摘要:

SUMMARYClinical ethical reasoning and analysis are skills as central to good patient care as the efficient application of biomedical knowledge to diagnosis and prognosis. However, experience in teaching clinical ethics to senior medical students has indicated that simply trying to ‘apply’ the knowledge learnt about ethical theories, principles, concepts and rules in the clinical setting does not ensure ethical competence in clinical decision‐making. In 1992, we developed and piloted a three‐session programme that focused on a more systematic approach to the way students identified and attempted to manage ethical issues in their clinical practice. This programme was modified and improved in 1993 and further expanded in 1994. Our experience suggests that many students are now better able to bridge what has been called the ‘gap’ between the possession of ethical knowledge and its actual use in clinical decision‐making.The remaining problem was assessment. How do you assess clinical ethical reasoning and decision‐making? In the preclinical years of medical education, knowledge‐based assessment tools, like the modified essay question (MEQ), provide a means for assessing the sensitivity of students to ethical issues. However, such tools permit neither an appraisal of how students actually make clinical ethical decisions, nor which factors students perceive as important in making an actual clinical decision. In order to make this type of appraisal, we developed a format for a written case report that facilitated our assessing the process as well as the end‐product, the decision. The results obtained from the use of the written case report in the annual assessment of our senior medical students in 1993, while encouraging, also identified a number of

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02796.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02883.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

摘要:

SUMMARYThis paper compares ethics programmes in clinical education in two medical schools in the Netherlands. Ethics education in the University of Maastricht is case oriented, whereas the emphasis in ethics teaching in the Catholic University of Nijmegen is focused on the methods of ethics and moral reasoning. The general objectives, format and evaluation are discussed. Both programmes assume that in clinical decision‐making normative and technical issues are intertwined; if a normative dimension is intrinsic to medical practice itself, students should learn during clinical training how to explicate and evaluate the moral quandaries of their profession. The positive characteristics of the Maastricht programme (student‐centred approach, relevant cases, team‐teaching of ethicist and clinician), if combined with those of the Nijmegen programme (a coherent theoretical framework and method for case analysis and interpretation), would create a new, powerful model for clinical ethics teaching. In a recent report such a model is advocated for all Dutch medical sc

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02797.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02884.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02885.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

摘要:

SUMMARYAnimal rights movements have increased the scope and intensity of their activities over the past decade. While it is generally assumed that doctors and other members of the health care professions favour the use of animals for science, few data are available. Student protests in various medical schools against use of animals in teaching laboratories indicated further need for objective data. A questionnaire about attitudes to the use of animals for teaching purposes was distributed to all the medical students at the Ben‐Gurion University of the Negev, present during classes on a given day. All students present (200) returned the questionnaire (70% of the student body). Also queried were attitudes towards related subjects. A high percentage of medical students surveyed had significant reservations about animal experimentation for teaching purposes and about the preferential priority for human life over that of animals. These attitudes, if confirmed, have serious implications for educators both in the health fields and otherwis

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02798.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

摘要:

SUMMARYMedicine and management should be more closely integrated not just at the level of health policy and health services management but also in matters of professional education and training. Learning is a continuous process from entering medical school to retirement and should reflect the transition from learning shaped by the curriculum to learning driven by the needs of the qualified professional in a career service post. The senior clinician does much more than practise clinically. He or she is a leader, a manager, a resource allocator, a teacher and team player. In these roles the values and priorities of the professional and the organization will not always coincide. In postgraduate training and in continuing medical education more joint activity should be developed around ‘medicine for non‐medical managers’ and ‘management for doctors’. Much of this shared learning and development will be local and problem‐based around local issues of quality, resources and priorities. However, the ‘regional’ postgraduate dean will play an increasingly pivotal role in maintaining the balance between the needs of the individual and the organization. To achieve this objective of closer integration postgraduate medical education funding should be brought together under a national finance levy against purchasers and allocated through devolved budgets managed by ‘regional’ postgraduate deans against explicit performance criteria agreed between the professional organizations, universities and health

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02886.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

摘要:

SUMMARYIn a research methodology course, second‐year medical students conducted a survey on ‘Enforcing a Smoking Ban in the Soroka Medical Center: a Survey of Hospital Employees on Facilitating Factors and Obstacles’. They defined the study objectives and design, developed the study instrument, carried out the survey, coded and entered the data into mainframe computers, analysed the computer output, and prepared oral and written reports. The aims of the project were twofold: to survey employees’ attitudes to a hospital smoking ban and to train medical students in the planning and conduct of a research project on public health or preventive medicine. Twelve students conducted a cross‐sectional survey of 208 hospital employees (10% of the hospital staff). Employees were surveyed regarding smoking status, interest in quitting smoking, knowledge of the law banning smoking in public places, knowledge of the health effects of passive smoking, attitudes towards a hospital smoking ban and potential obstacles to its implementation. The students rated the course as excellent. They gained important research skills, as well as practical medical and public health experience through active participation in the design and execution of a study project with public health implications. At the first meeting of the hospital committee appointed to enforce a smoke‐free hospital, the students' findings were reported in full, and their recommendations have guided polic

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02799.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02887.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID

摘要:

SUMMARYRestructuring of training in public health in the Hungarian medical schools is being undertaken in the context of a major European UniontempusJoint European Project. Under the aegis of this project a common core curriculum of public health has been developed. As part of the implementation of the curriculum, new approaches to learning are being explored that should enable students to appreciate the nature and magnitude of the major challenges to public health in Hungary and promote the development of their analytic, interpretative and presentational skills. One of the approaches is based on the individual preparation of reports on important public health issues, making use of secondary data from electronic databases (WHO HFA/PC and OECD Health Data) and traditional printed sources (annuals). This method called ‘computer‐based project work’ was introduced in Debrecen in 1992–1993 with a secondary objective to develop basic computing skills. The initial experiences of introducing computer‐based project work to the curriculum have been positive. This paper describes a practical example of the implementation of innovative approaches to teaching in a highly traditional setting in Central Europe, and one that provides ideas and encouragement to those facing similar problems in the countries of Central and Eastern Europe and the former Sov

ISSN:0737-3805    

DOI:10.1111/j.1365-2923.1995.tb02800.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: OVID