临床药学专业课程体系优化初探

临床药学是我国近年来新增的高等药学教育专业方向,由于多种原因,其课程体系还存在一定问题,研究和探索并解决其优化问题非常必要;论文搜集借鉴以美国为代表的发达国家药学教育及其培养模式的科学理念,结合我国临床药学教育的现状和问题,从转变人才培养模式,更新药学服务理念等方面结合药学教育实际进行了探索。     

The State of Medical Informatics in India: A Roadmap for Optimal Organization

In India, the healthcare delivery systems are based on manual record keeping despite a good telecommunication infrastructure. Unfortunately, Indian policy makers are yet to realize the importance of medical informatics (including tele-health, which comprises e-Health and Telemedicine) in delivering healthcare. In the medical curriculum also, nowhere is this treated as a subject or even as a tool for learning. The final aim of most of the medical and paramedical students should be to become good users, and if possible, also experts for advancing medical knowledge base through medical informatics. In view of the fast changing world of medical informatics, it is essential to formulate a flexible syllabus rather than a rigid one for incorporating into the regular curriculum of medical and paramedical education. Only after that one may expect all members of the healthcare delivery systems to adopt and apply medical informatics optimally as a routine tool for their services.     

Conversation analysis, doctor-patient interaction and medical communication

INTRODUCTION: This paper introduces medical educators to the field of conversation analysis (CA) and its contributions to the understanding of the doctor-patient relationship. THE CONVERSATION ANALYSIS APPROACH: Conversation analysis attempts to build bridges both to the ethnographic and the coding and quantitative studies of medical interviews, but examines the medical interview as an arena of naturally occurring interaction. This implies distinctive orientations and issues regarding the analysis of doctor-patient interaction. We discuss the CA approach by highlighting 5 basic features that are important to the enterprise, briefly illustrating each issue with a point from research on the medical interview. These features of conversation analytic theory and method imply a systematic approach to the organisation in interaction that distinguishes it from studies that rely on anecdote, ethnographic inquiry or the systematic coding of utterances. CONVERSATION ANALYSIS AND THE MEDICAL INTERVIEW: We then highlight recent CA studies of the "phases" of the internal medicine clinic and the implications of these studies for medical education. We conclude with suggestions for how to incorporate CA into the medical curriculum. It fits with biopsychosocial, patient-centred and relationship-centred approaches to teaching about medical communication.     

Do students have sufficient knowledge of clinical anatomy?

INTRODUCTION: Comparisons of anatomy knowledge levels of students from various curricula show either no differences or small differences to the detriment of innovative schools. To pass judgement on the general level of students' anatomy knowledge, we need an absolute standard. The purpose of this study was to compare students' levels of anatomy knowledge as measured by a case-based anatomy test with standards set by different groups of experts. METHODS: A modified Angoff procedure was used to establish an absolute standard against which the students' results could be evaluated. Four panels of 9 anatomists, 7 clinicians, 9 recent graduates and 9 Year 4 students, respectively, judged 107 items of an anatomy test. The students' results on these items were compared with the standards obtained by the panels. RESULTS: If the standard established by the panel of Year 4 students was used, 64% of the students would fail the test. The standards established by the anatomists, clinicians and recent graduates would yield failure rates of 42%, 58% and 26%, respectively. CONCLUSION: According to the panels' standards, many students did not know enough about anatomy. The high expectations that the Year 4 students appeared to have of their peers may contribute to students' uncertainty about their level of anatomy knowledge.     

The many and conflicting histories of medical education in Canada and the USA: an introduction to the paradigm wars

BACKGROUND: Medical education research is a maturing field of inquiry that derives theoretical perspectives from many domains. Yet while such theoretical diversity holds the promise of rich paradigmatic writing and debate, too often medical education researchers do not place their work in a historical or cultural context, giving the impression that they have somehow unearthed universal 'truths' about medical education. METHODS: This paper introduces some of the key 'histories' of medical education from the contexts of Anglophone Canada and the USA following a review of major works in the history of medical education. RESULTS: There are many and conflicting histories of medical education in North America that can be classified according to different socio-historical paradigms. CONCLUSIONS: To avoid the error of over-generalisation, a much greater effort must be made to include historical, sociological, economic and other social science perspectives in the design, interpretation and application of medical education research.     

Teaching and learning population and preventive health: challenges for modern medical curricula

OBJECTIVES: This study aimed to formally identify medical students' attitudes towards population and preventive health issues addressed in the University of Queensland's Bachelor of Medicine, Bachelor of Surgery (MBBS) programme, in response to informal student reports that population and preventive health issues were largely just matters of "common sense". METHODS: Year 2 medical students were surveyed in 1999 and 2000 using a custom-designed instrument incorporating Likert scales and requests for qualitative responses. A sample of students participated in semistructured interviews. RESULTS: A total of 341 students (71%) responded to the survey. Students' attitudes towards general population health issues were overwhelmingly positive, and more than 60% of students reported having a more positive attitude towards psychosocial and preventive health issues than they had when they commenced the MBBS programme. Just over half of the students, however, considered population and preventive health issues to be matters of common sense. Students reported poor role modelling by the faculty in relation to population and preventive health issues, with only 41% of students indicating they perceived a positive attitude towards psychosocial and preventive health issues in the School of Medicine. Qualitative data indicated that some students fear that the opportunity cost of dedicating study time to population and preventive health issues might endanger their future clinical knowledge, skills and management of patients. CONCLUSIONS: These findings have important implications for modern medical curricula. The challenge in teaching population health issues is to balance students' needs to understand and apply the principles of population and preventive health and the biopsychosocial model of patient care, with the need for them to be confident they will be able to practise safely if they do so.     

Informal learning in postgraduate medical education: from cognitivism to 'culturism'

BACKGROUND: Work-based learning occupies a central role in the training and ongoing development of the medical workforce. With this arises the need to understand the processes involved, particularly those relating to informal learning. Approaches to informal learning in postgraduate medical education have tended to consider the mind as an independent processor of information. METHOD: In this paper, such cognitive approaches are critiqued and an alternative socio-cultural view on informal learning described. Recent and imminent changes in postgraduate medical education are identified, namely the reduction in patient experience, the fragmentation of teaching, and the development of competency frameworks and structured curricula. It is argued that although the latter may be useful in the construction of formal learning programmes, they will do little to enhance the progression of the individual from newcomer to old-timer or the cultural assimilation of the learner into a profession. DISCUSSION: Strategies for enhancing informal learning in the workplace are recommended in which increased attention is paid to the development of the medical apprentice within a community of social practice. These include the establishment of strong goals, the use of improvised learning practices, attention to levels of individual engagement and workplace affordances, immersion in professional discourse and behaviours, support in relation to the development of a professional identity and the provision of opportunities to transform social practice.     

Defining professionalism in anaesthesiology

BACKGROUND: The Royal College of Physicians and Surgeons of Canada, through the CanMEDS 2000 project has identified the role of professional as 1 of 7 roles for which physicians are expected to be accountable when dealing with patients. Each specialty is responsible for defining this role relative to their specialty. METHODS: The qualities of professionalism for anaesthesiology were defined through a Delphi process involving Canadian anaesthesiology educators. The panellists took part in 3 rounds that identified qualities in 3 distinct areas of professionalism - humanistic qualities, personal development qualities and anaesthesiology meta-competences. RESULTS: A total of 23 of 29 anaesthesiologists responded (79%) in round 1, with response rates to rounds 2 and 3 being 72% and 69%, respectively. Of the original 36 qualities, some were combined, definitions were changed in 23, 11 qualities were added and 4 were deleted, leaving a list of 40 qualities. DISCUSSION: There is considerable interest in this issue among the Canadian educators in postgraduate anaesthesiology. Consensus on important professional qualities for anaesthesiologists was obtained through the Delphi technique. These qualities will form the basis of identifiable professional behaviours to which anaesthesiologists should aspire.