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Tong W, Zhang X, Zeng H, Pan J, Gong C, Zhang H. Reforming China's Secondary Vocational Medical Education: Adapting to the Challenges and Opportunities of the AI Era. JMIR MEDICAL EDUCATION 2024; 10:e48594. [PMID: 39149865 PMCID: PMC11337726 DOI: 10.2196/48594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 08/17/2024]
Abstract
Unlabelled China's secondary vocational medical education is essential for training primary health care personnel and enhancing public health responses. This education system currently faces challenges, primarily due to its emphasis on knowledge acquisition that overshadows the development and application of skills, especially in the context of emerging artificial intelligence (AI) technologies. This article delves into the impact of AI on medical practices and uses this analysis to suggest reforms for the vocational medical education system in China. AI is found to significantly enhance diagnostic capabilities, therapeutic decision-making, and patient management. However, it also brings about concerns such as potential job losses and necessitates the adaptation of medical professionals to new technologies. Proposed reforms include a greater focus on critical thinking, hands-on experiences, skill development, medical ethics, and integrating humanities and AI into the curriculum. These reforms require ongoing evaluation and sustained research to effectively prepare medical students for future challenges in the field.
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Affiliation(s)
- Wenting Tong
- Department of Pharmacy, Gannan Healthcare Vocational College, Ganzhou, China
| | - Xiaowen Zhang
- Department of Rehabilitation and Elderly Care, Gannan Healthcare Vocational College, Ganzhou, China
| | - Haiping Zeng
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianping Pan
- Scientific Research Division, Gannan Healthcare Vocational College, Ganzhou, China
| | - Chao Gong
- Student Work Division, Gannan Healthcare Vocational College, Ganzhou, China
| | - Hui Zhang
- Department of Rehabilitation and Elderly Care, Gannan Healthcare Vocational College, Ganzhou, China
- Department of Infertility and Sexual Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Urology, Dongguan Hospital Affiliated to Guangzhou University of Chinese Medicine, 22 Songshanhu Avenue, Guangdong Province, Dongguan, 523080, China, 86 0769 2638 5365
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Hancco-Monrroy DE, Caballero-Apaza LM, Abarca-Fernández D, Castagnetto JM, Condori-Cardoza FA, De-Lama Moran R, Carhuancho-Aguilar JR, Gutierrez S, Gonzales M, Berduzco N, Delgado Bolton RC, San-Martín M, Vivanco L. Medical Professionalism and Its Association with Dropout Intention in Peruvian Medical Students during the COVID-19 Pandemic. Behav Sci (Basel) 2024; 14:641. [PMID: 39199038 PMCID: PMC11351192 DOI: 10.3390/bs14080641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic introduced unprecedented challenges to medical education systems and medical students worldwide, making it necessary to adapt teaching to a remote methodology during the academic year 2020-2021. The aim of this study was to characterize the association between medical professionalism and dropout intention during the pandemic in Peruvian medical schools. METHODS A cross-sectional online-survey-based study was performed in four Peruvian medical schools (two public) during the academic year 2020-2021. Medical students, attending classes from home, answered three scales measuring clinical empathy, teamwork, and lifelong learning abilities (three elements of medical professionalism) and four scales measuring loneliness, anxiety, depression, and subjective wellbeing. In addition, 15 demographic, epidemiological, and academic variables (including dropout intention) were collected. Variables were assessed using multiple logistic regression analysis. RESULTS The study sample was composed of 1107 students (390 male). Eight variables were included in an explanatory model (Nagelkerke-R2 = 0.35). Anxiety, depression, intention to work in the private sector, and teamwork abilities showed positive associations with dropout intention while learning abilities, subjective wellbeing, studying in a public medical school, and acquiring a better perception of medicine during the pandemic showed a negative association with dropout intention. No association was observed for empathy. CONCLUSIONS Each element measured showed a different role, providing new clues on the influence that medical professionalism had on dropout intention during the pandemic. This information can be useful for medical educators to have a better understanding of the influence that professionalism plays in dropout intention.
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Affiliation(s)
| | - Luz M. Caballero-Apaza
- Facultad de Enfermería, Universidad Nacional del Altiplano, Puno 21001, Peru; (L.M.C.-A.); (D.A.-F.)
| | - Denices Abarca-Fernández
- Facultad de Enfermería, Universidad Nacional del Altiplano, Puno 21001, Peru; (L.M.C.-A.); (D.A.-F.)
| | | | | | - Raul De-Lama Moran
- Centro de Investigación en Educación Médica (CIEM-FMH), Universidad de San Martín de Porres, Lima 15011, Peru; (R.d.L.M.); (J.R.C.-A.)
| | - Jose R. Carhuancho-Aguilar
- Centro de Investigación en Educación Médica (CIEM-FMH), Universidad de San Martín de Porres, Lima 15011, Peru; (R.d.L.M.); (J.R.C.-A.)
| | - Sandra Gutierrez
- Facultad de Medicina, Universidad Nacional San Agustín de Arequipa, Arequipa 04000, Peru;
| | - Martha Gonzales
- Facultad de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco 08003, Peru; (M.G.); (N.B.)
| | - Nancy Berduzco
- Facultad de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco 08003, Peru; (M.G.); (N.B.)
| | - Roberto C. Delgado Bolton
- Servicio Cántabro de Salud, Consejería de Salud de Cantabria, 39011 Santander, Spain;
- Centro Nacional de Documentación en Bioética (CNB/FRS), Fundación Rioja Salud, 26006 Logrono, Spain;
| | - Montserrat San-Martín
- Centro Nacional de Documentación en Bioética (CNB/FRS), Fundación Rioja Salud, 26006 Logrono, Spain;
- Departamento de Estadística e Investigación Operativa, Universidad de Granada, 52005 Melilla, Spain
| | - Luis Vivanco
- Centro Nacional de Documentación en Bioética (CNB/FRS), Fundación Rioja Salud, 26006 Logrono, Spain;
- Facultad de Ciencias de la Salud, Universidad Europea del Atlántico, 39011 Santander, Spain
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, 26006 Logrono, Spain
- Plataforma de Bioética y Educación Médica, Centro de Investigación Biomédica de La Rioja (CIBIR/FRS), Calle Piqueras 98, 26006 Logrono, Spain
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Vivanco L. [Empathy in the context of the physician-patient relationship]. Aten Primaria 2024; 56:103043. [PMID: 39013337 PMCID: PMC11304025 DOI: 10.1016/j.aprim.2024.103043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Luis Vivanco
- Fundación Rioja Salud (FRS), Logroño, La Rioja, España; Universidad Internacional de La Rioja (UNIR), Logroño, La Rioja, España.
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Lachmann H, Löfvenmark C. Academic emotions and attitudes regarding interprofessional collaboration in health care activities: a prospective study among newly arrived physicians participating in a fourteen-week course. BMC MEDICAL EDUCATION 2023; 23:643. [PMID: 37679684 PMCID: PMC10486000 DOI: 10.1186/s12909-023-04620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND One way of facilitating entrance into the Swedish health care system, for newly arrived physicians from outside the European Union/European Economic Area, could be to set up and offer a course aimed to enhance understanding of it. This course was offered to increase insight about clinical practices, interprofessional teamwork and topics such as, Swedish health care laws, culture, and ethics. Acceptance of, and a flexible attitude towards, interprofessional teamwork are important for maintaining both the physician's professional identity and a high quality of patient care. The aim of this study was to investigate newly arrived physicians', academic emotions, experience of stress and flow during a fourteen-week course, as well as attitudes to interprofessional collaboration, both before and after. METHOD A prospective study was conducted, with participants asked to respond on one questionnaire every course day, by using the Contextual Activity Sampling System methodology. The participants were asked to complete a questionnaire comprising ten questions about ongoing activity and in what way they experience, e.g., collaboration, interprofessional teamwork, academic emotions, flow, and stress. Furthermore, the participants were asked to score their attitude towards interprofessional teamwork by using the interdisciplinary education perception scale both before and after the course. RESULTS The total sample comprised 27 qualified physicians, from outside the European Union/European Economic Area. In the interdisciplinary education perception scale category, "perception of actual cooperation¨, the participants had significantly higher scores after the course. Flow and academic emotions were felt mostly during own periods of study, seminars, and lectures. The academic emotions were apathy, anxiety, and boredom. The most frequently experienced academic emotion was apathy. Course participants rated stress highest in connection with the examination. CONCLUSION The results show that the course had a positive impact on the participants perception of actual cooperation. It appears that participating in this kind of course was a positive experience for the participants, since they mostly experienced high levels of flow. Collaborating with others was experienced as positive, with participants reporting a high degree of flow in activities during collaboration.
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Affiliation(s)
- Hanna Lachmann
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Caroline Löfvenmark
- Department of health promoting science, Sophiahemmet University, P. O. Box 5605, 114 86, Stockholm, Sweden
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Zhang HL, Wu C, Yan JR, Liu JH, Wang P, Hu MY, Liu F, Qu HM, Lang HJ. The relationship between role ambiguity, emotional exhaustion and work alienation among chinese nurses two years after COVID-19 pandemic: a cross-sectional study. BMC Psychiatry 2023; 23:516. [PMID: 37464335 DOI: 10.1186/s12888-023-04923-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND work alienation is receiving increasing attention as a psychological risk at work, and little is known about the mechanisms of role ambiguity and work alienation in nurses in the context of the COVID-19 pandemic. This article aims to examine how role ambiguity affects work alienation among Chinese nurses during the two years after COVID-19 pandemic and verify emotional exhaustion as mediators. METHODS A cross-sectional study design was used to recruit 281 Chinese nurses. Nurses completed online questionnaires containing demographic characteristics, role ambiguity, emotional exhaustion, and work alienation, and SPSS 26.0 and AMOS 24.0 were used for data analysis and structural equation modelling. RESULTS work alienation scores were (34.64 ± 10.09), work alienation was correlated with role ambiguity and emotional exhaustion (r1 = 0.521, r2 = 0.755; p < .01), and role ambiguity was positively correlated with emotional exhaustion (r = 0.512; p < .01). A mediating effect of emotional exhaustion between role ambiguity and work alienation held (mediating effect of 0.288, 95% CI: 0.221-0.369, accounting for 74.8% of the total effect). CONCLUSION Role ambiguity has a significant direct effect on nurses' feelings of alienation and exacerbates alienation through emotional exhaustion. Clarifying roles at work and being less emotionally drained are effective ways to reduce nurses' feelings of alienation.
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Affiliation(s)
- Hong-Li Zhang
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jia-Ran Yan
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jun-Hua Liu
- Department of Nursing, Qufu Traditional Chinese Medicine Hospital, Shandong, China
| | - Pei Wang
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Meng-Yi Hu
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Fang Liu
- School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Huan-Min Qu
- Human Resources Department, Tangdu Hospital, Air Force Medical University, Shaanxi, 710032, Xian, China.
| | - Hong-Juan Lang
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Matiz-Moya E, Delgado Bolton RC, García-Gómez E, Vivanco L. Empathy and Occupational Health and Well-Being in Ecuadorian Physicians Working with COVID-19 Patients: A Mixed-Method Study. Healthcare (Basel) 2023; 11:healthcare11081177. [PMID: 37108011 PMCID: PMC10138593 DOI: 10.3390/healthcare11081177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Approximately one out of ten COVID-19 cases in Ecuador was a physician. It has been reported that this situation has led to a serious detriment of physicians' health and well-being. This study aimed to (i) identify predictors of emotional exhaustion, somatization, and work alienation in Ecuadorian physicians working with COVID-19 patients and (ii) explore the pandemic impact on doctor-patient relationships and on empathy. In 79 Ecuadorian physicians (45 women) who worked with COVID-19 patients, two separate multiple regression models explained the following: 73% of the variability of emotional exhaustion was based on somatization, work alienation, working sector, and passing through a symptomatic infection (p < 0.001), and 56% of the variability of somatization was based on gender and emotional exhaustion (p < 0.001), respectively. Furthermore, intention to leave the profession was more frequent among physicians with greater work alienation (p = 0.003). On the contrary, more empathic physicians never considered leaving their profession during the COVID-19 pandemic (p = 0.03). In physicians' verbatim, cognitive empathy appeared associated to a positive change in doctor-patient relationships. On the contrary, having an overwhelming emotional empathy appeared associated to a negative change in doctor-patient relationships. These findings characterize differences in how physicians cope while working in the frontline of the pandemic.
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Affiliation(s)
- Estefan Matiz-Moya
- Hospital of Specialties Eugenio Espejo, Quito 170702, Ecuador
- Faculty of Health Sciences, International University of La Rioja, 26006 Logrono, Spain
| | - Roberto C Delgado Bolton
- Platform of Bioethics and Medical Education, Centre for Biomedical Research of La Rioja, 26006 Logrono, Spain
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro, 26006 Logrono, Spain
| | | | - Luis Vivanco
- Faculty of Health Sciences, International University of La Rioja, 26006 Logrono, Spain
- Platform of Bioethics and Medical Education, Centre for Biomedical Research of La Rioja, 26006 Logrono, Spain
- National Centre of Documentation on Bioethics, Rioja Health Foundation, 26006 Logrono, Spain
- Faculty of Health Sciences, European Atlantic University, 39011 Santander, Spain
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Cernega A, Meleșcanu Imre M, Ripszky Totan A, Arsene AL, Dimitriu B, Radoi D, Ilie MI, Pițuru SM. Collateral Victims of Defensive Medical Practice. Healthcare (Basel) 2023; 11:healthcare11071007. [PMID: 37046933 PMCID: PMC10094659 DOI: 10.3390/healthcare11071007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
This paper analyzes the phenomenon of defensive medical practice, starting from the doctor–patient relationship, and the behavioral and professional factors that can influence the proper functioning of this relationship and the healthcare system. We analyze medical malpractice, given the increase in the number of accusations, as an essential factor in triggering the defensive behavior of doctors, together with other complementary factors that emphasize the need for protection and safety of doctors. The possible consequences for the doctor–patient relationship that defensive practice can generate are presented and identified by analyzing the determining role of the type of health system (fault and no-fault). At the same time, we investigate the context in which overspecialization of medical personnel can generate a form of defensive practice as a result of the limiting effect on the performance of a certain category of operations and procedures. The increase in the number of malpractice accusations impacts the medical community—“the stress syndrome induced by medical malpractice”—turning doctors into collateral victims who, under the pressure of diminishing their reputational safety, practice defensively to protect themselves from future accusations. This type of defensive behavior puts pressure on the entire healthcare system by continuously increasing costs and unresolved cases, which impact patients by limiting access to medical services in the public and private sectors.
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Affiliation(s)
- Ana Cernega
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Marina Meleșcanu Imre
- Department of Prosthodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Calea Plevnei, 010221 Bucharest, Romania
| | - Alexandra Ripszky Totan
- Department of Biochemistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Andreea Letiția Arsene
- Department of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Bogdan Dimitriu
- Department of Endodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Delia Radoi
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
| | - Marina-Ionela Ilie
- Department of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Silviu-Mirel Pițuru
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania
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Cui Y, Yang T, Zhang M, Liu N, Liu Q, Zhang L, Zhang L, Yang H, Zhang Y. Influence of empathy on work alienation among Chinese nurses during the COVID-19 pandemic: The mediating effect of ego depletion. Front Psychol 2023; 14:1057460. [PMID: 36818075 PMCID: PMC9932043 DOI: 10.3389/fpsyg.2023.1057460] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Background Nurses' work alienation has become increasingly serious due to the increase in workload and risk during the coronavirus disease 2019 (COVID-19). However, no studies have investigated the link between empathy, ego depletion, and work alienation among Chinese nurses. The present study aimed to evaluate Chinese nurses' empathy, ego depletion, and work alienation and to examine whether nurses' ego depletion mediates the relationship between empathy and work alienation. Methods This was a descriptive, cross-sectional study involving 353 nurses from Shaanxi. The Jefferson Scale of Empathy-Health Professionals, Self-Regulating Fatigue Scale and Work Alienation Questionnaire were used to collect data through an online survey. Structural equation modeling was conducted to analyze the mediating model. Results Work alienation was negatively correlated with empathy (r = -0.305, p < 0.01) and positively correlated with ego depletion (r = 0.652, p < 0.01). Empathy was negatively correlated with ego depletion (r = -0.325, p < 0.01). Empathy can directly predict work alienation (β = -0.263, p < 0.01), while ego depletion has a mediating effect between empathy and work alienation (β = -0.309, p < 0.01), and the mediating effect accounts for 54.02% of the total effect. Conclusion Nurses' work alienation was at a moderate-to-high level. Improving empathy can reduce work alienation through less ego depletion. Nursing managers should discover nurses' work alienation as soon as possible. Interventions to improve empathy can help replenish nurses' psychological resources, thereby reducing ego depletion and work alienation.
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Affiliation(s)
- Yi Cui
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Tianqi Yang
- Department of Military Medical Psychology, Air Force Medical University, Xi’an, China
| | - Man Zhang
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Na Liu
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Qin Liu
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Lanfang Zhang
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Lihua Zhang
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Haoshuang Yang
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Yinling Zhang
- Department of Nursing, Air Force Medical University, Xi’an, China,*Correspondence: Yinling Zhang, ✉
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