Bates Victoria
Med Hist. 2017 Jan;61(1):48-65. doi: 10.1017/mdh.2016.100.
In the wake of the Second World War there was a movement to counterbalance the apparently increasingly technical nature of medical education. These reforms sought a more holistic model of care and to put people - rather than diseases - back at the centre of medical practice and medical education. This article shows that students often drove the early stages of education reform. Their innovations focused on relationships between doctors and their communities, and often took the form of informal discussions about medical ethics and the social dimensions of primary care. Medical schools began to pursue 'humanistic' education more formally from the 1980s onwards, particularly within the context of general practice curricula and with a focus on individual doctor-patient relationships. Overall from the 1950s to the 1990s there was a broad shift in discussions of the human aspects of medical education: from interest in patient communities to individuals; from social concerns to personal characteristics; and from the relatively abstract to the measurable and instrumental. There was no clear shift from 'less' to 'more' humanistic education, but rather a shift in the perceived goals of integrating human aspects of medical education. The human aspects of medicine show the importance of student activism in driving forward community and ethical medicine, and provide an important backdrop to the rise of competencies within general undergraduate education.
第二次世界大战之后,出现了一场旨在平衡医学教育明显日益技术化本质的运动。这些改革寻求一种更全面的护理模式,并将人——而非疾病——重新置于医疗实践和医学教育的中心。本文表明,学生常常推动了教育改革的早期阶段。他们的创新集中在医生与社区之间的关系上,并且常常采取关于医学伦理和初级保健社会层面的非正式讨论的形式。从20世纪80年代起,医学院校开始更正式地推行“人文”教育,特别是在全科医学课程的背景下,并且侧重于个体医患关系。总体而言,从20世纪50年代到90年代,医学教育人文方面的讨论发生了广泛转变:从对患者群体的关注转向对个体的关注;从社会关切转向个人特质;从相对抽象转向可衡量和实用。并非从“较少”人文教育向“更多”人文教育有明显转变,而是在整合医学教育人文方面的可感知目标上发生了转变。医学的人文方面显示了学生行动主义在推动社区医学和伦理医学发展中的重要性,并为普通本科教育中能力的兴起提供了重要背景。