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Press releases Saturday 2 October 2004
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under titles).
(1) STUDY REVEALS 'HIDDEN' CURRICULUM OF HUMILIATION IN MEDICAL SCHOOL
(2) CHANGING THE FACE OF ACADEMIC MEDICINE
(3) FASTING DURING RAMADAN COULD CAUSE PROBLEMS FOR MUSLIM PATIENTS
(4) PROMOTING WALKING AND CYCLING AS AN ALTERNATIVE TO USING CARS: WHAT WORKS?
(1) STUDY REVEALS 'HIDDEN' CURRICULUM OF HUMILIATION IN MEDICAL SCHOOL
(The hidden curriculum in
undergraduate medical education: qualitative study of medical students' perceptions
of teaching)
http://bmj.com/cgi/content/full/329/7469/770
A 'hidden' curriculum of haphazard tuition and teaching by humiliation exists in undergraduate medical education, finds a study in this week's BMJ.
Researchers interviewed 36 students at one UK medical school about their experiences and perceptions of the quality of teaching received during their undergraduate training.
Students reported many examples of positive role models and effective, approachable teachers. However, students also described a hierarchical and competitive atmosphere in which haphazard tuition and teaching by humiliation continue to occur.
Twenty-five students described the haphazard nature of teaching, particularly by clinical staff, who often disregarded the formal timetable. Final year students were especially critical of what they perceived as a lack of commitment and poor teaching skills in some staff members.
Twenty-one students reported 29 incidents of humiliation, particularly during ward rounds in their clinical years. Almost all the reported perpetrators were male doctors and three quarters were senior medical staff. One student said: "I've found my first rotation was very stressful, humiliating, I worked and read because of fear, because of being targeted ? and that was just miserable."
Overall, half of the students reported that competition rather than co-operation was the defining characteristic of medicine.
Although this study relies on interview accounts rather than observation of actual teaching and the data were collected from only one medical school, the reports suggest a worrying lack of accountability of medical teachers in overstretched clinical settings, say the authors.
Medical education has largely escaped from the quality control rigours imposed on clinical practice. Indeed, relatively few doctors have received formal training in teaching methods, educational theories, or modes of assessment.
Recognition and reform of the hidden curriculum is required to achieve the necessary fundamental changes to the culture of undergraduate medical education, they conclude.
Contacts:
Clive Seale, Professor of Sociology, Deapartment of Human Sciences, Brunel University, Uxbridge, UK
or
Heidi Lempp, Senior Qualitative Researcher, Guy's, King's and St Thomas' School of Medicine, King's College London, UK
(2) CHANGING THE FACE OF ACADEMIC MEDICINE
(Editorials, Education &
Debate, Letters)
http://bmj.com/cgi/content/full/329/7469/751
http://bmj.com/cgi/content/full/329/7469/787
http://bmj.com/cgi/content/full/329/7469/798
Academic medicine is failing to drive innovation and excellence in clinical practice, argue an international group of leading medical academics, in this week's BMJ.
They believe that academic medicine is failing to carry out its key roles of research, teaching, and patient care, and have developed a plan of action to tackle these problems. "We need a new vision for academic medicine," they write. "We need to articulate and demonstrate the economic and social value that academic medicine provides. And we need a global perspective."
Others question how academic medicine deals with gender issues. Researchers in the United States argue that improving gender equity (fairness and justness) rather than gender equality (equal numbers of men and women) is essential for a revitalised academic medicine, a strengthened health workforce, and improved public health.
Canadian doctors discuss conflicts involving academic freedom, while two editorials highlight how academic medicine can help improve health in developing countries.
Finally, in a letter to the BMJ, several authors argue that the governance of academic medicine should be turned over to public trustees. They ask: "If academic medicine exists to promote the public interest, is it not time to grant patients and the public at large a controlling interest in setting priorities and overseeing operations?"
Contact:
David Wilkinson, Deputy Head, School
of Medicine, University of Queensland, Brisbane, Australia
Email: david.wilkinson@uq.edu.au
Also in this week's BMJ:
(3) FASTING DURING RAMADAN COULD CAUSE PROBLEMS FOR MUSLIM
PATIENTS
(Drug intake during Ramadan)
http://bmj.com/cgi/content/full/329/7469/778
Fasting from dawn to dusk during Ramadan could cause problems for Muslim patients taking prescribed drugs, warn researchers in this week's BMJ.
During the Islamic holy month of Ramadan, which begins on 15 October 2004, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, between dawn and dusk. Patients with chronic diseases often insist on fasting even though they are permitted not to by Islamic rules.
Several studies have shown that patients arbitrarily modify the times of doses, the number of doses, the time span between doses, and even the total daily dosage of drugs during the month of Ramadan, often without seeking any medical advice.
This behaviour could alter the activity of drugs in the body, leading to therapeutic failures, say the authors. For instance, studies have found delayed absorption, problems with side effects, and drug-food interactions during Ramadan.
They suggest that further studies should be carried out to provide more guidelines about the ways in which the administration of drugs should be modified. In the meantime, doctors and scientists in the Muslim world should be encouraged to follow up their patients with chronic diseases during Ramadan, in order to establish optimal dosage regimens.
Consensus on these issues would allow health professionals to provide accurate and standardised advice on the appropriate use of drugs during the holy month of Ramadan, they conclude.
Contact:
Nadia Aadil, Assistant Professor,
Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy,
Casablanca, Morocco
Email: aadil_nadia@yahoo.fr
(4) PROMOTING WALKING AND CYCLING AS AN ALTERNATIVE TO USING CARS: WHAT WORKS?
(Promoting walking and cycling
as an alternative to using cars)
http://bmj.com/cgi/content/full/329/7469/763
What measures persuade people to shift from using cars to walking and cycling?
Transport policies aim to reduce traffic congestion by discouraging car use and encouraging alternative modes of transport, such as walking and cycling. A shift in population transport patterns has obvious potential health benefits, but we lack good evidence on what measures are effective.
Researchers in this week's BMJ assessed the best available evidence from towns and cities around the world, looking for evidence of measures that had reduced car use, increased walking and cycling, and, if possible, improved the health of the local population into the bargain.
They found that giving targeted advice and support to people who already want to change their behaviour can be effective, but for many other measures that could influence the wider population, the evidence is far from clear yet.
"We see this as a first attempt to map out what the evidence shows and to lay some ground work for further research," say the authors. "A lot of transport research has focused on how to reduce congestion or make the roads safer. These are obviously good things in their own right, but given the current interest in the health benefits of regular physical activity, we wanted to find out how the population can be encouraged to walk and cycle more instead of always taking the car.
"So far, there's remarkably little evidence that measures like traffic calming and publicity campaigns have actually had this effect in practice. That's not to say they couldn't work, of course. It's only recently that walking and cycling have been taken at all seriously in transport planning, and not much research has been done on this topic."
Contacts:
David Ogilvie, MRC Fellow, or Mark
Petticrew, Associate Director, MRC Social and Public Health Sciences Unit,
University of Glasgow, Scotland
Email: d.ogilvie@msoc.mrc.gla.ac.uk
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