医院治理结构改革与医院管理职业化

通过对当前两种医院治理结构的六个要素比较，认为这两种改革模式的主要问题在于不能很好地解决委托人(或董事会)人员来源和委托人的所有权约束和激励以及代理人的约束和激励等两个问题。并据此提出政策建议，认为解决委托人与经营者的约束和激励问题是医院治理中非常关键的一环，国资委应在医院经营中培育一个专业化、职业化的委托人和代理人阶层。     

责任指数对口腔医学专业学生职业精神考核的设想

医学生的责任心体现在其一定行为表现上,是医学生职业精神培养的重要内涵,因此对影响医学生责任心的负向行为进行一定的干预具有重要意义。分析国内外医学院校应用责任指数考核在医学生行为督导养成的评价研究,遵循我国口腔医学专业人才培养的规律,结合口腔医学生成长的特点,借鉴职业精神考核的相关指标——责任指数考核法,试设计口腔医学生行为责任指数测评方案,并预设可行性,为拓宽口腔医学生职业精神的培养提供思路。     

Luxury primary care,academic medical centers,and the erosion of science and professional ethics

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed.     

A change in paradigm: Giving back identity to donors in the anatomy laboratory

This article describes a paradigm of teaching in the anatomy laboratory where students interact with the families of the deceased persons whom they are dissecting. This approach focuses learning anatomy and medicine on the patient via the implementation of five guiding principles: the First Patient; Knowledge; Reflection and Reflective Practice; Treating the Total Patient; and Professionalism. Physician training typically begins with cadaveric dissection (i.e., dissection of the first patient), and therefore the medical school gross anatomy course provides an ideal environment for multifaceted educational experiences where cadaveric dissection is used to teach structure and function as well as the skills and competencies critical to patient care. Here, these principles are described, and the impact on student doctors and outcomes discussed. The results suggest that mastery of basic science knowledge and competencies, including professionalism, compassion, and leadership skill is enhanced by this protocol. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Perceptions of Radiation Therapists about Providing Psychosocial and Supportive Care to Patients at Peel Regional Cancer Center

BackgroundMany patients with cancer undergoing radiation treatment have unmet psychosocial and supportive care (PSOSC) needs. Radiation therapists (RTs) have a unique opportunity to provide PSOSC, but the published literature is limited regarding their perceptions and beliefs about delivering such care. A survey was designed to evaluate these aspects.MethodsA one-time, cross-sectional survey was distributed to 52 RTs at the Peel Regional Cancer Centre, Mississauga, Ontario, Canada. This survey contained six baseline questions and 34 item statements. The 34 statements spanned three themes: (1) convictions and motivations, (2) preparedness and execution, and (3) resources and facilitators. Participants were asked to rank statements on an eight-point scale, from “strongly disagree” to “strongly agree.”ResultsEighty-three percent of the RTs responded. Respondents reported they were engaged for 6.2 hours per week in supporting patients with PSOSC. This was despite a technical focus of organizing and delivering a course of radiotherapy for each patient, a relatively fixed schedule, and short-duration time slots booked per patient. Overall, respondents reported a moderately strong level of convictions and motivations for including PSOSC in practice. They perceived that they were not using all of their existing PSOSC skills and knowledge on the job and that supporting professional (eg, training and scheduling) and environmental (eg, screening tools, physical environment, and policies) infrastructures for PSOSC were not optimized.ConclusionsA majority of the respondents believed PSOSC to be an integral part of providing quality care to radiation oncology patients. Findings showed that staff members were highly motivated to provide this care and perceived that, with additional support, their capacity to provide such care in a way that is meaningful to patients would increase.     

Assessing professionalism within dental education; the need for a definition

Professionalism is a broad competency needed by dentists to act effectively and efficiently and is seen as a central part of both undergraduate and postgraduate curricula. Assessment is vital in education to assess progress and direct future learning. It is also an essential part of good professional regulation, which depends upon high quality assessment to maintain credibility. Educators must produce clear expectations that students can strive for. Thus dental educators are required to understand precisely what is meant by “professionalism” in relation to dentistry in order to both teach and assess it. The aim of this paper is to explain the importance of professionalism, explore its features and its assessment as described in the literature. The paper concludes that without a validated definition of this construct, assessment of professionalism within dental education will be compromised.