Department of Medicine, Centre for Medical Education, McGill University, Montréal, Québec, Canada.
Acad Med. 2010 Feb;85(2):378-83. doi: 10.1097/ACM.0b013e3181c87221.
Contemporary medicine is characterized by dualities. They include psyche and soma, subject and object, and, most important, science and humanism. The authors, in exploring Flexner's landmark publication, suggest that the history of curricular evolution has been marked by a quest for the integration of two knowledge bases: science and clinical medicine. They describe this goal as a preoccupation of medical educators, arguing that it was triggered, in part, by Flexner's recommendation for a two-phase curriculum. Their claim is illustrated with an analysis of motives for curricular renewal at one medical school and a review of published reports from educational opinion leaders. They discuss Flexner's conception of integration-namely, that unity could be achieved through methodology and, in particular, through inductive reasoning. They situate this perspective in the context of other purported integrative principles such as bioethics, narrative medicine, and the biopsychosocial model. They conclude by recommending an alternative framework for integration. The authors propose that a synthesis of two separate knowledge domains can be achieved through a common purpose and that, in a clinical context, that purpose is the well-being of the patient. Well-being is defined as the patient's ability to pursue achievable goals and purposes. It can be brought about by changing medicine's emphasis from the eradication of disease to the restoration of functions impaired by sickness. This idea is congruent with aspects of Flexner's understanding of medical practice, as shown in his statement that the restoration of normal functioning should be the doctor's "goal in action."
当代医学的特点是双重性。它们包括精神与肉体、主体与客体，最重要的是，科学与人文。作者在探讨弗莱克斯纳的里程碑式著作时指出，课程演变的历史一直以寻求整合两个知识基础为标志：科学和临床医学。他们将这一目标描述为医学教育者关注的焦点，认为这在一定程度上是弗莱克斯纳推荐两阶段课程所引发的。他们通过对一所医学院课程更新动机的分析以及对教育意见领袖发表的报告的回顾来说明这一目标。他们讨论了弗莱克斯纳对整合的构想，即通过方法论，特别是通过归纳推理，可以实现统一。他们将这一观点置于其他所谓的整合原则的背景下，如生物伦理学、叙事医学和身心社会模式。最后，他们推荐了一种整合的替代框架。作者提出，通过共同的目标，可以实现两个独立知识领域的综合，而在临床环境中，这一目标是患者的福祉。福祉是指患者追求可实现的目标和目的的能力。它可以通过改变医学的重点，从消除疾病转变为恢复疾病所损害的功能来实现。这一理念与弗莱克斯纳对医学实践的理解的某些方面是一致的，正如他在声明中所说，恢复正常功能应该是医生“行动的目标”。
