Exploring historical conflicts between midwives and nurses: a perspective from Chile

Abstract

This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives’ nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.     

Demystifying the role of expert witness for clinical toxicologists

While medical science continues to be shaped and molded by politico-economic and regulatory pressures, clinical toxicologists should possess basic understanding of legal system and terminology to further the interests of professional standing and contribution to better public health. A basic knowledge of law will be advantageous to promote clinical toxicology in the political and public arena.     

欠发达地区农村三级医疗机构医务人员培训现状与需求的调查

目的对实施新型农村合作医疗制度后的县、乡、村三级医务人员人力培训现状与需求进行调查,为制定合理的农村医务人员人力培训模式提供依据。方法采用分层抽样的方法抽取安康市县、乡镇、村卫生室三级医务人员共150名,对其进行有关培训现状及需求的问卷调查。结果县、乡镇、村三级医务人员培训的主观需求率明显高于获得率(P<0.05),导致培训不能满足需求的原因主要是培训内容不实用、培训方式不灵活、培训费用过高以及培训时间安排不合理等;不同层级机构医务人员对培训的周期、时间安排、内容、方式、费用及培训机构的选择方面存在差异。结论安康市农村各级医务人员培训现状不能满足需求,以村最为突出,其次为乡镇;各级医务人员培训需求亦各不相同。应关注农村各级卫生人力培训工作的自身特点,优化培训方法和培训环节,合理安排培训内容,开拓新医改背景下农村三级医疗机构医务人员的培训模式和理论,以推动欠发达地区卫生事业的发展。     

颈椎损伤患者的后送体会1例

我国是地震灾害最频发的国家之一。近年发生的较大地震有四川汶川地震、青海玉树地震、云南彝良地震及最近发生的四川芦山地震。地震灾难不仅能在瞬间夺走人们宝贵的生命,而且还会留下大量伤员。据统计,由地震造成的受伤人数是死亡人数的3倍〔1〕。如何及时、有效地后送地震伤员,对于降低死亡率及致残率意义重大。由于受到     

Scores From Riding's Cognitive Styles Analysis Have Poor Test–Retest Reliability

Background: The Cognitive Styles Analysis (CSA) purports to assess two cognitive style dimensions, wholist-analytic (WA) and verbalizer-imager (VI). CSA score reliability has not been studied in medical education. Purpose: The objective of this study was to evaluate test–retest reliability and learner-perceived accuracy of CSA scores. Method: CSA scores were measured twice and perceived accuracy of classifications once among 89 family medicine residents, internal medicine residents, and medical students. Results: Mean ± standard deviation interval between tests was 564 ± 136 days. Test–retest correlation for WA scores was 0.30, and for VI scores was 0.12. Upon retesting 44 learners (49%) were classified under a different WA style, and 56 learners (63%) were classified under a different VI style. There were 58 of 73 learners (79%) who agreed or strongly agreed with their WA classification, whereas 51 of 76 (67%) agreed with their VI classification. Conclusions: CSA scores have poor test–retest reliability. Educators may wish to avoid using the CSA and should exercise caution when interpreting CSA scores.     

RESEARCH BASIC TO MEDICAL EDUCATION: Pimping: Perspectives of 4th Year Medical Students

Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogical device of questioning students in the clinical setting, receives virtually no attention in medical literature. Purpose: Identifying 4th-year medical students' relevant knowledge and attitudes about pimping may help educators understand the range of beliefs about pimping and the role it plays in the socialization process into the medical community. Methods: Over a 2-month period, 11 fourth-year medical students at a Midwest medical school were asked 6 open-ended questions focusing on pimping as understood and experienced in the clinical setting. Investigators individually analyzed the interview data using qualitative methods to characterize students' experiences and recurring ideas and concepts. Results: All students noted the hierarchical nature of pimping, viewing it as a tool for attendings or residents to assess students' levels of knowledge. Although some students experienced malignant pimping, humiliated by incessant questioning or questions inappropriate to their level of training, all the students in the sample were positive about pimping and its effectiveness as a pedagogical tool. Investigators found that location within the clinical setting determines how students define and understand the motives for pimping. Conclusions: Understanding how students define and experience the pimping phenomenon prepares medical educators to scrutinize pimping as a pedagogical tool and to provide the most effective and encouraging environment for students.     

The Value of Bedside Rounds: A Multicenter Qualitative Study

Background: Bedside rounds have decreased on teaching services, raising concern about trainees’ clinical skills and patient–physician relationships. Purpose: We sought to identify recognized bedside teachers’ perceived value of bedside rounds to assist in the promotion of bedside rounds on teaching services. Methods: Authors used a grounded theory, qualitative study design of telephone semistructured interviews with bedside teachers (n = 34) from 10 U.S. institutions (2010–2011). Main outcomes were characteristics of participants, themes pertaining to the perceived value of bedside rounds, and quotations highlighting each respective theme. Results: The mean years in academic medicine was 13.7, and 51% were associate or full professors. Six main themes emerged: (a) skill development for learners (e.g., physical examination, communication, and clinical decision-making skills); (b) observation and feedback; (c) role-modeling; (d) team building among trainees, attending, and patient; (e) improved patient care delivery through combined clinical decision-making and team consensus; and (f) the culture of medicine as patient-centered care, which was embodied in all themes. Conclusions: Bedside teachers identify potential benefits of bedside rounds, many of which align with national calls to change our approach to medical education. The practice of bedside rounds enables activities essential to high-quality patient care and education.     

Teleradiology at the 121st General Hospital in Yongsan,Korea

Summary. The 121st General Hospital in the Yongsan district of Seoul. Korea provides teleradiology services for the US Armed Forces in South Korea. The operation of this teleradiology service is a model of the support of rural teleradiology, providing radiology services to outlying clinics over a large geographic area. In a typical week this hospital receives and processes 225 radiological exams or 45 exams per day from 13 outlying clinics. During military exercises the load can increase dramatically. The result of the teleradiology service is a sharp improvement in the radiology service at the outlying clinics and faster more effective care for the patients of those clinics.