CanMEDS与抗抗生素耐药性的斗争

Timothy S. H. Kwok
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我在渥太华医院完成了内科选修课。在那里,我有幸照顾了一些城里病情最严重的病人。随着选修课的进行,我开始注意到一种模式。每当医护人员进入病人的房间,他们都会疯狂地穿上长袍、口罩和手套,覆盖身体的每一个部位。很奇怪,我想知道为什么?突然,从眼角的余光中,我注意到一大堆写着“耐甲氧西林金黄色葡萄球菌治疗方案”的标志。那天晚上,我反思了“超级细菌”的问题是如何变得如此失控的。在讲座中,我们了解了抗生素耐药性产生背后的遗传原因,但我意识到一定有生物学领域之外的原因。事实上,经济、社会心理和政治因素的相互作用也导致了社会对这种宝贵资源的不当处理。作为医学生,我们在培训的早期阶段就被介绍到CanMEDS框架。CanMEDS由加拿大皇家内科医生和外科医生学院于20世纪90年代创建,旨在提高医生培训中七个关键支柱的能力,以改善患者护理(图1)。我深入思考了这一著名医学教育教条背后的七个角色如何在对抗抗生素耐药性的经济、社会心理和政治因素方面发挥作用。
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CanMEDS and the combat against antibiotic resistance
R I finished an Internal Medicine elective at The Ottawa Hospital. There, I was privileged to care for some of the city’s sickest patients. As the elective progressed, I began to notice a pattern. Every time medical staff entered a patient’s room, they would frantically put on gowns, facemasks, and gloves covering every part of their bodies. Curious, I wondered why? Suddenly, out of the corner of my eye, I noticed a sea of signs labeled “MRSA Protocols.” That evening, I reflected on how the problem of “superbugs” had gotten so out of hand. In lectures, we had learned the genetic reasons behind the development of antibiotic resistance but I realized there must be reasons beyond the realm of biology. In fact, there is an interplay of economic, psychosocial, and political factors that also contribute to society’s mishandling of such an invaluable resource. As medical students, we are introduced to the CanMEDS framework at an early point in our training. CanMEDS was created by The Royal College of Physicians and Surgeons of Canada in the 1990s to promote competencies in seven key pillars for physicians in training to improve patient care (Figure 1). I pondered deeply at how the seven roles behind this prominent medical education dogma could play a part in combating the economic, psychosocial, and political factors of antibiotic resistance.
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