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弗莱克斯纳时代已然落幕:医学教育体系随时间推移发生转变,逐渐回归到弗莱克斯纳时代之前的状态(去弗莱克斯纳化)。

Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization).

作者信息

Alzerwi Nasser A N

机构信息

Department of Surgery, Majmaah University, Majmaah 11952, Riyadh, Saudi Arabia.

出版信息

World J Clin Cases. 2023 Jul 26;11(21):4966-4974. doi: 10.12998/wjcc.v11.i21.4966.

Abstract

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.

摘要

现代医学教育体系自1910年起逐渐演变,采纳了亚伯拉罕·弗莱克斯纳的建议,他公开揭露了许多医学院校的恶劣条件,为推动改革所需的各方力量提供了一种手段。由于其他改革者与医学教育界有联系,他能说出他们说不出的话。但现在,由于多种原因,我们又回到了弗莱克斯纳时代之前的状态,比如基础科学科目对学生的重要性逐渐降低,临床研究人员发起的研究数量和质量下降,通过详细的临床检查和对体征进行适当观察以做出诊断的床边培训受到的重视减少,而不是过度依赖实验室检查和放射学手段进行诊断,从大学到住院医师培训阶段,基础临床技能的接触机会少,以及学生对理论课和临床/实践课不尊重和旷课的趋势。学生的态度只是完成规定的出勤,以免被禁止参加考试。这种去弗莱克斯纳化的趋势以及回归到弗莱克斯纳时代之前的标准、意识形态、结构、流程和态度,必然会产生弗莱克斯纳时代之前的结果,因为你会得到你所设计的东西。

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