國防醫學院2019年國際醫學教育研討會 灌注醫學人文於臨床醫學教育
Donald Boudreau
PhD, RN, FAAN, FNAP
Interim Chief Officer/EVP
Vice President, Accreditation Program and Institute for Credentialing Research
Director, Accreditation Program
American Nurses Credentialing Center
Silver Spring, MD
09:10 - 10:00
Physicianship
Teaching Ways of Knowing, Doing, and Being
Medicine has been defined as the curing of an illness or an injury. The process of curing ― the rooting out or elimination of disease ― is often considered by contemporary society as something reducible to biomedical science and technical expertise. In order to represent a more complete picture of medical practice, one that is more reassuring to the public, an ingredient of human solicitude has often been added. However, the core has remained unshakably scientific in its essence. The application of the theories and methods of science, along with a human and humane touch, has been described as a ‘dual discourse’. The duality comes in many forms: competence + compassion; science + art; soma + psyche; disease + illness; curing + healing. These dual conceptions of medicine have tended to relegate the social sciences and humanities to a secondary and supportive role.
There are alternative perspectives of medical practice. The Aristotelian concept of phronesis provides an avenue through which medical practice can be visualized as a unique and holistic human endeavor, one that is equally adept at dealing with individual and universal truths, that honors subjective as well as objective knowledge, and that recognizes the central importance of the personhood of patients and physicians. Medicine is sui generis. It is science using while it is interpretive and inter-subjective.
The notion of ‘physicianship’ opens up possibilities for an integrated and relationship-based approach to medicine. Physicianship highlights the roles of the physician as a healer and a professional. It too represents a duality, but one where healing is considered the primary mandate and professionalism is an organizing principle. Helping students acquire physicianship requires teaching ‘knowing’ (a disciplinary knowledge base), ‘doing’ (specific technical skills), as well as ‘being’ (the role modeling of unique behaviours and a physician’s identity). Demonstrating and inculcating physicianship depends, in part, on an approach to clinical methods and clinical thinking that has a bifocal perspective: one where identifying and applying general knowledge is balanced with the seeking and using of knowledge of particulars. In current medical education practices, the former has enjoyed hegemonic status. As a community of practitioners intent on instilling humanism in medical education, we can reap many benefits by deploying strategies to teach about the particular in addition to teaching about the general. These strategies include the explicit teaching of observation, listening and reflection.
Donald Boudreau
Institution :
Institute of Health Sciences Education, McGill University, Montreal, Canada
Position :
Former Associate Dean for Medical Education and Student Affairs
Director, Respiratory Division, Montreal General Hospital
09:10 - 10:00
Physicianship
Teaching Ways of Knowing, Doing, and Being
Medicine has been defined as the curing of an illness or an injury. The process of curing ― the rooting out or elimination of disease ― is often considered by contemporary society as something reducible to biomedical science and technical expertise. In order to represent a more complete picture of medical practice, one that is more reassuring to the public, an ingredient of human solicitude has often been added. However, the core has remained unshakably scientific in its essence. The application of the theories and methods of science, along with a human and humane touch, has been described as a ‘dual discourse’. The duality comes in many forms: competence + compassion; science + art; soma + psyche; disease + illness; curing + healing. These dual conceptions of medicine have tended to relegate the social sciences and humanities to a secondary and supportive role.
There are alternative perspectives of medical practice. The Aristotelian concept of phronesis provides an avenue through which medical practice can be visualized as a unique and holistic human endeavor, one that is equally adept at dealing with individual and universal truths, that honors subjective as well as objective knowledge, and that recognizes the central importance of the personhood of patients and physicians. Medicine is sui generis. It is science using while it is interpretive and inter-subjective.
The notion of ‘physicianship’ opens up possibilities for an integrated and relationship-based approach to medicine. Physicianship highlights the roles of the physician as a healer and a professional. It too represents a duality, but one where healing is considered the primary mandate and professionalism is an organizing principle. Helping students acquire physicianship requires teaching ‘knowing’ (a disciplinary knowledge base), ‘doing’ (specific technical skills), as well as ‘being’ (the role modeling of unique behaviours and a physician’s identity). Demonstrating and inculcating physicianship depends, in part, on an approach to clinical methods and clinical thinking that has a bifocal perspective: one where identifying and applying general knowledge is balanced with the seeking and using of knowledge of particulars. In current medical education practices, the former has enjoyed hegemonic status. As a community of practitioners intent on instilling humanism in medical education, we can reap many benefits by deploying strategies to teach about the particular in addition to teaching about the general. These strategies include the explicit teaching of observation, listening and reflection.
Jung-Yul Park
Institution :
Korea University College of Medicine, Seoul, South Korea
Position :
Professor of Medical Humanities & Medical Education
former Chairman, Department of Neurosurgery
Director, Spine and Pain Center, Korea University Anam Hospital
10:10 - 11:00
Past and Current Status of
Postgraduate Medical Education
in Korea: What needs to be changed?
The medical act for specialist in Korea was set by the government in 1951. In 1960, the first specialist examination was conducted in 10 specialties and the number of specialties increased to 26 in 1996. The quality management of resident education was started by legal mandate in mid 80s which consisted of three methods: checking the annual training requirement by resident year in each specialty set by the law, the training hospital accreditation visit conducts by Korean Hospital Association, and the clinical division site visit which takes 2-3 hours at each teaching hospital conducted by specialty societies. These methods all aim at quality supervision and promotion of resident training in pursuit of medical excellence. The teaching hospital visit is conducted through a total 5-day evaluation with a group of 7 to 8 individuals visiting university hospitals with 500 or more bed capacity. The accreditation visit for the teaching hospital is to check the compliance of the legal requirements/standards which are mostly input oriented rather than process or outcomes. The Ministry of Health and Welfare is the overarching body to overview all the quality issues. However, the teaching hospital visit is rather institutional evaluation rather than program evaluation, and the result from recent study done by Korean Resident Association claimed that this type of quality assurance measure, based could not improve the quality of resident education nor it led the safe learning environment. They also claimed that it should be changed into outcome based program type evaluation conducted by 3rd party not by hospital association. The author will discuss the current accreditation system based on legal requirements and address the some of the issues for the quality enhancement of postgraduate medical education in Korea which may provide more insights for future direction.
Nobuo Nara
Institution :
Japan Accreditation Council for Medical Education (JACME), Tokyo, Japan
Position :
Executive Director, JACME
Appointed Professor, National Institution for Academic Degrees and Quality Enhancement of Higher Education
Emeritus Professor, Tokyo Medical and Dental University
11:00 - 11:50
Professionalism and Ethics in Medical Education-
Humanity and Empathy
Physicians must take care of patients with not only physical but also mental problems. Patients suffer from some diseases with physical weakness which may also bring fears of death, permanent damage, losing occupation or money, etc. Physicians must cure their diseases with the most recent medical knowledge and excellent medical procedures. In addition, physicians sincerely have to provide emotional support and interact with patients’ families. Through relieving both physical and mental burdens from the patients and their families, physicians improve patients’ health and wellness.
Medical education in 21st century has shifted from the traditional time-based or process-based education to the competency-based or outcome-based education. The Accreditation Council for Graduate Medical Education (ACGME) in the US describes the core competencies which graduates from medical schools must demonstrate. These core competencies include patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice. Our university, Juntendo University, also defines the core competencies for graduates to demonstrate at graduation. They are medical practice and patient care, medical knowledge, safety in medical practice, team-based health care, communication skills, medical practice in society, ethics and professionalism, attitude for life-long learning, and pride and responsibility as a graduate from Juntendo University School of Medicine. Among these competencies, professionalism might be most important.
Japanese medical schools have introduced model core-curriculum proposed by the Ministry of Education since 2001. In this model core-curriculum, all medical students are requested to learn professionalism and ethics. Major topics in professionalism education include role and responsibilities of a physician, responsibilities in a society, respect for patients, trust, honesty, responsibilities for patient safety, good communication, respect for professional boundaries, ethics, unprofessional behavior etc.
In this symposium, we would describe the present medical education in Japan, focusing on the professionalism and ethics.
Yan-Di Chang
張燕娣
Institution :
National Defense Medical Center, Taipei, Taiwan
Position :
Deputy Director, Center for Medical Humanities Education
11:50 - 12:30
Embodied Learning in
Medical Education
How does one learn and perfect a skill or technique? Within a profession, why do only a few become masters while most remain craftsmen? In this talk, I shall first compare similarities between how chefs learn to cook a bowl of ramen and how medical apprentices acquire surgical skills. I argue that awareness of one’s body posture and arm movements are essential to performing a particular technique well. As one moves up the ladder of expertise, it is attention to details that distinguishes a master from an ordinary craftsman. This can be accomplished through mindfulness and constant thinking about what one is doing. I shall then share with the audience how educators may teach students to acquire skills and techniques more effectively. This is accomplished mainly through dance or theatre that require learners to imitate others’ actions and the use of reflective writing to heighten one’s awareness of one’s actions. Such training facilitates one to get the “feel” of the process. When applied to teaching about patients with certain ailments, it may also allow students to understand how those patients feel and even think. Thus we can teach empathy and instill humanism in medical education.
Donald Boudreau
Institution :
Institute of Health Sciences Education, McGill University, Montreal, Canada
Position :
Former Associate Dean for Medical Education and Student Affairs
Director, Respiratory Division, Montreal General Hospital
13:30 - 17:00
Workshop: Strategies in Teaching Selected Aspects of Physicianship
13:30 - 15:00
Part A: Teaching Clinical Observation
15:10 - 16:40
Part B: Teaching Attentive Listening
Part C: Teaching Reflection
16:40 - 17:00
General Discussion and Closing Remarks
Room 30, 3rd floor, National Defense Medical Center (NDMC)
國防醫學院(國醫中心) 30教室 3F
No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 114, Taiwan 台灣台北市內湖區民權東路六段161號
