1. B & H VI (GUS) – May 2013 PATIENT AS THE SOURCE OF KNOWLEDGE
PATIENT’S SAFETY
AND STUDENT’S SAFETY

2. 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

3. 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

4. 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

5. 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, p ,2000

6. 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:

7. 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:

9. 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

10. 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

11. CADAVER
INDISPENSABLE IN MEDICAL EDUCATION
TREAT WITH RESPECT

12. 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

13. Patient’s safety, Student’s safety
ETHIC PRINCIPLES (BENEFICENCE, NONMALEFICENCE, AUTONOMY, JUSTICE)
INFORMED CONSENT
RESPECT EACH OTHER
STANDARD PROCEDURES
COMPETENCIES
STANDARDIZED PATIENT

14. 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:

15. 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

16. 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

17. 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

18. 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

19. 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