Human values in medical education

Attitudes and values in medicine vary with the nature of the individual, his education and training, and the circumstances of his professional life. Comparisons are drawn between medical education in Britain 40 years ago and today. Though education has changed, British students are still mainly motivated by a desire to care for sick people. The impact of personal medicine on a country that has long accepted the need for some kind of national health service is described. It is postulated that as government and public become increasingly involved in health care, it is of paramount importance that medical education should provide a clear understanding of what a profession is and inculcate a determination to maintain true professional status. New responsibilities of the profession, to the public at large and to society, are suggested. The ability of medical education to exert a good influence on concern for human values in medicine depends in the final analysis on the ability to show excellence to medical students.     

Involvement of lipid peroxidation in free fatty acid-induced isolated rat pancreatic acinar cell injury

Ophthalmologists play a relatively peripheral role in medical student and resident education. A review of the evolution, funding, and administration of medical education in the United States lends insight into why this is so. The author reviews the current status of education in ophthalmology for medical students and residents; the development of an ophthalmology curriculum; alternatives to the traditional medical school curriculum and how these have been incorporated into ophthalmic education; and the effect of new trends in medical education and pressures created by health care reform on the education of medical students and residents. The role of ophthalmologists in the general practice of medicine and in teaching doctors about the eye is discussed. Finally, the opportunity that the current climate presents for ophthalmologists to define their role in health care through education is considered.     

Reaffirming professionalism through the education community

OBJECTIVE: To determine the role of the clinical training environment and a medical education community in reaffirming medical professionalism among physicians-in-training and faculty. DATA SOURCES: Published articles on undergraduate and graduate medical education and sociology works on professionalism were identified through research. STUDY SELECTION: Studies were selected that illustrated barriers to professionalism in medical education and patient care and the professional conduct of medical students, residents, and faculty. RESULTS: Factors that undermined the medical education community were the specialization of medicine, the faculty reward systems, and the service demands of residency because of the economics of health care. CONCLUSIONS: Establishment of a firm system with a core teaching faculty, creation of mentoring and role modeling programs, implementation of a longitudinal curriculum on medical professionalism, evaluation of physicians on professional conduct, and evaluation of the clinical training environment are suggested as strategies to re-establish an education community and reaffirm professionalism in medicine.     

Evaluation of a food frequency questionnaire-food composition approach for estimating dietary intake of inorganic arsenic and methylmercury

The author argues against the criticism that contemporary medical students, like most educated youth in our society, are self-centered moral relativists without a sense of social responsibility. He first frames his argument in terms of what Charles Taylor calls the three "malaises of modernity," namely, the rise of individualism, an emphasis on instrumental reasoning based on bureaucratic efficiency, and the loss of political action. He goes on to show how these malaises are manifested in the academic health center and their effect on the professional socialization of future physicians. Then, using John Evan's perspective of the need to shift from "supply-side" to "demand-side" thinking in the way today's medical students are trained and Hafferty and Frank's thesis that the most critical determinants of a physician's identity operate not within the formal curriculum but in a "hidden curriculum," he presents his own case of how Rush medical students, by participating in student-generated, voluntary projects--via the Rush Community Service Initiatives Program--are harnessing their individualism through commitment to serving the poor and disadvantaged. To show that the situation at Rush is not unique, the author also points to the impact that the Health of the Public and service-learning programs have been having both in academic health centers and in the communities being served. Finally, it is his contention that these community service experiences, given unconditionally to people in need, broaden the students' education by offering a population and community perspective of health and illness and, perhaps more important, bind them closer to society in both a moral and a political sense.     

Christian social policy and homosexuality in The Netherlands, 1900-1970

This essay explores the historical process in which homosexuality became an object for pastoral, medical, and mental health care in the Dutch Catholic community during the twentieth century. The confrontation between a moral-religious approach and the professional (medical and psychological) treatment of homosexuality is the central issue. In a continuing dialogue and a process of changing power relations between clergymen, physicians, psychiatrist, psychologists, and pedagogues as well as Catholic homosexuals themselves, homosexuality was transformed from sin and pathology into a psychological and social problem that could be treated in pastoral and mental health care. The changing attitudes of Catholics towards homosexuality can be explained in the context of the changing relations between religion on the one hand and health care on the other hand. Current viewpoints resulting from sociohistorical studies on the development of the medical and welfare professions have concluded that religion lost importance in modern society because physicians, psychiatrists, psycho-therapists, and social workers not only created new areas of intervention in people's private lives, but also took over the traditional tasks of the church in the field of charity and pastoral care. Medical anamnesis, psychoanalysis, and psychotherapy took the place of confession and pastoral care, thus the argument runs, and remission of sins and redemption were replaced by health and welfare. However, especially in the case of the development of the Dutch welfare state, there was a more complicated interplay between changing religious values and professional strategies. In the Netherlands professional health care and welfare institutions often were organized in a religious context and it is difficult to make a clear differentiation between religious and moral discourses on the one hand and medical and psychological ones on the other hand. Moreover, professional interventions did not take the place of pastoral care; it appears that pastoral care for homosexuals gained ground and was intensified after medical and psychological definitions of homosexuality had found acceptance in the Catholic community. Professional strategies did not supersede religion, but rather contributed to a moral re-orientation and a new pattern of Christian values and appreciations in the field of sexuality.     

Biomedical ethics and the biomedical engineer: a review

Biomedical engineering is responsible for many of the dramatic advances in modern medicine. This has resulted in improved medical care and better quality of life for patients. However, biomedical technology has also contributed to new ethical dilemmas and has challenged some of our moral values. Bioengineers often lack adequate training in facing these moral and ethical problems. These include conflicts of interest, allocation of scarce resources, research misconduct, animal experimentation, and clinical trials for new medical devices. This paper is a compilation of our previous published papers on these topics, and it summarizes many complex ethical issues that a bioengineer may face during his or her research career or professional practice. The need for ethics training in the education of a bioengineering student is emphasized. We also advocate the adoption of a code of ethics for bioengineers.     

Medical history in the undergraduate medical curriculum

History has long played a role in the education of American physicians, but the uses of medicine's past have changed over time. In the late nineteenth century, some physicians taught medical history to their students to supply a sense of continuity with professional traditions in times of rapid and bewildering change. Other physicians believed that instruction in medical history would impart a sense of refinement to medical practitioners. In the late twentieth century, medical history is increasingly viewed as a significant dimension of the professional, intellectual, and humanistic development of medical students. Further, it is one of the principal means by which recent, radical changes in health care can be given needed perspective. The knowledge that medicine and the medical sciences are fundamentally social enterprises is an important lesson for medical students. Through exposure to the history of health care, students also learn that medical knowledge is itself subject to change and is acquired in specific contexts. In the 1990s, medical history is taught in a variety of settings. In some schools, history is integrated into the teaching of medical humanities. Where medical history is institutionally distinct from the humanities, courses in medical history may be either elective or required. In order to reach students at every stage of their medical education, historians and clinicians can join forces to teach history in innovative and flexible programs.     

Viability and recovery of peripheral blood mononuclear cells cryopreserved for up to 12 years in a multicenter study

Polish physicians-philosophers tried to find a compromise between medicine as a science and medicine as a healing art. They stated that clinical practice should be transformed into science, bearing in mind that there would be no medicine without the existence of the sick. A perfect physician is a good and wise person and not exclusively a proficient expert. Polish physicians exercised a science that they called philosophy of medicine. It included logic, psychology, and medical ethics. The Polish school claimed that the history of medicine and philosophy of medicine are necessary for future doctors. The historical and philosophical approach makes it possible to recognize the subject of medicine (health, disease, and the sick) and its aim (treatment, restoration of health or just alleviation of suffering). The ethics teaches what values are pursued by medicine, what moral duties a doctor has, and what role model to follow to become a good physician. Placing the sick in the focus of medical interest, the Polish school taught future physicians to see in them suffering fellow men who should be embraced with care, compassion, and Christian charity. Such an approach to the ethical aspect of medical philosophy became incorporated into an education towards humane values, responsibility for ones' life and health in the spirit of the ethics of care.     

Training psychology students and professionals to recognize and intervene into partner violence: Borrowing a page from medicine.

Partner violence is an epidemic with serious medical and psychological consequences. While victims frequently seek medical and psychological help, they rarely, if ever, disclose victimization as a presenting problem. Conversely, health care professionals, including psychologists, rarely ask about violence or provide appropriate help when violence is detected. To address this problem, organized medicine has promoted and developed models and curricula for educating students and professionals to identify and help partner-violence victims. Psychologists have made important contributions to understanding partner violence. However, organized psychology has yet to develop and widely promote model violence education curricula for identifying and helping victims (as well as perpetrators) of partner violence. This article describes a medical-education curriculum and discusses its potential applications for psychology training. The curriculum emphasizes helping learners develop appropriate (a) knowledge of partner-violence issues and dynamics, (b) motivation to identify and help victims and perpetrators, and (c) requisite skills for identification and intervention. Applications of these principles are described and discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward psychology relative to other disciplines.

In a rapidly changing health care marketplace, professional psychologists are increasingly concerned about the public's attitude toward psychology. In two samples, one of the general population and one of college faculty, both psychology and sociology were rated as having made less important contributions to society and as having less expertise than biology, chemistry, medicine, and physics. The implications of these findings are considered in relation to the recent American Psychological Association (APA) public education campaign and the field's century-long concern about the public perception of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Education of medical informatics in Bosnia and Herzegowina

Time of information in which the authors live resulted in the increase of the amount of the information exponential growth of the new kind of knowledge, flourishing of the familiar ones and the appearance of the new sciences. Medical (health) informatics occupies the central place in all the segments of modern medicine in the past 30 years--in practical work, education and scientific research. In all that, computers have taken over the most important role and are used intensively for the development of the health information systems. Following activities develop within the area of health informatics: health-documentation, health-statistics, health-informatics and bio-medical, scientific and professional information. The pioneer in the development of the health statistics and informatics in Bosnia and Herzegovina (BiH) was Dr Evgenije Sherstnew, who was the Chief of Health Statistics in the Ministry of Health of BiH from 1946-1952, and who founded and led, from 1952 to the end of his life, the Department of Medical Documentation and Health Statistics of the Central Health Institute of BiH, the core around which a group of experts for the development of this field have gathered. In the eighties computers were intensively used as a tool for the processing medical data and with them the development of health information systems at the level of the outpatient-clinics, hospitals, clinical centers, as well as the integral information system of health, health insurance and the social security system of BiH began. Finally, Society for Medical Informatics of BiH, which as a professional association gathers experts in the area of health informatics, actively propagates this profession in the Republic, was founded. With reform of the lectures and curriculum at the medical faculty in Sarajevo, the course in 'Medical Informatics' has been in 1992. into the second semester, since it was assumed that an early insight into the principles of information along with studies of so called basic pre-clinic sciences, especially basics of information, would make things easier for the students the more informative education is in the course of their medical studies. The medical faculty in Sarajevo also established and accepted a course of health informatics and economics of post-graduate studies in 1979, of which the main objective is education of experts for work informatics jobs in health care system and services, especially for needs of the future information systems in BiH.     

Assisted suicide: clinical realities and ethical challenges

The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.     

The origin and mode of fibroblast migration and proliferation in granulation tissue

The professions of nursing and medicine are committed to interprofessional education, in the belief that through this, patient care and satisfaction will be improved. Most initiatives involving nurses have been at post-qualification level, in primary health care, and concerning interpersonal or information management skills. Much of this collaboration has been with professions allied to medicine or social services. This paper discusses an innovative programme of shared learning in acute care, involving final year medical students and newly qualified staff nurses. The programme, developed in response to the blurring of professional roles between nurses and junior doctors, took place in our interprofessional Clinical Skills Centre. It was based around a developing patient scenario which was pertinent to the participants' area of practice. Each session was led by an experienced nurse lecturer and doctor, supported by specialist contributors. The style of learning was participative, with small interprofessional groups addressing a range of patient management issues. In this way, relevant clinical and communication skills were integrated within the context of holistic patient care. The course was well evaluated by both professional groups of participants and their managers. Subsequent research and curriculum development are leading to the expansion of this successful initiative.     

Dynein inner arm heavy chain identification in cAMP-activated flagella using class-specific polyclonal antibodies

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.     

State authority, medical dominance, and trends in the regulation of the health professions: the Ontario case

The relationships amongst the health professions and between them and the state are rapidly changing. I argue that analysis of these relationships has to take into consideration: the fact that medicine played an intermediary role (through medical dominance in health care) between the state and the other health occupations; the permeability of the boundaries of the state and the professions; and the dual nature of professional organizations (as sites of intra-occupational conflict and as possible vehicles of extra-occupational control). In Ontario the medical profession partially 'mediated' the relationships between 'non-physician' health occupations and the state through medical control over other health care occupations. National/provincial health insurance brought the state into the health care system as an actor and forced a reconsideration of its relationships with medicine and with the other health care occupations. The state came to be directly involved in 'rationalizing' health care. This involvement meant curbing the power of medicine and modifying the relationships between medicine and the para-medical occupations. State influence is partly constructed through a particular kind of professional organization, namely, the professional College. These changing relationships are illustrated by historical and recent developments regarding medicine, nursing and chiropractic in Ontario.     

The teaching of clinical oncology in Italian medical schools. A survey among teachers and students

BACKGROUND: Oncologists, health care workers and health organizations consider well-performed teaching programs in clinical oncology a fundamental step in cancer control. The aim of our study was to assess the views of teachers and students on the present status of oncology teaching in Italian medical schools and on the most common shortcomings in cancer education. MATERIALS AND METHODS: A survey was carried out among teachers and students of 17 Italian medical schools using two different questionnaires. Six hundred forty-seven students of Northern, Central and Southern Italy in the final two years (5th and 6th) of their medical curriculum and 87 professors of pathology, surgery, internal medicine and medical oncology completed the questionnaires. RESULTS: Doctor/patient relationships and integration among disciplines were the most unsatisfactory aspects of oncology teaching, according to students. Biology, epidemiology, radiotherapy, and medical treatment were felt to be insufficiently treated, whilst diagnostic aspects, clinical management and surgery were rated sufficient. The median number of cancer patients to whom each student had access during his/her training was limited, averaging only 13 patients; however, a high degree of variability was noted. A larger number of patients was generally observed in smaller, less crowded medical schools, with notable exceptions. Although the majority of teachers had clinical practices related to their disciplines, only a small number of students underwent a period of clinical training. Traditional methods of teaching were preferred to innovative methods, while interaction among disciplines was uncommon. CONCLUSIONS: This survey emphasizes the dualism between students' expectations and teachers' ideas about cancer teaching. Doctor/patient relationships and poor attention to practical clinical problems seem the most critical issues for clinical oncology training in Italian medical schools.     

Challenges to Professional Psychology Education in the 21st Century: Response to Peterson.

Professional psychology education faces many critical challenges brought about by the major changes occurring in the health care arena. This article shows that professional schools and programs have a good record of responding to these challenges and of taking proactive steps sponding to prepare their graduates for new health care roles and delivery systems. Data on admissions to psychology doctoral training programs demonstrate little support for the toral concerns raised by Donald R. Peterson (2003, this issue) about the preparation of students for graduate training in professional programs. Although quality concerns are important to investigate, such examination best resides with portant the American Psychological Association's Committee on Accreditation, which has the promotion of quality and excellence in professional psychology education and training as its major goal and responsibility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is imposing risk awareness cultural imperialism?

Epidemiology is the main supplier of "bases of action" for preventive medicine and health promotion. Epidemiology and epidemiologists therefore have a responsibility not only for the quality and soundness of the risk estimates they deliver and for the way they are interpreted and used, but also for their consequences. In the industrialised world, the value of, and fascination with health is greater than ever, and the revelation from epidemiological research of new hazards and risks, conveyed to the public by the media, has become almost an every-day phenomenon. This "risk epidemic" in the modern media is paralleled in professional medical journals. It is in general endorsed by health promoters as a necessary foundation for increased health awareness and a desirable impetus for people to take responsibility for their own health through behavioural changes. Epidemiologists and health promoters, however, have in general not taken the possible side effects of increased risk awareness seriously enough. By increasing anxiety regarding disease, accidents and other adverse events, the risk epidemic enhances both health care dependence and health care consumption. More profoundly, and perhaps even more seriously, it changes the way people think about health, disease and death--and ultimately and at least potentially, their perspective on life more generally. The message from the odds ratios from epidemiological research advocates a rationalistic, individualistic, prospective life perspective where maximising control and minimising uncertainty is seen as a superior goal. The inconsistency between applying an expanded health concept, comprising elements of coping, self-realisation and psycho-physical functioning, and imposing intolerance to risk and uncertainty, is regularly overlooked. Acceptance and tolerance of risk and uncertainty, which are inherent elements of human life, is a prerequisite for coping and self-realisation. A further shift away from traditional working-class values like sociability, sharing, conviviality and tolerance can not be imposed without unwanted side effects on culture and human interaction. The moral and coercive crusade for increased risk awareness and purity in life style can too readily take on the form of cultural imperialism towards conformity. Epidemiologists and the health care movement in general have a mandate to fight disease and premature death; they have no explicit mandate to change culture.     

Developing curricula in spirituality and medicine

In recent years patients and some members of the medical community have expressed the concern that doctors have forgotten about compassion and too often ignore their patients' spiritual concerns. Patients can and should expect their physicians to respect their beliefs and be able to talk with them about spiritual concerns in a respectful and caring manner. Medical schools must teach their students how to meet these expectations, and health care systems need to provide practice environments that foster compassionate caregiving. Medical educators are recognizing the need to bring the art of compassionate caregiving back into the medical school curriculum. This paper focuses on one approach to achieving this goal, the study of spirituality and medicine. The authors discuss the relationship of spirituality and healing, and describe studies that have shown patients' desire to have spiritual issues addressed by their physicians and the potential health benefits of spiritual beliefs. Finally, they describe common elements of the spirituality courses offered by approximately 50 U.S. medical schools, including 19 schools that have been awarded grants from the National Institute for Healthcare Research for the development of curricula in spirituality and medicine.