Maudsley G, Strivens J
Department of Public Health, The University of Liverpool, Liverpool, UK.
Med Educ. 2000 Jan;34(1):53-60. doi: 10.1046/j.1365-2923.2000.00428.x.
The recommendations of the General Medical Council in Tomorrow's Doctors renewed efforts to define core knowledge in undergraduate medical education. They also encouraged better use of the medical knowledge base in nurturing clinical judgement, critical thinking, and reflective practice. What then does the medical world understand by 'science', 'critical thinking' and 'competence', given the need to address both growth and uncertainty in the knowledge base and to practise evidence-based healthcare?
This review aims to outline the role of these key concepts in preparing undergraduate medical students for professional practice. Specifically, it explores: the fallibility of the 'scientific' foundations of medical practice; the role of understanding and thinking in undergraduate medical education; the need for a broad interpretation of competence and its relationship to transferability, and the nature of clinical judgement.
Tensions are seen to lie in the varying interpretations of clinical decision making as art or science; the varying characterizations of the nature of skilled performance in the novice, the competent and the expert practitioner, and the varying reactions to the acceptability and usefulness of 'meta-' concepts in capturing the essence of professional practice. Habitual self-conscious monitoring of mental processes may be the key to the flexible transfer and application of knowledge and skills across the contexts, characterized by uncertainty and incomplete evidence, for which doctors must be prepared.
英国医学总会在《明日之医》中的建议再次推动了在本科医学教育中界定核心知识的努力。这些建议还鼓励在培养临床判断力、批判性思维和反思性实践中更好地利用医学知识库。鉴于需要应对知识库中的增长和不确定性并践行循证医疗，那么医学界对“科学”“批判性思维”和“能力”是如何理解的呢？
本综述旨在概述这些关键概念在使本科医学生为专业实践做好准备方面的作用。具体而言，它探讨了：医学实践“科学”基础的易错性；理解和思维在本科医学教育中的作用；对能力进行宽泛解释的必要性及其与可转移性的关系，以及临床判断力的本质。
临床决策被视为艺术还是科学，对此存在不同解读；新手、有能力的从业者和专家型从业者的技能表现本质有不同描述；对于“元”概念在把握专业实践本质方面的可接受性和有用性也有不同反应，这些方面都存在紧张关系。习惯性地对心理过程进行自我意识监测可能是在不确定性和证据不完整的情况下灵活转移和应用知识与技能的关键，而医生必须为此做好准备。
