Infusing the Interdisciplinary into Medical/ Health Sciences Education--论文代写范文精选

作为教育者,我们的选择方法,维生素或疫苗,学术界对课程改革将决定未来的医生发展。提出了一个概念性的框架,使用维生素和疫苗隐喻理解和分类，通过最终努力改变医学教育的课程。下面的essay代写范文进行详述。

Abstract
Academic medical institutions have responded to recent changes and challenges confronting the health care system with various recommendations for curricular reform; many grouped under the rubric of interdisciplinary training. The ultimate goal is to create physicians, with mastery over specialized knowledge, who can practice cost-effective, humanized medicine. This article elaborates a conceptual classification system that categorizes curricular reform recommendations into one of two approaches – Vitamins or Vaccines – that highlights differences in the processes of curricular reform programs. Programs seeking the same goal may create different types of practitioners depending on the approach dominating the professional training and socialization process. The Vitamins approach is reactive, supplemental, and incremental, often imparting instruction instead of education. The Vaccines approach is proactive, addresses fundamental factors, and seeks long-term solutions from a preventive perspective. As educators, our choice of approach, Vitamins or Vaccines, for curricular reform will determine how academia prepares physicians for the future.

Introduction
This paper presents a conceptual framework that employs the metaphors of vitamins and vaccines to understand and classify recent efforts to change curricula in medical education. This characterization of programs, recommendations, and efforts into Vitamins or Vaccines categories clarifies the underlying philosophies and processes of training and education, and helps predict the ultimate outcome, that is how these changes in the educational sphere will translate in actual practice. For instance, two separate recommendations for curricular change may suggest the same endpoint of interdisciplinary training. 

However, by virtue of their being classified into either one of vitamins or vaccines approaches would enable us to see how the courses offered in each would be interpreted differently, thus influencing implementation and subsequent process of learning. This would influence the medical student and his or her future practice in highly divergent ways. Therefore, using the conceptual lens of Vitamins and Vaccines can guide practical aspects of initiation, implementation, and sustainability of curriculum reform measures, and predict patterns of practice of future physicians. Recent changes in the health care environment, shifting alliances and organizational re-arrangements, have not only rendered it fluid and difficult to grasp, but also imposed constraints on physicians’ practice in a climate of fiscal accountability. 1,2 There are other equally important issues influencing medical education.

In a survey of about 1400 deans, faculty me mbers, and department heads of various medical schools nearly a decade ago, 61% of respondents believed that US medical education needed fundamental changes or thorough reform. Most believed that medical education at their own institutions had not kept pace with changes in the way medicine is currently practiced.5 A common complaint is that changes in the practice arena demand more collaboration on the part of practitioners. However, this need for collaborative practice skills is not being met in the sphere of training and education in the health professions.6 

This has led to numerous reports and recommendations for change in medical education over the last two decades.7 One of the earliest reports was the General Professional Education of the Physician (GPEP) Report issued by the Association of American Medical Co lleges (AAMC) in 1984. A number of medical schools substantially revised their curricula in response to the GPEP Report. One of the most important areas of change was in the way students were introduced to professional skills and perspectives they would need to practice clinical medicine. In order to accomplish this goal, a number of schools developed interdisciplinary courses that may have differed in scheduling, format, and focus, but shared a commitment to broadening skills and perspectives through experiential learning and small-group work. Most of these courses spanned the entire first two years of the curriculum, and some extended into the third and fourth years, blurring the line between the preclinical and clinical years. Among the most comprehensive programs were those at Northwestern University, Oregon Health Sciences University, the University of California, Los Angeles, and the University of Nebraska.8

Of the various alternatives proposed, interdisciplinary training is the one posited as a logical and collegial solution to the problem of a cost-ineffective, over-specialized, fragmented and dehumanized health care delivery system.10,11 Lack of interdisciplinary practice among health care professionals is seen as the result of a lack of adequate sensitization and training of students while still in the early stages of professional education. 12 This has been articulated clearly by some authors, “Patient needs are interdisciplinary, and improving health care is an interdisciplinary effort. 

Working as part of an interdisciplinary team to provide and improve health care is a skill; like other skills it is best learned during training, not after.”13 Various efforts, committees, curricular reform policies made at different levels (universities, academic medical centers, agencies, or foundations) 3,4 to address the lack of interdisciplinary training and reform curricula in health science schools have largely been unsuccessful in producing fundamental changes in the training of medical students.14 Moreover, efforts still remain loosely defined and are unclear from the perspective of implementation of a concrete nation-wide program. 

A systematic review conducted by two authors in the United Kingdom of Medline abstracts published between 1985 and 1998 on the topic of multi-professional learning in the health sciences found a lack of conceptual clarity. The authors found that despite an agreed positive perspective on the value of multiprofessional learning, which in the commonsense view meant that health professionals worked together in teams and understood each other’s professional values and roles better, there was a lack of agreement in the published literature about what the approach encompassed. Terms such as mu ltiprofessional, multidisciplinary, and interprofessional were used interchangeably. The authors concluded that multiprofessional learning seems to be a fashion that people describe rather than question and stated, “The lack of critical analysis and questioning is remarkable. How can the concept of multiprofessional learning become robust if we don’t know what it means, cannot agree to its goals, and do not seem able to report the weaknesses and problems encountered and lessons learned?”15

It is imperative that such efforts be afforded time to demonstrate their effectiveness and impact, however, the system of education itself has been presented as both the solution and the problem. The very nature of the current educational system in universities, with rigid specializations, departmental isolationism, emphasis on parallel care, and competition between the research and service missions, has been identified as an important barrier to integrative learning and collaborative practice.16 The classification of educational reform efforts into the categories of Vitamins and Vaccines will provide a stronger conceptual underpinning to the educational reform process, help medical educators examine recommended measures in a critical light, and take steps to remedy deficiencies in the methods or understanding of the issue.

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