مجله دانشکده پزشکی اصفهان

مجله دانشکده پزشکی اصفهان

ساختار سلسله‌مراتبی در آموزش پزشکی، پیامدها و راهکارهای بهینه‌سازی: یک مطالعه‌ی مروری

نوع مقاله : Review Article

نویسندگان
1 پزشک عمومی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
2 دانشیار، گروه پزشکی اجتماعی و خانواده، دانشکده‌ی پزشکی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
3 استادیار، گروه اخلاق پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
چکیده
مقدمه: سلسله‌مراتب به معنای طبقه‌بندی افراد بر اساس قدرت و جایگاه سازمانی است که در نظام‌های سلامت و آموزش پزشکی از ابعاد مختلف نقشی تعیین کننده دارد. با توجه به عمومیت داشتن این ساختار و تاثیر مستقیم آن بر فراگیران رده‌های پایین به‌ویژه دانشجویان، مطالعه‌ی حاضر با هدف شناسایی ابعاد، آثار و راهکارهای تعدیل ساختار سلسله‌مراتبی در آموزش پزشکی انجام شد.
روش‌ها: این پژوهش از نوع مطالعه‌ی مروری است و در سال ۲۰۲۳ انجام شد. جست‌وجوی منابع در پایگاه‌های داده معتبر علمی از جمله PubMed، Google Scholar و Elsevier با استفاده از واژگان کلیدی استخراج شده از MeSH و اصطلاحات مرتبط صورت گرفت. معیارهای ورود شامل مطالعات کیفی و کمی مرتبط با سلسله‌مراتب در محیط‌های بالینی بود.
یافته‌ها: ساختار سلسله‌مراتبی در آموزش پزشکی به عنوان بخشی از برنامه درسی پنهان، از یک سو موجب ارتقای هماهنگی گروهی و پیگیری اهداف می‌شود و از سوی دیگر، پیامدهای منفی چون محدودیت در بیان دیدگاه، رنج اخلاقی، افزایش سوءرفتار، فرسودگی شغلی، آسیب به هویت حرفه‌ای و کاهش همدلی را به‌دنبال دارد. همچنین، ناتوانی زیردستان در گزارش خطاهای افراد رده بالا به دلیل ترس از سیستم، ایمنی بیمار را به طور جدی به مخاطره می‌اندازد.
نتیجه‌گیری: اگرچه وجود سلسله‌مراتب برای سازماندهی محیط‌های پرفشار پزشکی ضروری است، اما رویکرد سنتی و صلب آن می‌تواند مخرب باشد. راهکار واقع‌بینانه، نه نفی کلی این مفهوم، بلکه تمرکز بر راهبرد‌های بهینه‌کردن از جمله ایجاد امنیت روان‌شناختی، اصلاح بازخوردهای آموزشی و تقویت شجاعت اخلاقی در فراگیران است.

تازه های تحقیق

نرگس معتمدی: Google Scholar

ندا یاوری: Google Scholar

کلیدواژه‌ها
موضوعات

عنوان مقاله English

Hierarchical Structure in Medical Education, Implications and Optimization Strategies: A Review

نویسندگان English

Zahra Molavi 1
Narges Motamedi 2
Neda Yavari 3
1 MD, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Community and Family Medicine, School of Medicine, Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Medical Ethics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده English

Introduction: Hierarchy means the classification of individuals based on power and organizational status, which plays a fundamental role in health systems and medical education. Given the pervasive presence of this structure and its direct impact on lower-level learners, especially students, the present study aimed to identify the dimensions, effects and strategies for adjusting the hierarchical structure in medical education.
Method: This study includes a review study that was conducted in 2023. A search of sources was conducted in reputable scientific databases, including PubMed, Google Scholar and Elsevier, using keywords extracted from the mesh and related terms. The inclusion criteria included qualitative and quantitative studies related to hierarchy in clinical settings.
Findings: Hierarchy as part of the hidden curriculum, on the one hand, promotes team coordination and goal pursuit, and on the other hand, it has negative consequences such as restrictions on expressing views, moral distress, increased misconduct, burnout, damage to professional identity, and reduced empathy. Also, the inability of subordinates to report errors of higher-ranking individuals due to fear of the system seriously jeopardizes patient safety.
Conclusion: Although the existence of hierarchy is essential for organizing high-pressure medical environments, its traditional and rigid approach can be destructive. The realistic solution is not to completely negate this concept, but to focus on optimization strategies such as creating psychological safety, modifying educational feedback, and strengthening moral courage in learners.

کلیدواژه‌ها English

Hierarchy
Medical Education
Medical Student
Hidden Curriculum
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دوره 44، شماره 862
هفته 2، تیر
خرداد و تیر 1405
صفحه 765-771

  • تاریخ دریافت 08 بهمن 1404
  • تاریخ پذیرش 14 تیر 1405