care and access to care, asking patients about their general practitioners' medical knowledge may yield invalid results. This is partly because patients defined medical knowledge in different ways, and partly because it appears that relatively few patients had enough knowledge about their own particular illnesses, or about possible alternative treatments, to make informed judgements about their general practitioners' medical knowledge.     

Science is fundamental: the role of biomedical knowledge in clinical reasoning

CONTEXT: Although training in basic science is generally considered a critical aspect of medical education, there is little consensus regarding its precise role in clinical reasoning. Whereas some reports suggest that biomedical knowledge is rarely used in routine diagnosis, other research has found that biomedical knowledge can become an integral part of the expert knowledge base. OBJECTIVE: The purpose of the current paper is to present evidence in support of different views regarding the role of biomedical knowledge, including the two-world hypothesis, encapsulation theory and recent work on the role of biomedical knowledge in novice diagnosticians. The implications of these models for clinical teaching will be examined. DISCUSSION: Recent work suggests that biomedical knowledge can help novices develop a coherent and stable mental representation of disease categories. As a result, learners are able to retain clinical knowledge over time and maintain diagnostic accuracy when faced with clinical challenges. This suggests that clinical teachers should attempt to make explicit connections between biomedical knowledge and clinical facts during training.     

Expert and non-expert knowledge in medical practice

One problematic aspect of the rationality of medical practice concerns the relation between expert knowledge and non-expert knowledge. In medical practice it is important to match medical knowledge with the self-knowledge of the individual patient. This paper tries to study the problem of such matching by describing a model for technological paradigms and comparing it with an ideal of technological rationality. The professionalised experts tend to base their decisions and actions mostly on medical knowledge while the rationality of medicine also involves just as important elements of the personal evaluation and knowledge of the patients. Since both types of knowledge are necessary for rational decisions, the gap between the expert and the non-expert has to be bridged in some way. A solution to the problem is suggested in terms of pluralism, with the patient as ultimate decision-maker. This revised version was published online in July 2006 with corrections to the Cover Date.     

医疗告知缺陷案例分析与思考

结合案例分析,认为医务人员法律知识缺乏、法律意识淡薄是知情同意告知亟需解决的问题.针对为什么告知、向谁告知、告知什么等医务人员认知中存在的普遍性问题,建议建立医务人员法制教育长效机制,将法律知识培训和告知意识培养作为重要工作严格落实.     

Promoting professional knowledge, experiential learning and critical thinking for medical students

It has been recognized internationally that undergraduate medical education must adapt to changing needs, as illustrated by the Tomorrow's Doctors recommendations from the General Medical Council. This paper aims to relate contemporary educational theory to under-graduate medical educational requirements, specifically highlighting conditions (e.g. experiential learning) for: professional knowledge acquisition; critical thinking, problem-solving and clinical problem-solving; and lifelong professional learning. Furthermore, problem-based learning (PBL) is highlighted as potentially providing such conditions. There are lessons from contemporary educational theory for the reform of undergraduate medical education. These include valuing prior knowledge and experience; promoting learner responsibility through facilitating rather than directing learning; encouraging learners to test out and apply new knowledge, and using small-group work to foster explicitly the elusive skills of critical thinking and reflection. Contemporary educational theory contributes valuable insights, but cannot dictate the ultimate 'mix'; at best it provides some principles for reflective analysis of the learning experiences created for tomorrow's doctors.     

在市场经济条件下重振医疗器械标准化工作

叙述新时期的标准化工作的内涵和重要意义及法律责任．认定医疗器械标准是技术基础工作．是行政监督的主要的技术支持。介绍了国内医疗器械标准化工作的现状，并就全面推进医疗器械标准化工作提出各项要求。     

Medical Work: Accommodating a Body of Knowledge to Practice

Abstract It is the purpose of this paper to examine the relationship between the production of new scientific knowledge and the application of that knowledge to medical practice. The paper focuses, first, on the growth of the scientific enterprise and argues that the expanding medical division of labor is the profession's accommodation to the increased size of its body of knowledge. The paper goes on to discuss the emergent role of a new category of workers in that division of labor, clinical researchers. The second major focus of the paper concerns the relationship among medical specialists, who must allocate the new scientific discoveries among themselves. The final portion of the paper identifies the components of the process which accomplishes the task of distributing medical work among the specialty communities. The issue of primary concern to this discussion, which appears only as an underlying theme until the concluding section, is the effect of this allocation process on the structure of the medical profession and the type of medical care it delivers.     

基于《侵权责任法》的急诊管理及流程改进

根据急诊工作的特点,对已经颁布并即将实施的《侵权责任法》进行了较为深入的探讨。结合自身实际,重点探讨了高危孕产妇抢救流程的改进。指出积极学习相关法律知识,主动进行急诊管理和流程改进是医疗机构适应新形势的要求。     

运用知识管理创新高等医学教育

知识管理是管理领域的新理念、新思想,在企业得以广泛应用,对高等医学教育的改革和创新具有借鉴价值。在介绍知识管理内涵的基础上,分析知识管理对高等医学教育创新的启示,并就高等医学院校如何实施知识管理提出一些对策。     

西部地区业务再培训医务人员中艾滋病知识、态度和行为调查

目的了解来自西部地区医院业务再培训的医务人员对艾滋病预防知识知晓情况,掌握医务人员对艾滋病健康教育的需求,为在医务人员中进一步开展健康教育提供依据,以提高职业防护能力。方法对282名来自西部地区各医院业务再培训的医务人员进行AIDS知识和态度调查。结果医务人员的艾滋病相关知识水平整体较高,仅1.42%的被调查人员认为看起来健康的人不会携带艾滋病病毒,但是对AIDS诊断治疗及职业防护方面的知识掌握相对较差。36.17%的医务人员既往接受过AIDS专门培训,97.52%的医务人员有接受AIDS相关知识培训需求和意愿;大多数医务人员对PLWHA持同情和理解态度,但仍有一定比例的医务人员持恐惧回避态度;77.66%的医务人员表示“不愿意”去治疗或护理PLWHA的医院或科室工作;91.13%的医务人员认为自己有“职业感染HIV的危险”。结论西部地区医务人员对PLWHA持有一定的歧视态度,而且存在有恐惧和对职业暴露感染HIV风险的担忧。因此,医务人员的AIDS相关知识有待进一步提高,应开展针对性AIDS防治知识的专门培训。     

Practices of reading and writing: the constitutive role of the patient record in medical work

This paper contributes to a reappraisal of the sociological significance of the medical record. Building upon re-evaluations of the notion of ‘representation’ in ethnomethodological and science and technology studies, it attempts to portray the medical record as an artefact which mediates the social relations that act and work through it. Through practices of reading and writing, it is argued, the medical record figures as a fundamental, constitutive element of medical practice. To address some of the dimensions that are involved, three case fragments are discussed. The way the medical record enters into the process of ‘medical decision making’ in the doctor-patient interaction, and into that interaction itself, is discussed first. Subsequently, some aspects of how the record mediates medical work as it is performed in the wards of a hospital are outlined. A third instance of its prominent role demonstrates how practices of reading and writing tend to produce particular renderings of patients’ histories - including notions of how medical work is structured.     

Setting performance standards for medical practice: a theoretical framework

BACKGROUND: The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. METHODS: The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. CONCLUSION: Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.     

The challenge of comparative health policy research for applied medical anthropology

In this paper I argue that medical anthropologists can work in settings outside of academia to effect policy and that this work can simultaneously contribute to scientific knowledge and to the discipline of anthropology. In doing this, I first discuss the concept of policy and bind these ideas within the framework of health policy. Then I discuss the roles of anthropologists in the health policy field and the problems of selecting issues for research and the concern about the dichotomy between pure and applied research. Finally, I review some key health policy issues in American society and discuss how medical anthropologists can work toward practicing their craft in practical ways.     

The relevance of traditional medical cultures to modern primary health care

This paper attempts to identify forms of traditional medicine which have the greatest potential for advancing primary health care goals. It begins by differentiating traditional medical systems into types, according to the kinds of medical knowledge which they depend on for preventing, diagnosing, and treating sickness. Emphasis is given to the facts that some traditional systems concentrate on producing varieties of pathophysiological knowledge, while others focus on forms of etiological knowledge; and that some traditional systems accumulate the medical knowledge which they produce, while others diffuse and fragment it. These differences give clues to a medical tradition's abstract potential for achieving three distinct, and only sometimes linked, ends: curing disease, healing illness, and enhancing the productivity of official primary health care programs. To make these clues concrete, it is also necessary to know something about the different ways in which traditional medical beliefs and practices are embedded, together with modern (cosmopolitan) medicine, in actual patterns of resort. The remainder of the paper assesses the relevance, for advancing primary health care goals, of particular classes of traditional healers--e.g. herbalists, midwives, bonesetters--and technologies within different types of medical systems. Four possibilities are described; integration, complementarity, rivalry and intercalation.     

1例高校校医院外伤换药的护理体会

通过一例典型的门诊换药病例,探讨校医院门诊护理的特点,为日常护理工作的开展及大学生健康教育提供指导。大学生运动量大,外伤是学生就医的重要原因之一。由于有的学生缺乏相应的医疗常识,小的创伤处理不及时或处理不当而导致伤情加重、甚至引发交叉感染的情况时有发生。总结校医院护理工作中的典型病例,有利于采取积极有效的措施预防疾病的发生,更好地发挥校医院的职能。