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
• REAL PATIENT IS ESSENTIAL,
MANNEQUIN ≠ HUMAN BODY
• ANXIOUS, HESITATE TO APPLY
MEDICAL PROCEDURES
• MEDICAL ERROR
• NOSOCOMIAL INFECTION
• PROBLEM WITH CADAVER
COMMENT
• RESPECT FOR PATIENTS, BEHAVE
AS A DOCTOR, MEDICAL ETHICS
• BE SKILLFUL, REPETITIONS IS
NEEDED TO REACH PROFICIENCY
• FOLLOW THE SOP
• 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