102 11 13 ppt

Derek Bok(2006) 8

1.(The Ability to Communicate)

2.(Critical Thinking)

3.(Moral Reasoning)

4.(Preparing Citizens)

5.(Living with Diversity)

6.(Living in a More Global Society)

7.(A Breadth of Interests)

8.(Preparing for Work)

Key questions

1. ?

2.

3.

Outcome based Education

Structure and process Competency

?

UNESCO, 1996 4The Four Pillars of Education

1.Learning to know

2.Learning to do

3.

Learning to live together

4.[] Learning to be

THE DEFINITION AND SELECTION OF KEY

COMPETENCIES De Se Co

Key Competencies for a Successful Life and a

Well-Functioning Society

Dominique Simone Rychen and Laura Hersh Salganik (eds.)

Hogrefe & Huber, Gttingen Final report in 2003

PISA

In 1997, OECD member countries launched the Program for International Student Assessment (PISA), with the aim of monitoring the extent to which students near the end of compulsory schooling have acquired the knowledge and skills essential for full participation in society.

Key Competencies in Three Broad Categories

1. Use tools interactively (e.g. language, technology) (,)

2. Interact in heterogeneous groups

3. Act autonomouslyto take responsibility for managing their own lives, situate their lives in the broader social context and act autonomously.

Civil Society : VS

Patient Care

Medical Knowledge

Practice-Based Learning and Improvement

Interpersonal and Communication Skills

Professionalism

System-Based Practice

System-Based Practice

1.

2.

3.

4.

V.S

Knowledge, skill communication skills

innate factors Lowe M, Kerridge I, Bore M, Munro D and Powis D. J Medical Ethics 2001

Knowledge Skill Attitude

?

1. Skill training in communication and ethical reasoning

2. Ethical reasoning is considered as logic game. And according to Kohlbergs theory, reasoning is independent of action.

Cultivate morality? ? daily practice?

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Caring

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Let the world change you... and you can change the world.----Che Guevara ----

Nussbaum MarthaA classical defense of reform in liberal education

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Health Care MatrixTRMSimulation

systems-based practice

OSCE

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learning by doing

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(Research Ethics Committee)

81

(1)

1.

(2)

2.

(clerkship)

(OSCE)(mini-CEX, p-MEX,

Kalamazoo )

(formative assessment):

Kalamazoo

Consensus Scale

Kalamazoo Consensus Scale

Jefferson Scale of Physician Empathy

JSPE-s

IRS

JSPE-s:

1.

2.

3.

4.

5.

6.

51

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JSPE-s JSPE-s

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(Kalamazoo)(p-MEX)

:

(JSPE-s)

(Mini-CEX)

(SPOSCE)

Jefferson Scale of Physician Empathy

Mini-CEX

Kalamazoo Consensus Statement

McGill

University Prof. Cruess Professionalism mini Evaluation ExerciseP-MEXProf. Cruess

The human dimension of learning

Gaining Technical competence

Biological kowledge

Communication, less on pyschosocial issue

undergraduate

Developing professional identity

Intern / Residents

Learning from practice

Learning to heal

Humble

Wisdom toward practice

At least 5-10 yearnot every physician achieve this level

1>2>3>4>5>

Stretching and pulling out the rice shoot so that they can grow faster.

Practice points Professionalism reflects societal values. An institutional definition must be

agreed. Situated learning in the early years is not enough. Learning must be supported

in the workplace. Role models are powerful. Both positive and negative behaviour will be seen. Reflection on action and mentoring are important to ensure appropriate

learning is achieved. Assessment must be integrated across the course using multiple tools.

MedEdPORTAL AAMC

ACGME Core Competency Chapter 1-Competency 1: Interpersonal and

Communication Skills Chapter 2-Competency 2: Medical Knowledge Chapter 3-Competency 3: Patient Care Chapter 4-Competency 4: Practice-Based

Learning and Improvement Chapter 5-Competency 5: Systems-Based

Practice Chapter 6-Competency 6: Professionalism

Set of professional responsibilities defined in the Physicians charter on professionalism (Project Medical Professionalism 2002).

Commitment Actions including, amongst others

1 Professional competence Life long learning to maintain medical knowledge and skills

2 Honesty with patients Complete and honest information, including reporting of medical error

3 Patients confidentiality Disclosure of patients information

4 Maintaining appropriate relationships with patients

Avoid sexual advances, financial gain

5 Improving quality of care Reducing medical error and increase patient safety, optimize outcome

6 Just distribution of finite resources

Wise and cost-effective management of limited clinical resources

7 Scientific knowledge Promote research, create new knowledge

8 Maintain trust by managing conflicts of interest

Recognise, disclose and deal with conflicts of interest

9 Professional responsibilities Collaborate respectfully, participate in process of self-regulation, and standard setting

As the U.S. medical education community increases efforts to enhance behavioral and social science understanding, physician educators abroad also are recognizing the importance of these disciplines in medical education. During the first week of the reports release, the Taiwanese Ministry of Education requested permission to translate the report into Mandarin Chinese

treatment optionshealth strategies

CanMEDS

Practice points Professionalism reflects societal values. An institutional definition must be

agreed. Situated learning in the early years is not enough. Learning must be supported

in the workplace. Role models are powerful. Both positive and negative behaviour will be seen. Reflection on action and mentoring are important to ensure appropriate

learning is achieved. Assessment must be integrated across the course using multiple tools.

Teaching and learning professional issues Van Mook 2009e). 1. Setting expectations/creating awareness and mindset

Providing clear definitions Defining goals and objectives Developing clear policies and procedures White coat ceremonies Undergraduate introductory lectures Recital Hippocratic oath Pre-clerkship and clerkship orientation sessions Workshop on altruism

Teaching and learning professional issues 2 Providing experiences: formal curriculum Literary discussions, including books, narratives, poetry,

history of medicine etc Hard case discussions Cine medication Grand rounds Resident as teacher programmes Medical ethics courses Humanism sessions Writing of short narratives about important incidents Chart stimulated recall Economic/political dimensions Discussion of legal issues

Teaching and learning professional issues 2 Providing experiences: formal curriculum Teaching leadership/management skills Teaching of feedback skills Teaching of communication skills Teaching of reflection skills Sociological consciousness development, including

community service programmes Anatomy sessions, including issues as death and dying Annual retreat or symposium on professionalism Journal club articles on professionalism Incorporation of professionalism concepts into morbidity

and mortality conferences Simulated or standardized patients

Teaching and learning professional issues 3. Providing experiences: informal/hidden curriculum

Role modelling Educational climate and leadership Learning by experience

4. Evaluating outcomes: assessment before entry Selection

Hidden curriculum Learned by watching what teachers and clinicians do

rather than by merely listening to what they say,

continues to undermine compassion, collaboration,

and communication.

hidden curriculum

formal curriculum

Hidden curriculum: the set of influences that function at the level of

organizational structure and culture including, for

example, implicit rules to survive the institution such

as customs, rituals, and taken for granted aspects

While most of medical education and training is about the nuts and bolts of clinical care how to treat hypertension, how to manage a ventilator, how to take out a gallbladder the process also involves learning how to be a doctor.

As opposed to lessons covered in textbooks and classrooms, this kind of learning is done through modeling, or what medical sociologist F. W. Hafferty has called the informal or hidden curriculum

First, Purified your heart Put othes benefit at the upper most.

Master YinSune

Medical

humanities

Dr Pt

communication

()Ethics

7

1

2

3

4

5

6

Integrating professionalism into the curriculum: AMEE Guide No. 61 Medical teacher 2012; 34: e64e77

MOE Medical Education Reform Project - Vertical integration humanities , commuication and Ethics in Tzuchi University 2008

Professionalism and medical humanities in Tzuchu University Vertical integration

Basic medical knowledge < - - > Clinical Three kinds of curriculum

Formal curriculum Informal curriculum Hidden curriculum

Six core competencies Communication Ethics / law Culture competency // Medical history, literature, philosophy Medical sociology Professionalism

Future development of professionalism curriculum

Med 1 Med 2 Med 3 Med 4 Med 5 Med 6

1 2 1 2 1 2 1 2 1 2 1 2 Humanities , caring and practice 1,2,3,4 (2 credits / semester) (Integrate humanities, commumication, social service, gender issue)

Population Health 1,2,3,4 (Integrate public health, epidemiolog, family medicine)

Physicianship 1-8 (2 credits hour / semester ) (Integrate ethics, communication, law, humantities, medical history )

Teaching communication across 7 years

Med 1 Med 7

Interact with

society

Interact with

science

Interact with

patient

Interact with

difficult situation

Med year 1-2

Diary/ twice a week Intrapersonal communication

Training for self reflection

()

2

2,

Med Year 5 - 6 Standardize patient / video record general examination, angry paient truth telling ()

Medical ethics in Med Year 4 (past)

Role model

Illness literature

Film : 1/ The right to die 2 () 3 The wit 4Doctor

Video used in medical ethics lecture

Integrating into basic and clinical learning in the future PBL + culture, psychocial issue, ethical / law issue

Clinical disease topic taught by clinical physician

+ disease historical backgound, culture, psychocial

issue, ethical / law issue (Prepare /assist from the

team of medical humanities).

Content of the program Communication

Standardized patient , video record, discussion M5 1 : general medical problem M5 2: Angry patient / family M6 telling the beds M6/7 communication medical error

Ethics: Small group individual case-based discussion CBD Reflective report

Humanities: Patient center, cultue sensitive CBD and narriative writing Role modeling : Appreciating inquiry through facebook

Clinical ethics Patient center decision - 3 E

Evidence based medicine

Experienced based

Ethical based

Decision making

Approach of clinical ethics 4 Boxes Medical indications

Principles of Beneficence and Nonmaleficence

Patient preferences Principle of Respect for Autonomy

Quality of life Principles of Beneficence and Nonmaleficence and Respect

for Autonomy

Contextual features Principle of Loyalty and Fairness

Clinical Ethics 5th Jonsen AR

Patient center care - six domains (disease and the illness experience)

(feelings . Ideas , effects on function

and expectations FIFE )

Understanding the whole person

(Personal history , life histroy , development

)

The proximal context (family, work, social relation)

The distil context (culture, heath ecology..)

- : 2

Health enhancement Risk avoidance Risk reduction Early identification Complication reduction

Enhancing the patient-doctor relationship Compassion power Healing Self-awareness

The Patients Perspective

Disease Illness Disease Illness

Reflection practice

Reflection In Action

Reflection On Action

Reflection For Action

Reporting

Reasoning

?Reconstructing

Reflective cycle5 R

Relating

Responding

Experience and explanation cycles

Teaching strategies for developing the reflective physician Role modeling and reflection

Reflective feedback: a strategy for teaching and

enhancing reflection

Learning mindfulness

Narrative medicine and storytelling

Learning in reflection groups

Models of learning Situated learning Students observe and learn from expert role

models, students will develop professionalism more effectively when involved in clinically related tasks rather than guided classroom-based activities.

Three key learning principles : attenuated authentic participation Freedman and Adam (1996): Learning and knowing are context specific Learning is accomplished through a process of

coparticipation Cognition is socially shared.

Lave and Wengers (1991) theory of Legitimate Peripheral Participation and Wengers (1999) subsequent work on Communities of Practice

(Appreciating Inquiry AI)

In Tzuchi Foundation

Always say the good word, Lotus coming from your mouth

Bad things spread immediately to the whole world

Good things never know out of the doors

Attributes of the physician

R. Cruess & S. Cruess

1

2 /

3 4

5

6

8 9

15

10

14 13

11

12

16

17

19

18

Healer

Professional

God grant me the serenity

To accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.

Reinhold Niebuhr

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2013 ()The human dimension of learning 4 5MedEdPORTAL AAMCACGME Core Competency 8Set of professional responsibilities defined in the Physicians charter on professionalism (Project Medical Professionalism 2002). 10 11 17Teaching and learning professional issues Van Mook 2009e). 1. Setting expectations/creating awareness and mindsetTeaching and learning professional issues 2 Providing experiences: formal curriculumTeaching and learning professional issues 2 Providing experiences: formal curriculumTeaching and learning professional issues 22Hidden curriculumhidden curriculumHidden curriculum: 26The development of Medical Humanities curriculum Professionalism in Tzuchi Foundation 29Professionalism and medical humanities in Tzuchu UniversityFuture development of professionalism curriculum Teaching communication across 7 yearsMed year 1-2 Diary/ twice a week Intrapersonal communicationTraining for self reflectionMed Year 5 - 6Standardize patient / video record general examination, angry paient truth telling ()Medical ethics in Med Year 4 (past)Video used in medical ethics lectureIntegrating into basic and clinical learning in the futureMed Year 5 6 Clinical ethics, Communication and Medical Humanities Content of the programClinical ethicsPatient center decision - 3 E Approach of clinical ethics 4 Boxes Patient center care- six domains - : 2The Patients Perspective Reflection practice 47Experience and explanation cyclesTeaching strategies for developing the reflective physicianModels of learning 51(Appreciating Inquiry AI)In Tzuchi Foundation Always say the good word, Lotus coming from your mouth 53 54 55 56

()

102 11 13 ppt

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