Allen Dawn, Wainwright Megan, Mount Balfour, Hutchinson Tom
McGill University, Montreal, Canada.
Med Teach. 2008;30(3):260-4. doi: 10.1080/01421590701758665.
This article responds to repeated calls in the literature to teach medical students how to treat the whole patient, not just the disease. It focuses on the educational experiences of medical students in a Canadian university in an effort to clarify the determinants of "caring" in medical education.
Nineteen (19) second-year medical students volunteered to keep weekly journal entries during the first five months of their medical apprenticeship. In journal entry analyses, the authors identified themes through a consensus-building coding process detailed in the work of Maykut and Morehouse (1994) and Huckin (2004). For this article, the authors focus on those themes most closely related to the students' caring experiences during their apprenticeship.
The data highlight components of the medical system which made it difficult for students to engage in caring practices during their apprenticeship: the competing discourses of empathy and efficiency, the objectification of patients, the power of the medical hierarchy, and the institutionalized practice of wounding.
The authors argue that returning medical care and students' experience to a balance of attention to curing and caring is a complex undertaking requiring a re-conceptualization of the process and goals of medical care.
本文回应了文献中多次提出的呼吁，即教导医学生如何治疗完整的患者，而不仅仅是疾病。它聚焦于加拿大一所大学医学生的教育经历，以努力阐明医学教育中“关怀”的决定因素。
19名二年级医学生自愿在医学见习的前五个月每周撰写日志。在日志分析中，作者通过Maykut和Morehouse（1994年）以及Huckin（2004年）著作中详述的共识构建编码过程确定主题。对于本文，作者聚焦于那些与学生见习期间的关怀经历最密切相关的主题。
数据突出了医疗系统中那些使学生在见习期间难以践行关怀行为的因素：共情与效率的相互竞争话语、患者的客体化、医疗等级制度的权力以及制度化的伤害行为。
作者认为，使医疗护理和学生体验回归到治疗与关怀并重的平衡状态是一项复杂的任务，需要重新构想医疗护理的过程和目标。
