PDF(Pubmed)
Abstract：
The practice of medicine since Hippocrates, the father of medicine (460-377 BC) had the care of the patient in the core of its ideals which included scholarship; confidentiality, altruism and no harm doing. These ideals evolved from individual physician adoption to professional organization adoption. The medical profession used to have autonomy, prestige, and values centered on patient care. With societal changing values and the appearance of managed care and bioethics the medical profession lost its autonomy, prestige and self regulation. This led to widespread dissatisfaction among the profession members and reflected in deficiency in education and training of medical students and young physicians and resulted in deficiency of clinical skills required to deliver health care. This situation has been referred to as hyposkillia. This sagging has been reported in many countries worldwide and brought concern to many medical education authorities and societies. In this paper nine cases are reported to demonstrate that hyposkillia is also prevalent in our part of the world and show some deficiencies in the clinical skills that are avoidable. Inadequacies in: accurate history taking, complete appropriate physical examination, pertinent investigation and sound critical reasoning in management planning, all precluded optimum health care delivery initially in these cases. Many professional and education authorities have suggested that the process of redemption of the medical profession should start before admission to medical school by change in admission requirements to include behavioral and social sciences, and that the curricula in the medical schools should be redesigned to meet the changing societal values and priorities. Teaching clinical skills should be a continuous lifelong learning process from the medical school through training and into practice. Modern technology is to complement and not to replace bedside teaching and the patient should remain the best teacher for the physician.
摘要：
自希波克拉底以来的医学实践，医学之父（公元前460-377年）在其理想的核心中照顾患者，其中包括奖学金;保密，利他主义，没有害处。这些理想从个人医生采用发展到专业组织采用。医学界曾经拥有自主权，声望,和以病人护理为中心的价值观。随着社会变革的价值观以及管理式护理和生物伦理学的出现，医学界失去了自主权，声望和自我调节。这导致了专业成员的普遍不满，并反映在对医学生和年轻医师的教育和培训方面的不足，并导致提供医疗保健所需的临床技能不足。这种情况被称为hyposkillia。这种下垂已在世界许多国家报道，并引起了许多医学教育当局和社会的关注。在本文中，据报道有9例病例表明，在我们这个地区也很普遍，并且在临床技能方面存在一些可以避免的缺陷。不足：准确的历史记录，完成适当的体检，管理规划中的相关调查和健全的批判性推理，在这些情况下，最初都排除了最佳的医疗保健提供。许多专业和教育当局建议，医疗专业的救赎过程应该在被医学院录取之前开始，通过改变录取要求，包括行为和社会科学，医学院的课程应该重新设计，以适应不断变化的社会价值观和优先事项。临床技能教学应该是一个从医学院通过培训到实践的持续终身学习过程。现代技术是补充而不是取代床边教学，患者应该仍然是医生的最佳老师。
