Ye Hongnan
Department of Academic and Medical Education, Beijing Alumni Association of China Medical University, Beijing, China.
J Patient Exp. 2024 Aug 14;11:23743735241273669. doi: 10.1177/23743735241273669. eCollection 2024.
Patient- and disease-focused clinical teaching is considered the cornerstone of medical education. Current clinical teaching is increasingly taking place in outpatient settings, but this can cause discomfort to patients. Although many professional organizations have developed a set of ethical considerations in response to this issue to use these considerations to guide clinics in their outpatient procedures, these guidelines are not well adhered to in outpatient practice. My experience as an eczema patient in a dermatology outpatient is good evidence of this. In my opinion, there is nothing inherently wrong with the pedagogy of medical students observing clinical interactions in outpatient settings; the real problem lies in not informing the patient of the medical student's presence or allowing the patient to exercise his or her right of refusal. Therefore, the following recommendations are made: First, academic medical centers should provide regular training to doctors and medical students to ensure that they are fully aware of what is contained in the ethical guidelines established by the professional organizations and that they recognize the importance of adhering to these guidelines in clinical practice. Second, each clinical teaching activity should have the informed consent of the patient and be based on the patient's wishes. Finally, it is recommended that hospitals establish appropriate evaluation mechanisms to assess doctors' compliance with the ethical guidelines and provide continuing education and training for doctors and medical students who fail to comply.
以患者和疾病为中心的临床教学被视为医学教育的基石。当前的临床教学越来越多地在门诊环境中进行,但这可能会给患者带来不适。尽管许多专业组织已针对此问题制定了一系列伦理考量,以利用这些考量指导诊所的门诊程序,但这些指南在门诊实践中并未得到很好的遵守。我作为一名皮肤科门诊湿疹患者的经历就是很好的证明。在我看来,医学生在门诊环境中观察临床互动的教学方法本身并没有错;真正的问题在于没有告知患者医学生的存在,或者没有让患者行使其拒绝权。因此,提出以下建议:第一,学术医疗中心应定期对医生和医学生进行培训,以确保他们充分了解专业组织制定的伦理指南内容,并认识到在临床实践中遵守这些指南的重要性。第二,每项临床教学活动都应获得患者的知情同意,并基于患者的意愿。最后,建议医院建立适当的评估机制,以评估医生对伦理指南的遵守情况,并为未遵守的医生和医学生提供继续教育和培训。