Kenny Nuala P, Mann Karen V, MacLeod Heather
Department of Bioethics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
Acad Med. 2003 Dec;78(12):1203-10. doi: 10.1097/00001888-200312000-00002.
Forming technically proficient, professional, and humanistic physicians for the 21st century is no easy task. Mountains of biomedical knowledge must be acquired, diagnostic competence achieved, effective communication skills developed, and a solid and applicable understanding of the practice and role of physicians in society today must be reached. The central experience for learners in this complex and challenging terrain is the "modeling of" and "learning how to be" a caregiver and health professional. Role modeling remains one crucial area where standards are elusive and where repeated negative learning experiences may adversely impact the development of professionalism in medical students and residents. The literature is mainly descriptive, defining the attributes of good role models from both learners and practitioners' perspectives. Because physicians are not "playing a role" as an actor might, but "embodying" different types of roles, the cognitive and behavioral processes associated with successfully internalizing roles (e.g., the good doctor/medical educator) are important. In this article, the authors identify foundational questions regarding role models and professional character formation; describe major social and historical reasons for inattention to character formation in new physicians; draw insights about this important area from ethics and education theory (philosophical inquiry, apprenticeship, situated learning, observational learning, reflective practice); and suggest the practical consequences of this work for faculty recruitment, affirmation, and development.
培养21世纪技术熟练、专业且有人文素养的医生并非易事。必须掌握海量的生物医学知识,具备诊断能力,培养有效的沟通技巧,并且对当今医生在社会中的实践和角色有扎实且适用的理解。在这片复杂且具有挑战性的领域中,学习者的核心体验是“塑造”以及“学习如何成为”一名护理人员和健康专业人员。榜样示范仍然是一个关键领域,在这个领域中标准难以捉摸,反复的负面学习经历可能会对医学生和住院医生的职业素养发展产生不利影响。文献主要是描述性的,从学习者和从业者的角度定义了优秀榜样的特质。由于医生并非像演员那样“扮演一个角色”,而是“体现”不同类型的角色,与成功内化角色(例如,优秀医生/医学教育工作者)相关的认知和行为过程很重要。在本文中,作者确定了关于榜样和职业品格形成的基本问题;描述了新医生忽视品格形成的主要社会和历史原因;从伦理学和教育理论(哲学探究、学徒制、情境学习观察学习、反思性实践)中汲取了关于这一重要领域的见解;并提出了这项工作对教师招聘、认可和发展的实际影响。