Yesterday's Doctors: The Human Aspects of Medical Education in Britain, 1957-93

Beyond 'born not made': challenging character, emotions and professionalism in undergraduate medical education

In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific 'character'. In the late nineteenth century, an ideal of the medical student as 'born not made' was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of 'character' becomes 'characteristics'. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors' education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.

Humanistic Care in Nursing: Concept Analysis Using Rodgers' Evolutionary Approach

Background

Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing.

Materials and Methods

Based on Rogers's evolutionary concept analysis, keywords such as "humanistic car *," "caring behave *," "humanistic nurs *," "humanistic model of care," were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty-five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis.

Results

Nine attributes of the humanistic care, including "excellence in clinical literacy," "creating a healing environment," "a comprehensive and unique viewpoint," "contribution to clients' adaptation and flourishing of their talents," "unrequited love and affection," "preservation of human dignity," "real presence," "constructive dynamic interaction," and "nurse's self-care," were recognized. Assessing the historical and evolutionary course of the concept's semantic tendency revealed three periods: The focus in first, second, and third was on the nurse-patient relationship, quantitative tendency/measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline.

Conclusions

Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

How do students approach the study of the History of Medicine? Some considerations after the final exams at the first year and fourth year

BACKGROUND AND AIM

Reports about the teaching of the History of Medicine in universities worldwide can be found easily in medical literature. They are often comparative studies in which the opinions provided by the professors are collected and the teaching programs are compared. Our study focuses instead on the relationship between the students and the discipline, what they look for from it, and how their interest changes with the progress of the course of study.

METHODS

The final tests of the students of two Italian universities, Parma and Bologna, were analyzed, in which the candidate had the ability to choose the topic of discussion and to outline his personal analysis. The course year in which the final examination was faced is different: in the first year in Bologna, in the fourth year in Parma.

RESULTS

This survey show that in both universities most students have carried out autonomous research regardless of the educational material made available to them. This attitude can be interpreted as a real interest in the history of medicine, widening their search throughout all the fields of the discipline.

CONCLUSIONS

These results seem to suggest to teachers of History of Medicine to convey to their students the methodology of historical and epistemological research, giving the student to the pupils the opportunity to become passionate about history in the way he/she prefers. (www.actabiomedica.it).

Improving Graduate Medical Education Through Faculty Empowerment Instead of Detailed Guidelines

Calls for improvement and reform in graduate medical education (GME) have led to more detail in educational and curricular guidelines. The current level of detail in curriculum guidelines for GME training programs is high, encompassing, for example, competency frameworks, entrustable professional activities, and milestones. In addition, faculty must employ an increasing number of assessment tools and elaborate portfolio systems for their residents. It is questionable whether any further increase in curriculum detail and assessment formats leads to better GME programs. Focusing on this type of system development may even lead to less engaged faculty if faculty are not encouraged to use their own professional judgment and creativity for teaching residents. Therefore, faculty members must be empowered to engage in curricular innovation, since system development alone will not result in better training programs. Raising faculty members' awareness of their virtues and value as teachers and involving them in the debate about how GME can be enhanced might increase their engagement in resident training.

Development and Psychometric Analysis of the Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: Trainee Version (PAMETHIC-CLIN-T)

OBJECTIVE

This study was conducted to develop and assess psychometric properties of the "Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: trainee version (PAMETHIC-CLIN-T)" as a data collection tool to enhance research performance rigor in future medical ethics studies.

PATIENTS AND METHODS

A multi-tiered six stage procedure was applied to develop the PAMETHIC-CLIN-T and assess its psychometric properties in a sample of Iranian medical science undergraduate students (n=263). The final constructed item pool contained 16 questions with the response options in five Likert-type categories. The higher total score indicated better compliance with the ethics and professional conduct regulations. Internal consistency reliability was examined and exploratory factor analysis (EFA) with direct oblimin rotation and principal components analysis (PCA) were carried out to reduce the overall constructed items into latent factors based on commonalities within the data set.

FINDINGS

Factor analysis results revealed a 4-factor solution. All 16 items had factor loading greater than absolute value of 0.3 that accounted for 60.57% of the variance. The value of Kaiser Meyer Olkin (KMO) measure of sampling adequacy for factor analysis (0.909) and also Bartlett's test of sphericity (X2=1630.63, df=120, P-value<0.001) approved interpretability of the EFA output.

CONCLUSION

Feasibility testing and psychometric analysis of the constructed scale yielded research evidence to support a four-factor model to be applied in future studies about the extent of perceived adherence to the principles of medical ethics in clinical educational settings.

Roadmap for cardiovascular education across the European Society of Cardiology: inspiring better knowledge and skills, now and for the future

AIMS

The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes.

METHODS AND RESULTS

The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes.

CONCLUSION

These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective.

'Humanizing' healthcare environments: architecture, art and design in modern hospitals

In recent decades, hospital design literature has paid increasing attention to an apparent need to 'humanize' hospital environments. Despite the prevalence of this design goal, the concept of 'humanizing' a space has rarely been defined or interrogated in depth. This article focuses on the meaning of humanization, as a necessary step towards understanding its implementation in practice. It explores the recent history of humanistic design as a goal in healthcare contexts, focusing on the UK in the late twentieth century. It shows that many features of humanistic design were not revolutionary, but that they were thought to serve a new purpose in counterbalancing high-technology, scientific and institutional medical practice. The humanistic hospital, as an ideal, operated as a symbol for wider social concerns about the loss - or decentring - of patients in modern medical practice. Overall, this article indicates a need to interrogate further the language of 'humanization' and its history. The term is not value free; it carries with it assumptions about the dehumanization of modern medicine, and has often been built on implicit binaries between the human and the technological.