医学职业精神：明日医生的矛盾价值观。
Medical professionalism: conflicting values for tomorrow's doctors.
机构信息
General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK.
出版信息
J Gen Intern Med. 2010 Dec;25(12):1330-6. doi: 10.1007/s11606-010-1485-8. Epub 2010 Aug 26.
BACKGROUND
New values and practices associated with medical professionalism have created an increased interest in the concept. In the United Kingdom, it is a current concern in medical education and in the development of doctor appraisal and revalidation.
OBJECTIVE
To investigate how final year medical students experience and interpret new values of professionalism as they emerge in relation to confronting dying patients and as they potentially conflict with older values that emerge through hidden dimensions of the curriculum.
METHODS
Qualitative study using interpretative discourse analysis of anonymized student reflective portfolios. One hundred twenty-three final year undergraduate medical students (64 male and 59 female) from the University of Cambridge School of Clinical Medicine supplied 116 portfolios from general practice and 118 from hospital settings about patients receiving palliative or end of life care.
RESULTS
Professional values were prevalent in all the portfolios. Students emphasised patient-centered, holistic care, synonymous with a more contemporary idea of professionalism, in conjunction with values associated with the 'old' model of professionalism that had not be directly taught to them. Integrating 'new' professional values was at times problematic. Three main areas of potential conflict were identified: ethical considerations, doctor-patient interaction and subjective boundaries. Students explicitly and implicitly discussed several tensions and described strategies to resolve them.
CONCLUSIONS
The conflicts outlined arise from the mix of values associated with different models of professionalism. Analysis indicates that 'new' models are not simply replacing existing elements. Whilst this analysis is of accounts from students within one UK medical school, the experience of conflict between different notions of professionalism and the three broad domains in which this conflict arises are relevant in other areas of medicine and in different national contexts.
背景
与医学职业精神相关的新价值观和新实践引发了人们对此概念日益浓厚的兴趣。在英国，这是医学教育以及医生评估和再认证发展中的一个当前关注点。
目的
调查即将毕业的医学生在面对临终患者时如何体验和解释新的职业价值观，以及这些新价值观如何与通过课程隐藏维度浮现出的旧价值观发生潜在冲突。
方法
采用解释性话语分析方法，对剑桥大学临床医学院 123 名即将毕业的本科生（64 名男性，59 名女性）的匿名学生反思性组合进行了定性研究。这些学生来自于普通科实践和医院环境，共提供了 116 份关于接受姑息治疗或临终关怀的患者的组合，以及 118 份关于姑息治疗或临终关怀的患者的组合。
结果
所有组合中都普遍存在职业价值观。学生强调以患者为中心、全面的关怀，这与更现代的职业精神理念是一致的，同时也强调了与他们未直接教授的“旧”职业精神模式相关的价值观。整合“新”职业价值观有时会出现问题。确定了三个潜在冲突的主要领域：伦理考虑、医患互动和主观界限。学生明确和间接地讨论了一些紧张关系，并描述了解决这些问题的策略。
结论
概述的冲突源于与不同职业精神模式相关的价值观的混合。分析表明，“新”模式并不是简单地取代现有元素。虽然这项分析是基于英国一所医学院学生的描述，但不同职业精神观念之间的冲突以及这种冲突出现的三个广泛领域在医学的其他领域和不同的国家背景下都是相关的。
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