基于"四主题理论"的临床实践教学伦理问题分析——以患者拒绝医学生操作为例

Clarify and Resolve Ethical Issues in the Teaching of Clinical Practice Based on the Four-topics Theory——An Example of Patients' Refusal to the Practice of Medical Students

摘要: 临床实践教学过程中经常遇到棘手的伦理问题，如医学生的受教育权与患者"最佳利益"之间的冲突。正确认识这一临床伦理问题，并制定恰当的应对方案，有助于临床带教医师、医学生从容应对该矛盾，并提高患者满意度。本文以"患者拒绝医学生操作"为例，从临床伦理学角度，基于医疗适用性、患者偏好、生命质量及情境特征"四主题理论"模式进行评估，提炼核心伦理问题，并结合国内外文献及自身经验提出应对策略和建议，以期为临床教学提供参考和帮助。

Abstract: This article addressed the ethical issues during teaching medical students the clinical practice, which focused on the conflict between the best interest of patients and the obligation to accept practice of medical students. It firstly evaluated the ethical issue based on the "four topics", which included medical indications, patients' preferences, quality of life, and contextual features to clarify the core clinical ethical problem. Then it provided suggestions based on the viewpoints in literature as well as the authors' own experiences, including respecting patients' autonomy and right of informed consent, and improving physician-patient communica- tion. Based on the above discussion, this article provided some insights into how to solve this kind of ethical problem for mentors and medical students.