Schwartz Alan
Departments of Medical Education and Pediatrics, Mail Code 591, 808 S.Wood Street, 986 CME, University of Illinois at Chicago, Chicago, IL 60612, USA.
Perspect Biol Med. 2011 Winter;54(1):68-74. doi: 10.1353/pbm.2011.0010.
The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.
《弗莱克斯纳报告》强调了教导医学生对不确定性进行推理的重要性。医学决策科学旨在解释医学判断和决策在理想情况下应如何做出、在实际操作中是如何做出的，以及在医学实践的限制条件下如何加以改进。该领域既考虑由个体患者做出或为个体患者做出的临床决策，也考虑旨在造福公众的社会决策。尽管决策制定与医学实践相关，但目前在美国医学院课程中它很少受到正式关注。本文提出医学决策在医学教育中的三个作用。首先，基础决策科学将是医学培训的一个有价值的先决条件。其次，几种与决策相关的能力将是医学教育的重要成果；这些能力包括医生自身的决策技能、在共同决策中指导患者的能力以及在社会层面的卫生政策决策知识。最后，决策制定可以作为医学课程设计中的一个统一原则，围绕培养有能力且有爱心的决策者这一需求整合其他课程内容。
