By C. Arokkh. New School University. 2017.

The correspondence between the inquisitive and interventionist outlook of medical science and the dynamic and progressive values of Victorian Britain was the key to the early success of the medical profession purchase naprosyn 250 mg without a prescription. Dumbing down In Tomorrow’s Doctors, the GMC outlined the ‘goals and objectives’ of the new curriculum under the rubric of ‘knowledge, skills and attitudes’ (GMC 1993). Whereas in the past knowledge was crammed for exams, skills were picked up on the job, and attitudes (for better or for worse) unconsciously assimilated, now students were going to be taught formally in all three areas. Knowledge would be reduced to a ‘factual quantum’ defined by a ‘core 147 THE CRISIS OF MODERN MEDICINE curriculum’: this would include the familiar basic medical sciences, but also unfamiliar subjects such as ‘human relationships’ and ‘the importance of communication’. The extensive and detailed attitudinal objectives reflected the values of the culture of therapy and the demands of political correctness (neither previously a major influence on the medical mainstream). Students would be expected to show respect for patients’ diverse identities and rights, they should be able to ‘cope with uncertainty’ and they should display an ‘awareness of personal limitations, a willingness to seek help when necessary and an ability to work effectively as a member of a team’. One of the key concepts of the new curriculum is that of ‘prob- lem-based’ learning: instead of acquiring a grounding in basic medical sciences before encountering sick patients, students begin from a clinical problem presented by a patient and organise their studies around this problem (Lowry 1993:28–32). The idea is that, by being relevant to the resolution of a real clinical problem, their study of anatomy, physiology, biochemistry, etc. The role of the teacher is no longer to transmit knowledge, but to facilitate the process of problem-solving by students, working collectively, in teams. The defect of problem-based learning is that it assumes that defining a clinical problem is a straightforward matter, whereas in practice it is often profoundly difficult. According to Abraham Flexner, whose historic 1910 report promoted the reorganisation of medical education in the USA on the basis of scientific medicine, ‘for the analysis of the simplest situation which the ailing body presents, considerable knowledge is required’ (Flexner 1925:13) Furthermore, for practical treatment ‘still another volume of knowledge and experience is requisite’. Flexner explicitly rejected the method of proceeding on ‘superficial or empirical lines’ which is what is implied by the notion of the ‘relevance’ of scientific inquiries to the problem that has been identified.

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A warm environment naprosyn 500 mg amex, blankets, and thermal reflector sheets help to maintain body temperature. If a helicopter is used, the possibility of immediate transfer to a regional spinal injuries unit with acute support facilities should be considered after discussion with that unit. Initial management at the receiving hospital Primary survey When the patient arrives at the nearest major emergency department, a detailed history must be obtained from ambulance staff, witnesses, and if possible the patient. Simultaneously, the patient is transferred to the trauma trolley and this must be expeditious but smooth. Alternatively a scoop stretcher can be Head injuries (coma of more than 6 hours’ duration, used for the transfer but this will take longer. In the absence of brain contusion or skull fracture) in 12% either device, the patient can be subjected to a coordinated Chest injuries (requiring active treatment, spinal lift but this requires training. The examination must be thorough because spinal trauma is frequently associated with multiple injuries. As always, the patient’s airway, breathing and circulation (“ABC”—in that order) are the first priorities in 6 Evacuation and initial management at hospital resuscitation from trauma. If not already secure, the cervical C=cervical Posterior spine is immobilised in the neutral position as the airway is T=thoracic columns assessed. Following attention to the ABC, a central nervous L=lumbar S=sacral system assessment is undertaken and any clothing is removed. The corticospinal S tract spinal injury itself can directly affect the airway (for example T L C by producing a retropharyngeal haematoma or tracheal deviation) as well as the respiratory and circulatory systems L T C (see chapter 4). S S L Spinothalamic Secondary survey T tract Once the immediately life-threatening injuries have been C addressed, the secondary (head to toe) survey that follows allows other serious injuries to be identified.

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