医学生如何学好生理学的几点体会

生理学是一门重要的医学基础学科,是联系基础医学与临床医学的桥梁课程,在坚持传统的三段学习法基础之上,再通过实验训练,利用多媒体及网络资源等现代信息载体,以提高学习效率。     

长学制医学生的生活事件与幸福感

 目的 研究北京协和医学院八年制医学生的幸福感与影响最大的生活事件。方法 通过发放,自愿填写的方式进行问卷调查,包括青少年生活事件量表和总体幸福感量表。采用t检验、方差分析均值和偏相关分析得到结果。结果 发放问卷共计634份,有效问卷390份,占发放问卷的61.51%,其中男性155名,女性199名,医学预科阶段224人,基础医学阶段47人,临床医学阶段166人。总体幸福感量表医学预科阶段为74.23±12.40,基础医学阶段为72.09±12.37,临床医学阶段为79.57±10.88。生活事件量表各个年级略有不同,但总体来说得分较高的3项为人际关系2.95±0.93、学习压力2.74±0.81、丧失2.94±1.43。学习压力与幸福感总分的偏相关系数为-0.317,p<0.001。结论 基础医学阶段的学习压力最高,导致其幸福感偏低,这一问题应该为学校所重点关注。     

提高检索语言与信息素养教育的思考

 在网络与信息技术不断发展的进程中,医学生文献检索课程的教学理念与内容不可避免地向信息素养教育转变。北京协和医学院检索语言与信息组织课程与传统检索语言教学相比,增加了临床信息组织工具内容,概念范围也从单一的检索语言延伸到信息组织范畴,重点讲述检索语言与信息的关系、检索语言与信息组织的关系,信息组织与个人发展的关系。应用七何分析法（5W2H）比较检索语言与临床问诊语言的特点,加深医学生对信息组织工具的认识与理解。课堂上采取提出问题,分组讨论、代表汇报、全班分享的方式,激发学生的学习兴趣。教学效果经分析显示,对学生了解信息素养、检索与组织信息有一定帮助。     

学生主体性在医学生职业素养教育中的地位

 在医学生职业素养教育中,学生主体性教育模式可以增加了学生对职业教育的认同,形成了对课堂教学中不足的自觉补充,也在此过程中也完成自己对于职业素养的再审视,深入并强化了对职业素养的理解。但学生主体性教育模式也存在内容有选择性,可传递性和可复制性存疑,需要其他教育模式的补充。     

血脂异常的联合药物治疗

混合性血脂异常较为常见,联合作用机制不同的降脂药物治疗可提高血脂水平的达标率,有利于全面调整血脂异常,减少与增大剂量相关的不良反应。目前常用的治疗方案多在他汀类药物的基础上联合另一种药物,包括他汀类与贝特类、烟酸类或依折麦布合用。联合降脂药物特别需要注意安全性,从各自的小剂量开始,严密观察不良反应。     

热休克蛋白47参与TGF-β1促人胚肺细胞胶原合成

  摘要：目的 观察热休克蛋白47（HSP47）对人胚肺成纤维细胞（HELF）胶原合成及间质细胞标志物的影响,探讨它与肺纤维化的关系。方法 用TGF－β1诱导HELF表达HSP47,观察用5ng/mL TGF-β1作用不同时间和用不同浓度TGF－β1作用于HELF48h; WST法检测TGF-β1对HELF增殖影响;细胞免疫荧光法检测HSP47的表达;免疫印迹技术检测HSP47、Ⅰ型胶原（COLLAGENⅠ）及间质细胞标志物α-平滑肌肌动蛋白(α-SMA)、波形蛋白(VIMENTIN)的表达。结果 正常HELF表达少量HSP47,随着HELF在TGF-β1作用时间的延长和剂量逐渐增加,HSP47、COLLAGENⅠ、α-SMA和VIMENTIN的表达均同步增强（P<0.05）。结论 HSP47在TGF－β1的作用下,促进人胚肺成纤维细胞胶原蛋白的合成,作为胶原特异性分子伴侣在肺纤维化的发生发展过程中发挥至关重要的作用。     

siRNA沉默AFP基因对肝癌细胞系 EGHC-9901 增殖的影响

 目的 建立稳定表达AFP-siRNA质粒的肝癌细胞系并探讨对其增殖的影响。方法 构建AFP-siRNA,用脂质体法转染肝癌细胞系,G418筛选4～5周,Western blot 及RT-PCR检测靶基因表达,分组：实验组,转染AFP-siRNA组;阳性对照组,转染空载体组;空白对照组,未处理组。MTT绘制生长曲线,平板克隆实验观察集落形成,流式细胞仪分析细胞周期。结果 成功建立稳定表达AFP-siRNA的肝癌细胞系,实验组表达AFP近乎完全抑制;实验组增殖能力显著低于空载体组;实验组＞75μm集落形成数19±2,低于空载体组62±6;实验组G1期细胞数较空载体组提高20％左右。 结论 成功建立稳定表达AFP-siRNA的肝癌细胞系,抑制AFP表达可使肝癌细胞发生G1期阻滞,明显抑制其增殖及集落形成能力。     

循环血管内皮祖细胞血管修复作用的研究进展

循环内皮祖细胞在血管损伤的情况下,可归巢到受损区域,增殖分化为成熟内皮细胞,并分泌营养因子,促进内皮新生。但是,由于其干细胞特性,在微环境改变的情况下,可能无法分化为功能细胞,甚至表达纤维化、成骨分化等表型,加速血管损伤。因此,纯化单一细胞群,稳定微环境,明确病程是决定循环内皮祖细胞发挥积极作用的关键。     

Attitudes and reactions of Jordanian medical students to the dissecting room

Emotional and psychological reactions of Jordanian medical students to the dissecting room (DR) were assessed. A questionnaire was distributed to 200 students in preclinical years in the academic year 2002–2003 in the faculty of medicine at Jordan University of Science and Technology; 145 students have responded. Varying degree of fear on first entering the DR was reported by 28.4%. The most frequent reactions were recurring visual images of cadavers 28.9% and palpitation 19.3%. Students’ reactions were most commonly elicited by smell of the DR 58.5% and by fear of infection 50.3%. The most frequent method of coping with such fears was by rationalization 89.8%. Significant gender differences (P<0.05) were found in the most aspects of DR experiences. Female students showed higher level of fear, reported recurring visual images of cadavers more often than males, were more disturbed by certain stimuli in the DR and used religious books and praying as coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before DR practical on human cadavers is discussed.     

Problem-based learning in medical informatics for undergraduate medical students: an experiment in two medical schools

PURPOSE: The objective of this work was to assess problem-based learning (PBL) as a method for teaching information and communication technology in medical informatics (MI) courses. A study was conducted in the Schools of Medicine of Rennes and Rouen (France) with third-year medical students. METHODS: The "PBL-in-MI" sessions included a first tutorial group meeting, then personal work, followed by a second tutorial group meeting. A problem that simulated practice and was focused on information technology was discussed. In Rouen, the students were familiar with PBL, and they enrolled on a voluntary basis, while in Rennes, the students were first-ever participants in PBL courses, and the program was mandatory. One hundred and seventy-seven students participated in the PBL-in-MI sessions and were given a questionnaire in order to evaluate qualitatively the sessions. RESULTS AND DISCUSSION: The response rate was 92.1%. The overall opinion of the students was good. 69.8% responded positively to the program. In Rouen, where the students participated in PBL-in-MI sessions on a voluntary basis, the students were significantly more enthusiastic about PBL-in-MI. Moreover, attitudes and opinions of students are plausibly related to differences in previous PBL skills. The fact that the na?ve group had two tutors, one trained and one na?ve as the students, has been investigated. Teacher naivety was an explanatory factor for the differences between Rennes and Rouen.     

Relationship between self-reported cognitive and behavioural empathy among medical students

ObjectiveThe aim of this study was to explore the relationship between cognitive and behavioural empathy in medical students.MethodsFourteen 4th year medical students recruited on the basis of their scores on the self-reported Jefferson Scale of Empathy (JSE-S) were divided into two groups: low JSE-S scorers (n = 8) (M = 96.75, SD = 10.3) and high JSE-S scorers (n = 6) (M = 121.3, SD = 2.94). They were discreetly videotaped while taking history with an incognito standardized patient. Students’ behavioural empathy was measured using the Verona Coding System (VR-CoDES-P) and rating of non-verbal behaviour.ResultsPatients expressed the same number of concerns per encounter in both groups but gave more cues to high-scorers (p = 0.029). However, students of both groups demonstrated the same amount of verbal empathy (high: 16% vs low: 15% p = 1.00). High JSE-S scorers’ non-verbal communication tended to be rated slightly higher than low JSE-S-scorers with a higher use of facial expression (p = 0.008).ConclusionThis study did not reveal any differences of students’ verbal empathy to patients’ cues and concerns between low and high JSE_S scorers.Practice implicationsThe VR-CoDES_P is a useful tool to assess medical students and physicians empathic behaviour, allowing to disentangle the different components of empathy.     

Attitudes and reactions of Arab medical students to the dissecting room

A questionnaire on the emotional and psychological reactions of Arab medical students to the dissecting room (DR) was distributed to 272 students in four successive pre-clinical and clinical years in the same academic year (1993-1994) at Sultan Qaboos University (SQU) Medical College; 205 students responded. Varying degrees of fear on first entering the DR was reported by 46%. The most frequent reactions were recurring visual images of cadavers (total 38%) and temporary loss of appetite (total 22.5%). Students' reactions were most commonly elicited by the smell of the DR (total 91%) and by fear of infection (total 62%). The most frequent method of coping with such fears was by rationalization (total 65%). Significant gender differences (P < 0.05) were found concerning all aspects of the DR experience. Female students showed higher levels of fear, reported stronger physical and behavioral reactions, were more disturbed by certain stimuli in the DR, and used certain coping methods more frequently than their male peers. The need for appropriate psychological preparation of students before studying human cadaveric anatomy is discussed. Clin. Anat. 10:272-278, 1997. © 1997 Wiley-Liss, Inc.     

Teaching medical students to express empathy by exploring patient emotions and experiences in standardized medical encounters

ObjectivesTo increase medical students’ ability to detect contextual and emotional cues and to respond empathetically to patients.Methodsa training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerkships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters.ResultsStudents improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions.ConclusionsThe course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10 min.Practical implicationsThe program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes.     

Teaching medical students how to deliver diagnoses of Down syndrome: Utility of an educational tool

ObjectiveThis study assessed whether using an educational tool increased the knowledge and perceived comfort level of first-year medical students in giving a diagnosis of Down syndrome.MethodA total of 295 students taking a genetics course completed a knowledge questionnaire and Situations Inventory (aimed at assessing comfort with sharing certain information), prior to and following use of Brighter Tomorrows, a web-based educational module on giving parents a diagnosis of Down syndrome.ResultsThe pre-intervention mean on the knowledge survey was 3.67, which significantly increased to 5.47 following the intervention. Mean Situational Inventory scores were significantly higher pre-intervention (M = 45.5), which indicates greater discomfort, compared to post-intervention (M = 36.7). Qualitative analysis of responses regarding lessons learned fell into 5 major themes. The most common theme (48% of responses) was related to communication skills. The most frequently cited lesson learned was the importance of demonstrating empathy.ConclusionsThis study found that knowledge and perceived comfort levels of first-year medical students in giving a postnatal diagnosis of Down syndrome were significantly increased following use of an educational tool.Practice ImplicationsEducational modules can provide medical students with foundational knowledge on providing distressing information to help prepare for future clinical encounters.     

Gross anatomy: An outdated subject or an essential part of a modern medical curriculum? Results of a questionnaire circulated to final-year medical students

Final-year undergraduate medical students were given a questionnaire on the gross anatomy curriculum they had experienced in their first year at medical school 5 years earlier. They were asked to evaluate the relevance of the dissection course, lectures and seminars in gross anatomy for clinical courses, clerkships, and everyday practical work on the ward. About two-thirds of the students found the time spent on 10 different regions in anatomy to be adequate, and a considerable number of students would have liked even more details. The vast majority expressed a wish to repeat topographical anatomy during their clinical teaching. Furthermore, ～75% of the students showed interest in short, specialized dissection courses during the clinical curriculum. Medical students just before graduation ranked gross anatomy with the dissection course and integrated clinical topics as a keystone for their clinical courses. The results of such surveys should be taken into consideration when discussing modification to teaching gross anatomy or arguing about a balanced dissection course. © 1993 Wiley-Liss, Inc.