B & H VI (GUS) – May 2014
• PATIENT AS THE SOURCE OF
KNOWLEDGE
• PATIENT’S SAFETY
AND STUDENT’S SAFETY
Patient as the source of
knowledge
THE PATIENT IS THE TEACHER
THE STUDENT BEGINS WITH
THE PATIENT, CONTINUES
WITH THE PATIENT, AND ENDS
HIS STUDIES WITH THE
PATIENT, USING TEXTS AND
FACULTY AS TOOLS
Sir William Osler, 1932
• MEDICAL PROFESSION IS A HELPING
PROFESSION
→ CARE AND CURE TO THE PATIENT AND
PATIENT’S RELATIVES
→ PROFESSIONAL BEHAVIOR SUPPORTED BY
STRONG BIOETHICS AND HUMANISM
VALUES
→ BIO-PSYCHO-SOCIO-CULTURAL APPROACH
DOCTOR – PATIENT RELATIONSHIP
• CRUCIAL IN THE PRACTICE OF MEDICINE
• GOOD RAPPORT, EMPATHY, RESPECT
• GOOD COMMUNICATION
ESSENTIAL IN MEDICAL PRACTICE, ACTIVE
LISTENING, HONEST ⇒ when and how , CLEAR
INFORMATION, INFORMED CONSENT
• BIOPSYCHOSOCIAL MODEL OF DISEASE (GEORGE
ENGEL)
KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY 7TH ED 1994
KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY 10TH ED 2007
CULTURAL INFLUENCES
SOCIO-CULTURAL DIFFERENCES (ETHNICITY,
NATIONALITY, RELIGION ETC) INFLUENCE DR/PST
PERCEPTION → IMPAIR COMMUNICATION
(COMPLAINT, SYMPTOMS PRESENTATION, PST
UNDERSTANDING OF ILLNESS AND NEED FOR
TREATMENT, RAPPORT)
MISUNDERSTANDING
ASKING, DO NOT ASSUMING
HELMAN CG, CULTURE, HEALTH & ILLNESS, 4TH ED, OXFORD,
BUTTERWORTH HEINEMANN, p170-201,2000
ALTRUISM
• BEING DEVOTED TO OR LIVING FOR THE
WELFARE OF OTHERS → “OTHER DIRECTED”
• PROSOCIAL ORIENTATION, PROSOCIAL
BEHAVIOR → FOCUSES ON HELPING ACT AND
POSITIVE BENEFIT FOR BOTH THE RECIPIENT
AND THE HELPER
• INFLUENCE BY BIOLOGICAL, PSYCHOLOGICAL
AND SOCIOCULTURAL FACTORS
BURKS DJ, KOBUS AM, Medical education 2012:46:317-325
SOFT SKILLS
• NO ULTIMATE DEFINITION OF SOFT SKILLS, BUT IT SHOULD
INCLUDE ETHICS, ATTITUDES, INTERPERSONAL ABILITIES,
COMMUNICATION ABILITIES, INTERPERSONAL AND SOCIAL SKILLS
IN A CARING, ETHICAL AND HUMANE PROFESSIONAL DOCTOR-
PATIENT RELATIONSHIPS AND BEING A LIFE LONG LEARNER
Berg AM, Van Staden CW, SA Fam Pract 2006;48(8):15; Joubert PM et al,
S Afr Psychiatry Rev 2006;9:28-32; SCHULTZ B, JOURNAL OF LANGUAGE AND
COMMUNICATION, 2008
• SOFT SKILLS REFER TO THE CLUSTER OF PERSONALITY TRAITS
SOCIAL GRACES, FACILITY WITH LANGUAGE, PERSONAL HABITS,
FRIENDLINESS, AND OPTIMISM
SCHULTZ B, JOURNAL OF LANGUAGE AND COMMUNICATION, 2008
EXAMPLES OF SOFT SKILLS
SCHULTZ B, Journal of Language and Communication, 2008
• COMMUNICATION SKILLS • RESPONSIBILITY
• CRITICAL AND STRUCTURED • ETIQUETTE AND GOOD
THINKING
MANNERS
• PROBLEM SOLVING SKILLS
• CREATIVITY • COURTESY
• TEAMWORK CAPABILITY • SELF-ESTEEM
• NEGOTIATING SKILLS • SOCIABILITY
• SELF-MANAGEMENT • INTEGRITY/HONESTY
• TIME MANAGEMENT • EMPATHY
• CONFLICT MANAGEMENT
• WORK ETHIC
• CULTURAL AWARENESS
• COMMON KNOWLEDGE • PROJECT MANAGEMENT
• BUSINESS MANAGEMENT
PATIENT AS THE SOURCE OF KNOWLEDGE
REG COMMENT
• MUTUAL BENEFIT • PRIMACY : LEARN FROM THE
PATIENT
• BEHAVE AS A DOCTOR; GOOD • GOOD DR-PTS RELATIONSHIPS,
COMMUNICATION SOFT SKILLS
• SELF-CONFIDENCE → PROPER
INTRODUCTION, WELL TRAINED • CLINICAL PROFICIENCY →
ON CLINICAL SKILLS UNDER FEEDBACK AND REFLECTION, BED
SUPERVISION, ACTIVELY SIDE TEACHING, ROLE MODELING
INVOLVED IN PATIENT’S CARE
Patient’s safety, Student’s safety
• ETHIC PRINCIPLES (BENEFICENCE,
NONMALEFICENCE, AUTONOMY, JUSTICE)
• INFORMED CONSENT
• RESPECT EACH OTHER
• STANDARD PROCEDURES
• COMPETENCIES
• STANDARDIZED PATIENT
PROFESSIONALISM IN MEDICINE
PRINCIPLES
• PRIMACY OF PATIENT WELFARE
• PATIENT AUTONOMY
• SOCIAL JUSTICE
CENTRAL VALUES OF PROFESSIONALISM
• Altruism, Accountability, Excellence, Duty and
advocacy, Service, Honour, Integrity, Respect for
others, Ethical and moral standards
McNAIR RP, MEDICAL EDUCATION 2005;39:456-464
CLINICAL SKILLS
• INTERACTIONS AMONG PATIENTS,
INSTRUCTORS AND STUDENTS DETERMINE
THE INFORMATION AVAILABLE FOR LEARNING
WOOLISCROFT JO, MEDICAL STUDENT CLINICAL EDUCATION, IN
INTERNATIONAL HANDBOOK OF RESEARCH IN MEDICAL EDUCATION, 2002
• CONVERTING THEORY INTO PRACTICE
KAUFMAN DM, BMJ 2003
• EXPERIENTIAL LEARNING
LEARNING IS OFTEN MOST EFFECTIVE WHEN
BASED ON EXPERIENCE
CYCLICAL PROCESS LINKING CONCRETE
EXPERIENCE WITH ABSTRACT
CONCEPTUALISATION THROUGH REFLECTION
AND PLANING
SPENCER J, LEARNING AND TEACHING, IN
THE CLINICAL ENVIRONMENTIN ABC OF LEARNING AND TEACHING IN MEDICINE
PRACTICAL WORKS, CLINICAL WORKS IS A MUST
→PROFFESSIONAL BEHAVIOR
• BE HUMANE AND ETHICAL (empathy)
• DISCIPLINE, PUNCTUALITY
• COMMUNICATION
• MASTER ESSENTIAL MEDICAL ABILITY (medical
examination, diagnostic, management)
• TAKE CARE OF OWN HEALTH AND SAFETY etc
BEDSIDE TEACHING
• ROLE-MODEL FOR PHYSICIAN-PATIENT INTERACTION
FEEDBACK AND REFLECTION
FEEDBACK
• PROMOTE PROFICIENCY
• BRIEF CONCRETE, USEFULL SUGGESTION
• BASED ON OBSERVED INCIDENTS AND ON MODIFIABLE
BEHAVIORS
• SMALL, DIGESTIBLE QUANTITIES
• NON-EVALUATIVE, NONJUDGMENTAL LANGUAGE
REFLECTION
REFLECTION IN ACTION
REFLECTION ON ACTION
CADAVER
• INDISPENSABLE IN MEDICAL EDUCATION
• TREAT WITH RESPECT
PATIENT’S SAFETY, STUDENT’S SAFETY
REG COMMENT
• REAL PATIENT IS ESSENTIAL, • RESPECT FOR PATIENTS, BEHAVE
MANNEQUIN ≠ HUMAN BODY AS A DOCTOR, MEDICAL ETHICS
• ANXIOUS, HESITATE TO APPLY • BE SKILLFUL, REPETITIONS IS
MEDICAL PROCEDURES NEEDED TO REACH PROFICIENCY
• MEDICAL ERROR • FOLLOW THE SOP
• NOSOCOMIAL INFECTION
• PROBLEM WITH CADAVER • TREAT WITH RESPECT,
ANONIMITY, GOOD PREPARATION
(ALLERGY, SENSITIVITY)
IDEAL PHYSICIAN FOR THE 21st CENTURY
TECHNICALLY PROFICIENT, PROFESSIONAL, HUMANISTIC
BIOMEDICAL KNOWLEDGE, DIAGNOSTIC COMPETENCE,
EFFECTIVE COMMUNICATION SKILLS, SOLID AND
APPLICABLE UNDERSTANDING OF THE PRACTICE AND
ROLE OF PHYSICIANS IN SOCIETY
ACQUIRE THE SKILLS, VALUES, AND ATTITUDES THAT COMPRISE A
PROFESSIONAL IDENTITY (A CAREGIVER AND A HEALTH PROFESSIONAL)
PERFORM HUMANE, VALUE-CONSCIOUS MEDICAL PRACTICE IN THE
TREATMENT OF PATIENTS
GOOD RELATIONSHIPS WITH COLLEAGUES
