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在具备结构胜任力的医学课程中为残疾研究留出空间:关于长期新冠的思考

Making space for disability studies within a structurally competent medical curriculum: reflections on long Covid.

作者信息

Hunt Joanne

机构信息

Independent disabled researcher, Stroud, Gloucestershire, UK

出版信息

Med Humanit. 2022 Jul 19. doi: 10.1136/medhum-2022-012415.

Abstract

While critically informed approaches to medical education are increasingly advocated in literature, discussion of the potential role of disability studies in informing pedagogy and practice is largely lacking. The emergence of long Covid, alongside the strong possibility of a wave of covid-related disability, underlines an urgent need for medicine to develop more contextualised, nuanced and structurally competent understandings of chronic illness and disability. This article argues that the integration of thinking from disability studies into medical curricula offers a pathway to such understanding, informing a more equitable, holistic and patient-centred approach to practice. Further, a structurally competent, antiableist approach positions clinicians and patients as allies, working together within a structural context that constrains both parties. Such positioning may mitigate tensions within the clinical encounter, tensions that are well documented in the realm of marginalised chronic illness and disability. While the possibilities arising from a partnership between disability studies and medicine are numerous, the foci here are the social relational model of disability and the concept of psycho-emotional disablism, within a broader framework of critical disability studies. It is argued that inadequate healthcare provision and policy in the realm of long Covid can be understood as a form of structural and psycho-emotional disablism, arising from and reinforcing an ableist psychosocial imaginary permeated with neoliberal assumptions, and carrying a risk of furthering both disability and impairment. After considering long Covid through these particular lenses, the article concludes with a discussion of how a partnership between disability studies and a structurally competent approach to medical education might translate into practice.

摘要

虽然文献中越来越多地倡导对医学教育采取批判性的知情方法,但在很大程度上缺乏对残疾研究在为教学法和实践提供信息方面潜在作用的讨论。长期新冠后遗症的出现,以及与新冠相关的残疾浪潮的极大可能性,凸显了医学迫切需要对慢性病和残疾形成更具情境化、细致入微且具备结构胜任力的理解。本文认为,将残疾研究的思想融入医学课程提供了一条通往这种理解的途径,为更公平、全面且以患者为中心的实践方法提供了信息。此外,一种具备结构胜任力的反能力主义方法将临床医生和患者定位为盟友,在一个对双方都有制约的结构背景下共同努力。这种定位可能会缓解临床接触中的紧张关系,这种紧张关系在边缘化慢性病和残疾领域有充分记载。虽然残疾研究与医学之间的伙伴关系产生的可能性众多,但这里的重点是在批判性残疾研究的更广泛框架内的残疾社会关系模型和心理情感能力主义概念。有人认为,长期新冠后遗症领域医疗保健提供和政策的不足可被理解为一种结构和心理情感能力主义的形式,它源于并强化了一种充满新自由主义假设的能力主义社会心理想象,并存在加剧残疾和损伤的风险。通过这些特定视角审视长期新冠后遗症后,本文最后讨论了残疾研究与具备结构胜任力的医学教育方法之间的伙伴关系如何转化为实践。

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