Abstract:
OBJECTIVES:To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS:A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS:The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS:Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
journal_name
Med Educjournal_title
Medical educationauthors
Salmon P,Young Bdoi
10.1111/medu.13204subject
Has Abstractpub_date
2017-03-01 00:00:00pages
258-268issue
3eissn
0308-0110issn
1365-2923journal_volume
51pub_type
杂志文章,评审abstract::In a study of the development of professional attitudes in medical students, a modified version of the Medical Attitudes Inventory (Harris, 1974) was administered to 141 male and female first year medical students in Lagos, Nigeria. The results show that the students have well-defined attitudes on certain issues and a...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1978.tb01417.x
更新日期:1978-11-01 00:00:00
abstract:OBJECTIVES:Educational interventions may ultimately impact on patient care as well as affecting individuals' learning. Critical evaluation of educational literature by those involved in designing and developing educational interventions is therefore important. A checklist instrument for critically appraising reports of...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.1999.00479.x
更新日期:1999-12-01 00:00:00
abstract:CONTEXT:The responsibility to determine just who is competent to practice medicine, and at what standard, is great. Whilst there is still a period available for potential remediation, examinations at the completion of year three of the four-year Graduate Entry Medical Programme (GEMP) at Flinders University of South Au...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2000.00690.x
更新日期:2000-05-01 00:00:00
abstract::In order to provide "horizontal" integration of related clinical subjects, a combined teaching course in community medicine, general practice, geriatric medicine and mental health has been devised. The course lasts 12 weeks and is divided between joint teaching of topics of common interest and clinical clerkships in i...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1982.tb01074.x
更新日期:1982-05-01 00:00:00
abstract:OBJECTIVE:To develop and assess the feasibility and psychometric properties of multi-source feedback questionnaires to monitor international medical graduates practising in Canada under 'defined' licences. METHOD:Four questionnaires (patient, co-worker, colleague and self) were developed and administered in 2 phases t...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2929.2006.02410.x
更新日期:2006-04-01 00:00:00
abstract:PURPOSE:Implementing problem-based learning (PBL) in the clinical years of a medical degree presents particular challenges. This study investigated the effectiveness of using an online Clinical Reasoning Guide to assist integration of PBL in the clinical setting and promote further development of students' clinical rea...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2929.2004.01839.x
更新日期:2004-06-01 00:00:00
abstract:CONTEXT:Prior studies suggest that clinicians can categorise patients in an emergency room as 'sick' or 'not sick' using rapid visual assessment. The rapid nature of these decisions suggests clinicians are relying on pattern recognition or System 1 processing; however, this has not been studied experimentally. In this ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.13396
更新日期:2017-11-01 00:00:00
abstract::The development of published material relating to the practice of medicine in multiracial and multicultural Britain is briefly reviewed. The utilization of such information in English medical schools is found to be absent or at a low level of priority. A more detailed study of one region demonstrates that junior hospi...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1986.tb01388.x
更新日期:1986-11-01 00:00:00
abstract::Reasons for choosing dentistry as a profession were analysed among first-year dental students at the University of Toronto. The motivations of various sub-groups were also examined. It was found that an extrinsic motivation, financial rewards, was the most widespread, although the other widely chosen motivations refer...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1977.tb00578.x
更新日期:1977-03-01 00:00:00
abstract::The housemanship performance of the first two classes of the University of Gezira Medical School was assessed on 107 occasions by using a questionnaire administered to the senior doctors (consultants) in the units in which they worked and the data, which covered 32% of all housemanship rotations taken by these graduat...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1992.tb00159.x
更新日期:1992-05-01 00:00:00
abstract::The central premise of this paper is that medical education today is being driven by intellectual and social imperatives to make fundamental changes in the way it prepares students to be the doctors of tomorrow. Fully aware that over the past 50 years at least eight major national commissions in the USA alone have mad...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1995.tb02897.x
更新日期:1995-01-01 00:00:00
abstract::It is important to provide an epidemiological presence when teaching clinical medicine to undergraduate medical students in order to supply the underlying facts about disease. A series of pictorial or tabular presentations which together make up a 'master set' of Data Boards has been designed to give the medical stude...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1976.tb00480.x
更新日期:1976-11-01 00:00:00
abstract::At the mid-term test in Part I Physiology at the University of Zagreb the students (n = 280) were graded by our standard pass level (SPL) arbitrarily set at 54% correct answers (SPL = 0.54). The test consisted of 50 items of the one best answer type. Items were selected from the pool by one examiner to conform, by his...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1994.tb02552.x
更新日期:1994-09-01 00:00:00
abstract::Medical education is primarily about training physicians and maintaining their capabilities over time. Given that physicians are the primary focus of the field, there is a need for a clear idea of what physicians are or could be. This paper seeks to explore this issue by posing the simple question: ?Where do physician...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.13095
更新日期:2016-12-01 00:00:00
abstract:CONTEXT:A new student selection instrument has been designed to assess candidate suitability for a problem-based learning, small group curriculum. OBJECTIVE:To evaluate the performance of the new teamwork selection instrument in terms of its discriminatory power, fairness, validity, reliability and acceptability among...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2929.2005.02086.x
更新日期:2005-03-01 00:00:00
abstract::By providing injecting equipment to drug misusers, community pharmacists in the UK may become involved in preventing the spread of HIV via the intravenous route. Over 60% of pharmacy graduates from the School of Pharmacy enter community pharmacy and, as part of their undergraduate course, attend a series of lectures a...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1994.tb02725.x
更新日期:1994-11-01 00:00:00
abstract::An account is given of the introduction of MCQ in an Indian Medical institution in 1974/75. Preliminary results suggest that the reliability coefficient of MCQs rises with their difficulty, and that Pearson-type coefficient indicates a higher degree of correlation with essay marks than do Spearman coefficients. A 'stu...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1978.tb00352.x
更新日期:1978-07-01 00:00:00
abstract:CONTEXT:About 40% of British General Practitioners (GPs) train formally in a psychiatric post as part of their general practice training, but such training may not fully meet the needs of future GPs. A specific course in psychiatry for family doctors has run in Manchester for more than a decade. METHOD:Semi-structured...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.1999.00343.x
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2929.2006.02612.x
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Given the complexity of competency frameworks, associated skills and abilities, and contexts in which they are to be assessed in competency-based education (CBE), there is an increased reliance on rater judgements when considering trainee performance. This increased dependence on rater-based assessment has l...
journal_title:Medical education
pub_type: 杂志文章,评审
doi:10.1111/medu.12973
更新日期:2016-05-01 00:00:00
abstract:CONTEXT:There is a growing literature on diagnostic errors. The consensus of this literature is that most errors are cognitive and result from the application of one or more cognitive biases. Such biased reasoning is usually associated with 'System 1' (non-analytic, pattern recognition) thinking. METHODS:We review thi...
journal_title:Medical education
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2923.2009.03507.x
更新日期:2010-01-01 00:00:00
abstract::There is evidence that nurses fulfil the requirements of objective judgement better than doctors. Simulation of Initial Medical Problem-Solving (SIMP), a paper-and-pencil test for the assessment of medical problem-solving, consists of case histories, followed by an open-ended question. The scoring of open-ended questi...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1989.tb01564.x
更新日期:1989-07-01 00:00:00
abstract::This study was undertaken to measure the prevalence of psychological morbidity, and the nature and source of stress, in first year medical students. Two hundred and four first year medical students at a university in the north of England were sent a postal, self-report questionnaire. They were asked to complete the Ge...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1995.tb00022.x
更新日期:1995-09-01 00:00:00
abstract::To determine whether admission interviews could differentiate applicants on their personal qualities (such as integrity, empathy and commitment) 456 applicants from two medical schools were tested on the Defining Issues Test (DIT), which measures the amount of principled or post-conventional moral reasoning. No differ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1984.tb01297.x
更新日期:1984-11-01 00:00:00
abstract::Continuing education should be convenient, relevant, individualized, systematic and include means of assessment. Educational technology provides the link between teaching and learning; it should accommodate the essential interactions between learner, instructor, environment and material. Media in open learning systems...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1985.tb01328.x
更新日期:1985-07-01 00:00:00
abstract:CONTEXT:Effective communication skills are at the core of good health care. Simulated patients (SPs) are increasingly engaged as an interactive means of teaching, applying and practising communication skills with immediate feedback. There is a large body of research into the use of manikin-based simulation but a gap ex...
journal_title:Medical education
pub_type: 杂志文章,评审
doi:10.1111/medu.13387
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVES:Although peer-assisted learning (PAL) is widely employed throughout medical education, its effectiveness for training in technical procedures in skills laboratories has been subject to little systematic investigation. We conducted a prospective, randomised trial to evaluate the hypotheses that PAL is effecti...
journal_title:Medical education
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1365-2923.2008.03252.x
更新日期:2009-02-01 00:00:00
abstract:CONTEXT:Simulated clinical immersion (SCI), in which clinical situations are simulated in a realistic environment, safely and gradually exposes novices to complex problems. Given their limited experience, undergraduate students can potentially be quite overwhelmed by SCI learning tasks, which may result in misleading l...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.13748
更新日期:2019-04-01 00:00:00
abstract::The diagnostic thinking process is often described as one of hypothesis generation and testing. Yet descriptions of the clinical problem solver's thinking prior to generation of the first diagnostic hypothesis are lacking. This paper reports a study of this phase in students, house officers and registrars. Theories of...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1982.tb01214.x
更新日期:1982-01-01 00:00:00
abstract:INTRODUCTION:We describe the steps taken to develop an appropriate list of 'clinical problems' used to define the content of the objective structured clinical examination (OSCE) component of the Professional and Linguistic Assessments Board (PLAB) examination. METHOD:A blueprint and list of 255 clinical problems was c...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2000.00553.x
更新日期:2000-07-01 00:00:00