Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.
Med Educ. 2021 Apr;55(4):530-540. doi: 10.1111/medu.14428. Epub 2020 Dec 20.
Medical school accreditation is recognised internationally as an important quality control process for programmes that lead to the Medical Doctor (MD) degree. Accreditation standards govern the accreditation process which in turn drives educational objectives. Given the power of these standards to shape what becomes valued in the curricula, it is therefore imperative to ensure that core values and ideals of the profession are meaningfully incorporated. As the provision of compassionate care has long been a central medical value, this value should be clearly articulated in MD programme accreditation standards.
We conducted a Critical Discourse Analysis of compassionate care within Undergraduate Medical Education (UME) Accreditation Standards governing North American medical schools since 1957. We explored how and to what extent the written language of the accreditation standards incorporated compassionate care.
References to compassionate care in the UME Accreditation Standards were few and far between. Historically, a statement of 'The Objectives of Undergraduate Medical Education' published by the Association of American Medical Colleges (AAMC) was referenced for the first and only time in the 1957 standards, describing the development of attributes such as the provision of compassionate care as a basic objective of UME. Thereafter, there was infrequent mention of this value. Terms that could potentially incorporate aspects of compassionate care were identified, yet these were explicated in ways that limited connection to compassion. Instead, the term 'care' has increasingly been used instrumentally (ie acute care, chronic care).
The relative absence of language pertaining to compassionate care in accreditation standards is troubling as compassion is integral to good medical care. This absence is particularly important to attend to in the current era of competency-based training where we must be explicit about all important curricular objectives lest essential values and practices be unintentionally lost.
医学院校认证在国际上被公认为是对导致医学博士（MD）学位的项目进行质量控制的重要手段。认证标准管理着认证过程，而认证过程反过来又推动了教育目标。鉴于这些标准有塑造课程中被重视的内容的力量，因此必须确保专业的核心价值观和理想得到有意义的体现。由于关爱患者一直是医学的核心价值观之一，因此该价值观应明确纳入 MD 项目认证标准。
我们对自 1957 年以来规范北美的医学院校本科医学教育（UME）认证标准中关爱患者的内容进行了批判性话语分析。我们探讨了认证标准中的书面语言是如何以及在何种程度上纳入了关爱患者。
在 UME 认证标准中，提到关爱患者的内容很少。历史上，美国医学院协会（AAMC）首次也是唯一一次在 1957 年的标准中提到“本科医学教育的目标”，描述了培养关爱患者等属性的发展，这是 UME 的基本目标之一。此后，很少再提到这一价值观。虽然确定了一些可能包含关爱患者方面的术语，但这些术语的解释方式限制了与同情的联系。相反，“关怀”一词越来越多地被工具化（即急性关怀、慢性关怀）。
认证标准中与关爱患者相关的语言相对缺失令人担忧，因为同情是良好医疗保健的重要组成部分。在以能力为基础的培训时代，这种缺失尤其值得关注，因为我们必须明确所有重要的课程目标，以免无意中失去必要的价值观和实践。
