DPR 1: Sep-Dec 2013

Teaching Staff DPR-1

Dr. Himadri Roy - Course Director (email: h.roy@saba.edu)

Dr. Teresa Pinlac

Dr. Ivana Despotovic

Dr. Sudhir Ambati

Dr. Dheeraj Bansal

House Rules

You are here to LEARN - No eating, drinking, talking,

sleeping or surfing the internet in the classroom you will
be asked to leave the room and do all these things
elsewhere.
Attendance Absences must not exceed 10% of total
classes
Late in coming to class considered ABSENT
Absence on exam days: need island doctors note that
day
Ask questions during the time allotted after each
lecture.

DPR 1: SEP-DEC 2013

1.
2.
3.
4.
5.

Bring your lab coat to all labs.

Make sure you can log onto sabamed.org
Submit all assignments on time
Review the full syllabus carefully and look at the example
of the full patient interview write-up.
Be aware of the 17 competences that will be assessed.

The DPR 1 grade will be based on Oral exams (75%) and the role-play
patient interview write-up (25%).
Submission of assignments are part of competency assessment, and
must be submitted.

Assignments
1.

Make a PowerPoint presentation (minimum 10 slides) on : Ethical issues

in clinical research (Last date of submission October 30, 2013)

2.

Why you want to be a Doctor ? And what are your expectations (from this
profession)? (Word document) (Last date of submission October 30,
2013)

3.

Fill up - Assessment of Coping Style and The Stress Scale (Holmes

Rahe Social Readjustment Scale) (Last date of submission October
30, 2013)

4.

Required reading from text: Patient Centered Interviewing (Chapters 13) by Robert C. Smith

How to submit your assignment

Submit your assignment through email with

attachment files to h.roy@saba.edu with Subject
line: DPR1

Assignment files should have your name. e.g.

John_smith.docx or john_smith.pptx

Course Objectives
1.

Demonstrate professionalism and the professional

attitude necessary to foster and maintain an ethical
patient/physician relationship.

2.

Understand what is important about maintaining

rapport with a patient, and demonstrate rapportbuilding techniques.

3.

Properly introduce oneself to a patient.

4.

Begin an interview in a patient-centered manner and

set an agenda for the interview.

Course Objectives (cont.)

5.

Remain open-ended in questioning a patient until the

patient's full story is elicited.

6.

Handle emotions shown by the patient during the

patient-centered interview, using the NURS (N-ame the
emotion; U-nderstand R-espect; S-upport) model.

7.

Understand one's own coping skills and how to assess

patient coping.

8.

Understand how to assess a patient's chief complaint

and elicit the patient's explanatory model.

Course Objectives (cont.)

9.

Seek patients beliefs about the cause of their

symptoms or the concerns that they have about their
symptoms.

10. Transition from patient-centered interviewing to doctor-

centered interviewing when appropriate.

11. List the components of a psychosocial history.
12. Understand the basics in taking a complete sexual

history.

Course Objectives (cont.)

13. Understand the basics in taking a complete substance

history.
14. Understand the basics of a Review of Systems.
15. Understand what a full patient history entails, involving

all components of the history (Medical History,

Psychosocial History, Review of Systems)
16. Write up a (role-play) patient history covering all

aspects except the Review of Systems.

The goal of medical education is to produce

physicians who are prepared to serve the fundamental
purposes of medicine. To this end, physicians must
possess the attributes that are necessary to meet their
individual and collective responsibilities to society. Medical School Objectives Project Report

Competency-based medical education (CBME)

CBME is a - curricular concept designed to provide the

skills physicians need, rather than solely a large,
prefabricated collection of knowledge

The Six SUSOM Competencies :

1.

Patient Care

2.

Scientific and Medical Knowledge

3.

Lifelong learning, scholarship and collaboration

4.

Professionalism

5.

Communication and interpersonal skills

6.

Social and Community context of health care

PROFESSIONALISM

H. Roy MD, MD/PhD

What is Professionalism?

A professional man or woman is

one who does skilled work to
achieve a useful social goal.
Mortimer J. Adler
(1902 2001)

Professionalism is the conduct,

aims or qualities that characterize a
profession or a professional person

Professionalism in
Medicine
You are in this profession as a calling, not as a
business; as a calling which exacts from you at every
turn self-sacrifice, devotion, love and tenderness to
your fellow-men. Once you get down to purely
business level, your influence is gone and the true
light of your life is dimmed. You must work in the
missionary spirit, with a breadth of charity that raises
you far above the petty jealousies of life.

Dr. William Osler

(1849-1919)

Why is Professionalism
Important to Medical
Education?

Professionalism in physicians is
associated with improved medical
outcomes and of unprofessional
behavior with adverse medical outcomes

Disciplinary action by a medical board

was strongly associated with prior
unprofessional behavior in medical
school (Papadakis et al,2005)

Professionalism in medical students

As medical students you will have

privileged access to people, and to their
personal health information.

The trust that society places in you is

accompanied by responsibility and
expectations regarding your behavior

It is important that you are aware of these

responsibilities and expectations from the
beginning of your medical training

Professionalism in medical students

Any breach of these expectations

could result in serious repercussions
for you, your continuing medical
education and your later career

From now on, you should think of

yourself as a doctor-in-training,
rather than as a ordinary student in
theoretical studies

Commitments as a professional Medical

Student
Respect for professors, preceptors, and peers

Respect for guest speakers and visiting patients

Respect for cadavers and anatomical specimens

in the anatomy lab

Respect for the institution of which you are a part

Respect for patients and their families at clinical

encounters

Commitments as a
professional Medical Student
(cont.)

Respect for patient confidentiality

Unless the patient is a threat to society

Respect for all members of the health care team

Respect for administrative and support staff

Respect for the core values of professionalism

A Physician Charter (*ABIM) Fundamental Principles

1.

Primacy of patient welfare : This principle is based on

a dedication to serving the interest of the patient.
Altruism contributes to the trust that is central to the
doctorpatient relationship.
Primacy of patient welfare includes - causing no harm

and principle of beneficence

*American Board of Internal Medicine (ABIM)

To what extent should the benefactor suffer for the

beneficiary?

A Physician Charter (ABIM) Fundamental Principles (cont.)

2.

Patient autonomy: Physicians must be honest

with their patients and empower them to make
informed decisions about their treatment

A Physician Charter (ABIM) Fundamental Principles (cont.)

3.

Social justice :
Physicians should work actively

to eliminate discrimination in
health care, whether based on
race, gender, socioeconomic
status, ethnicity, religion, or any
other social category.
Physicians should promote fair

distribution of health care resources

e.g. overuse or misuse of medical tests
and procedures that provide little benefit

Lack of Professionalism
1.

2.

3.

Abuse of power
Abuse while interacting with patients and
colleagues
Bias and sexual harassment
Breach of confidentiality
Arrogance
Offensive display of superiority and selfimportance
Greed
When money becomes the driving force

Lack of Professionalism (cont)

Misrepresentation
Lying, which is consciously failing to tell the
truth
Fraud, which is conscious misrepresentation
of material fact with the intent to mislead
5. Impairment
Any disability that may prevent the physician
from discharging his/her duties e.g. Drugs.
Alcohol, Age, Illness
4.

Lack of Professionalism (cont)

6. Lack of conscientiousness or apathy
Irresponsible - Failure to fulfill responsibilities
or lack of commitment
Doing only the minimum

7. Conflicts of interests
Self-promotion/ advertising or unethical
collaboration with industry
Acceptance of gifts; and misuse of services
Overcharging
Inappropriate treatment
Prolonging contact with patients

Learning
Professionalism

Professionalism has been also described as

an ideal to be pursued, recognizing that
physicians will not always meet all of the
conditions required, but must continually
strive to do so

Learning Professionalism

Reflection and self-awareness are

necessary for the development of
professionalism.
The ability to reflect enables physicians

to develop in-sight into interactions with

patients and colleagues
Reflection enhances critical thinking,

and is one factor that separates

professionals from technicians

Learning Professionalism - Habit of Self

Questioning
Examples:

How might my previous experience affect my actions with this patient?

What am I assuming about this patient that might not be true?

What surprised me about this patient? How did I respond?

What interfered with my ability to observe, be attentive, or be respectful

with this patient?

If there were relevant data that I ignored, what might they be?

What would a trusted peer say about the way I managed this situation?

Were there any points at which I felt judgmental about the patient - in a
positive or negative way?

Learning Professionalism Reflective writing

Reflect on your clinical and other experiences in

a journal
This increases awareness of developing

professional identities.

Learning Professionalism
Role Models
Role modeling is an important
modality for learning
professionalism, even in
preclinical years.
Role models may include faculty,
peers and physicians in clinical
settings

John B. Gurdon

Shinya Yamanaka

Learning Professionalism
Simulated Patients

Simulated patients accurately

reproduce a history, physical and/or
emotional medical scenario that a real
patient would present.

Standardized patients provide students

opportunities to refine a variety of skills,
including communication, interview,
diagnostic, and clinical skills.

Learning Professionalism

Bed Side Teaching

Bedside teaching not just improves

students clinical skills, and

knowledge of clinical ethics, but
also can teach them
professionalism.
It allows the students to develop

empathy with the patients

Learning Professionalism

Small Group Discussions

May help students to identify and

analyze the professional behaviors
they observe

The SUSOM CompetenciesProfessionalism

1.

Show compassion in the treatment of patients and respect

for their privacy, dignity and beliefs

2.

Demonstrate personal integrity, ethical behavior and

altruism

3.

Exhibit dependability and responsibility

4.

Acknowledge and accept the limitations in his or her

knowledge and clinical skills

The SUSOM Competencies Professionalism

5.
6.
7.
8.

Demonstrate the ability to deal with uncertainty

Demonstrate skills in effectively reconciling
conflicts
Demonstrate the ability to identify and utilize
effective personal coping strategies
Develop sensitivity to discuss the ethical issues
involved in clinical practice and the use of
human subjects in clinical research

Case scenario

A student observes an exemplary student

during the end of semester final using a
textbook during a major closed book
examination.
(Identify the elements, characteristics, or

attributes of professionalism raised in this case.

You may then discuss solutions to the problem)