Group items tagged

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system - and with improved outcomes. We asked them about their secret to success. Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there's no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them. If Mayo can do it, why can't everyone else? The AARP believes that the potential is there for most communities to have excellent care - we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It's a big job and will take some investment, but we have many opportunities to do a better job than we're doing today.

"The duty of the teacher in this model is not to judge and rate but, rather, to read and tell what is seen. Our teachers, having been trained in the acts of close reading, are equipped not with rating rubrics but, rather, with a reading guide that prompts the reader to attend to several narrative features of a text. The reader/coach can thereby first see and then show the writer what is contained in the written text, at least from that reader's vantage point, helping along the process not only of the writing but also of the reflection the writing birthed. Multiple readers swell and complicate the lessons learned. As a dividend, we have observed, the group of readers/writers form strong, trusting, collaborative teams. And so our training for reflection also fulfills other difficult missions of medical education in teamwork, peer learning, trust, and care."

How could this impact medical education?

Whereas present theories of transformative learning tend to focus on the rational and reflective actor, in this article it is suggested that spontaneous action may play a decisive role in transformative learning too. In the spontaneity of action, novelty finds its way into life, gains momentum, is respected by others and reflected by the actor. Such transformation processes are investigated both with the means of theoretical reflection and of empirical inquiry. Based on nine narrative interviews typical phases of transformative learning processes are identified. Owing to the comparative nature of the study, it was also possible to develop an age-related typology that overlaps certain phases of the transformation process. These empirical findings constitute the background against which the nexus of spontaneous action and transformative learning is reflected theoretically. Theories drawn upon include John Dewey's Pragmatism and George Herbert Mead's Social Pragmatism. Both scholars provide rich theoretical concepts for reflecting on the nature of that what so often eludes from the control of both educators and learners: the spontaneity of the beginning.

ePBLMs are actual patient cases in CD format that permits free inquiry. The learner can ask any question of the patient in any sequence and get the patient's response and perform any item of the physical examination in any sequence and learn the result as in the real clinical situation. Any laboratory and diagnostic test can be ordered in any sequence as well. Whatever can be done with the actual patient on history and physical and the ordering of laboratory tests can be done with the ePBLM. A separate "User's Guide" provided with each ePBLM can be used with any of the ePBLMs in the series and provides the key for free inquiry.

"Yet the presence of a computer in the examination room and the pressure to document the visit in the EHR are often perceived as adversely affecting the patient-physician interaction. How can the EHR instead have a positive effect on this interaction and promote patient activation during the course of the outpatient visit? When clinicians invite patients to view the computer screen and parts of their electronic chart, it not only avoids uncomfortable periods of idle silence that sometimes accompany EHR-related tasks, but it may enhance the relational aspect of patient-physician communication in a way that fosters patient activation in real time."

"The results can be used to reframe understanding of the SP role and of the psychometric discourse of assessment. Ratings awarded by SPs are socially constructed and reveal the complexity of the OSCE process and the unfeasibility of absolute objectivity or standardisation. Standardised patients valued individuality, subjective experience and assessment for learning. The potential of SPs is under-used their greater involvement should be used to promote real partnership as educators move into a post-psychometric era. New-generation assessments should strive to value subjective experience as well as psychometric data in order to utilise the significant potential for learning within assessment."

" The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized."

Key benefits of the NAS include the creation of a national framework for assessment that includes comparison data, reduction in the burden associated with the current process-based accreditation system, the opportunity for residents to learn in innovative programs, and enhanced resident education in quality, patient safety, and the new competencies. Over time, we envision that the NAS will allow the ACGME to create an accreditation system that focuses less on the identification of problems and more on the success of programs and institutions in addressing them.

"In conclusion, a relatively small percentage of students use multimedia (audio and video) that are provided as a duplication of lectures in the basic sciences. The distribution of frequency of access of both video and audio files was consistent across the various courses offered in the first two years of medical school. There were significant correlations in the frequencies with which individual students viewed videos of lectures from course-to-course. Finally, there was a trend for an inverse association between the frequencies with which students viewed lectures and the grades they received in the course. This is an important observation that requires further investigation since it may be indicative of a maladaptive learning strategy for some students. It also does not exclude the possibility that additional computer-aided resources may be detrimental to some students. "

"The aim of this iBook is to help students learn and understand the structure and function of the brachial plexus by guiding the reader through four key areas. There is extensive use of interactive content throughout the app in the form of videos, question sessions in addition to the options offered as part of the iBooks app. This includes the ability to highlight passages, make notes or generate study cards based on material within the iBook."

" The BEME Collaboration is a group of individuals or institutions who are committed to the promotion of Best Evidence Medical Education through: the dissemination of information which allows medical teachers, institutions and all concerned with medical education to make decisions on the basis of the best evidence available; the production of appropriate systematic reviews of medical education which reflect the best evidence available and meet the needs of the user; and the creation of a culture of best evidence medical education amongst individual teachers, institutions and national bodies."

"Using René Magritte's well-known painting The Treachery of Images (This is not a pipe), we argue that the current focus on competencies throughout medical education can sometimes lead educators to rely too heavily on scores, checkmarks, or other forms of assessment that come to be viewed as equivalents for the actual existence of what is being measured. Magritte insisted that the image he created on the canvas was not a pipe but rather a representation of a pipe, an important distinction for educators to remember as we seek ways to evaluate trainees' attainment of the fundamental knowledge and skills of the profession. We also urge that the focus on broader skills, values, flexibility, reflection, and insight development should fall outside the net of a competency orientation in a supportive environment spared from traditional assessment methods, using a classroom in undergraduate medical education as an example of working toward this end. "

By considering clinical reasoning as a skill to be learnt rather than a concept to be understood, a framework for teaching this skill can be developed. The learner initially observes a consultation by the teaching clinician, followed by the teacher explaining the reasoning processes used including hypothesising, hypothesis testing, re-analysis and differential diagnosis. The student then comments on the reasoning of the teacher in a subsequent consultation, followed by feedback from the teacher on the student's reasoning in a third consultation.

Every Woman Every Child" is a global effort bringing together governments, philanthropic institutions and other funders, the United Nations and multilateral organizations, civil society and non-governmental organizations, the business community, health-care workers and professionals, and academic and research institutions around the world that support the "Global Strategy for Women's and Children's Health", which was launched during the United Nations Millennium Development Goals Summit. The Global Strategy for Women's and Children's Health provides a new opportunity to improve the health of hundreds of millions of women and children around the world, and in so doing, to improve the lives of all people.

"It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context."

"Narratives have always been a vital part of medicine. Stories about patients, the experience of caring for them, and their recovery from illness have always been shared-among physicians as well as among patients and their relatives. With the evolution of "modern" medicine, narratives were increasingly neglected in favor of "facts and findings," which were regarded as more scientific and objective. Now, in recent years medical narrative is changing-from the stories about patients and their illnesses, patient narratives and the unfolding and interwoven story between health care professionals and patients are both gaining momentum, leading to the creation or defining of narrative-based medicine (NBM). The term was coined deliberately to mark its distinction from evidence-based medicine (EBM); in fact, NBM was propagated to counteract the shortcomings of EBM.1,2 But what is NBM? Is it a specific therapeutic tool, a special form of physician-patient communication, a qualitative research tool, or does it simply signify a particular attitude towards patients and doctoring? It can be all of the above with different forms or genres of narrative or practical approach called for depending on the field of application. "

This study underscores the need for greater emphasis on the social determinants of health in medical education in the context of homelessness. These insights may help to inform the development and design of service-learning initiatives that integrate understandings of the social determinants of health, and thus potentially improve the readiness of clinicians to address the complex factors that shape the health of homeless populations.

"To describe the essential components of the medical model of substance use disorders. To delineate the interviewing skills necessary to screen effectively for substance use and abuse. To understand the high rate of psychiatric and medical co-morbidity and more effectively screen patients for these disorders. To demonstrate skills for evaluating patients' stage of change, readiness to accept the diagnosis, and readiness to undertake behavior change. To clearly and supportively recommend treatment to patients with substance use disorders. To describe the skills required for addiction prevention counseling. To define the skills that help set respectful limits on patient requests for prescription medication. To demonstrate awareness of how physician/clinician attitudes toward patients with substance use disorders impact recognition, diagnosis, and treatment of patients. To demonstrate knowledge of substance use disorder treatment standards and the ability to recommend appropriate referrals."