B & H VI (GUS) – May 2013 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 AND EMPATHY HEAVY WORKLOADS, STRENUOUS DEMANDS, NON-HUMANISTIC INFORMAL PRACTICES IN MEDICINE → EMOTIONAL SUPPRESSION, DETACHMENT FROM PATIENTS, BURN-OUT → DECREASE OF ALTRUISTIC IDEALS AND QUALITIES OF EMPATHY AMONG MEDICAL STUDENTS CLINICAL EMPATHY…..an affective and cognitive understanding of the patient’s reactions, thoughts or feelings, followed by a behavioral demonstration of that understanding back to the patients → DECLINING AMONG SENIOR MEDICAL STUDENTS ? BURKS DJ, KOBUS AM, Medical education 2012:46:317-325

INFLUENCE BY BIOLOGICAL, PSYCHOLOGICAL AND SOCIOCULTURAL FACTORS 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

ETIQUETTE AND GOOD MANNERS COURTESY SELF-ESTEEM SOCIABILITY EXAMPLES OF SOFT SKILLS SCHULTZ B, Journal of Language and Communication, 2008 COMMUNICATION SKILLS CRITICAL AND STRUCTURED THINKING PROBLEM SOLVING SKILLS CREATIVITY TEAMWORK CAPABILITY NEGOTIATING SKILLS SELF-MANAGEMENT TIME MANAGEMENT CONFLICT MANAGEMENT CULTURAL AWARENESS COMMON KNOWLEDGE RESPONSIBILITY ETIQUETTE AND GOOD MANNERS COURTESY SELF-ESTEEM SOCIABILITY INTEGRITY/HONESTY EMPATHY WORK ETHIC PROJECT MANAGEMENT BUSINESS MANAGEMENT

CADAVER INDISPENSABLE IN MEDICAL EDUCATION TREAT WITH RESPECT

PATIENT AS THE SOURCE OF KNOWLEDGE REG A NILAI DASAR BIOETIKA-HUMANIORA SALING PERCAYA PS ADALAH GURU MENGASAH ILMU SANTUN, SUNGUH SUNGGUH, JUJUR, JAGA HARGA DIRI PS STUDENT DOCTOR → DOKTER (MUDA) PETUGAS KESEHATAN → KOMPETENSI, SUPERVISI REG B EXCEPTIONAL LEARNING EXPERIENCES (interaction, information) RESPECT GOOD STANDARD OF PRACTICE AND CARE (competence, collaborative, supervision) IINTRODUCED BY SUPERVISOR (name, role) → (YOUNG) DOCTOR

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

PATIENT’S SAFETY, STUDENT’S SAFETY REG A KOMPETENSI HATI HATI, PROSEDURAL PS UMUMNYA MENDUKUNG KEHADIRAN MHS → PS ESENSIAL PD PENDIDIKAN DOKTER SHOWS, DOES → SKDI KELELAHAN REG B CLEAR INSTRUCTION, SUPERVISION FITNESS TO PRACTICE GOOD STANDARD OF PRACTICE AND CARE (procedures) SENSITIVITY TO CERTAIN CHEMICAL COMPOUNDS A PATIENT IS INDISPENSABLE (interview, physical exam, relationship) HONEST, INTEGRITY

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