Exploring students' Feelings Counts in Education:The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics

Borahmah A [1], AlRasheedi S [1], Al-Braheem A [1], Elamir H [3], Jacob S [1], Bouhaimed M [1,2]

[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine.[2] Department of Surgery, Kuwait University Faculty of Medicine.

[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH

Background:

Learning consists of cognitive, emotional and social dimensions. In medical education, the cognitive dimension (Fig 1) is usually measured through assessments of performance, while the social and emotional dimensions are more challenging to capture. One of the objectives of the ethics and professionalism elective course on “Patient Safety: Better Knowledge for Safer Care” is to apply different reflection tools to the students’ hospital experiences to enable their development as future doctors. The Gibbs Reflective Cycle (Fig 2) was applied to the students’ experience of one of the nine World Health Organization "Patient Safety Solutions" (Fig 3) adopted by the Ministry of Health in Kuwait. In this case presentation, the four steps of the Gibbs cycle: to describe, to express feelings, to evaluate and finally to make sense of experience were applied to the “Performance of Correct Procedure at Correct Body Site” protocol. The first step in the protocol is the verification of the intended patient, procedure, site laterality (right or left without abbreviation) and any implant or prosthesis.

Remembering

Understanding

Applying

Analyzing

Evaluating

Creating

1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy

Fig 1: Bloom’s Taxonomy (Revised)

Can the student distinguishbetween di�erent parts?

Appraise, compare, contrast, criticize, di�erentiate, discriminate, distinguish,

examine, experiment, question, test

De�ne, duplicate, list, memorize,recall, repeat, state

Can the student recall orremember the information?

Can the student explain ideas orconcepts?

Can the student use informationin a new way?

Classify, describe, discuss, explain,identify, locate, recognize, report,

select, translate, paraphrase

Choose, demonstrate, dramatize,employ, illustrate, interpret, operate,

schedule, sketch, solve, use, write

Can the student justify a standor decision?

Appraise, argue, defend, select,support, value, evaluate

Can the student create a newproduct or point of view?

Assemble, construct, create, design,develop, formulate, write

Look-alike,Sound-Alike(LASA) Medication Names

Patient Identification

Single Use of InjectionDevices

Performance of CorrectProcedure at CorrectBody Site

Improved Hand Hygiene to PreventHealthcare-Associated Infection

Assuring MedicationAccuracy at Transitionsin Care

Avoiding Catheter andTubing Misconnection

Control of concentratedelectrolyte solutions

Communication DuringPatient Handovers

Patient safetySolutions

Fig 3:

DescriptionWhat happened?

DescriptionWhat sense can you make

of the situation?

Fig 2: Gibbs Reflective Cycle

FeelingsWhat were you thinking

and feeling?

Action PlanIf it arose again, what

would you do?

ConclusionWhat else could you have

done?

EvaluationWhat was good & badabout the experience?

Reflection can be used as a tool to facilitate the teaching of hospital based clinical ethics and patient safety in medical education.

Conclusion: Contacts:

For further information, please contact Dr. Manal BouhaimedEmail: manal_q8 @hsc.edu.kw Tel(office): 24636532

Acknowledgement:We would like to acknowledge the assistance provided by Quality Nurses: Abeer G. Dossokey, Amal T. Mohamed, Asila A. Alrasheedi, Lea Martinez & Rinto Francis.

Case Summary:

The students were able to identify that in a recent retrospective audit of 33 medical records of surgical procedures involving a bodypart that needed to be specified in terms of side laterality, there were 6 records that included at least one wrong entry (Fig 4). Out of a total of 86 different opportunities to enter the specific site of the procedure in the 6 patients’ records the following sources wereidentified (Fig 5a, b):

The students’ feelings were initially those of “shock and frustration, fear and need to be precautious going into the world of medicine, motivation to learn, and finally excitement and ambition to attain new perspectives about clinical ethics and patient safety".

0 20 40 60 80 100

Correct & Not Abbreviated

Abbreviatted

Missed

Wrong &Abbreviated

38%

Medical Forms

31%

Anaesthesia Forms

23%

Nursing Forms

8%Investigation Forms

Patient (1) had

WRONG SIDE surgery

Procedure: Right Pyelo lithotomy # of opportunities = 33 Correct & not abbreviated= 4 Wrong & abbreviated= 7 Correct & abbreviated= 15 Missed= 6

Patient (2) Procedure: Mesh repair for Right Inguinal Hernia # of opportunities = 11 Correct & not abbreviated= 1 Wrong & abbreviated= 1 Correct & abbreviated= 7 Missed= 2

Patient (3) Procedure: Amputation for gangrenous Left big toe # of opportunities = 10 Correct & not abbreviated= 4 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 0

Patient (4) Procedure: Amputation for Left Lower Limb Ischemia # of opportunities= 6 Correct & not abbreviated= 1 Wrong & abbreviated= 2 Correct & abbreviated= 2 Missed= 1

Patient (5) Procedure: Mesh repair for Left Inguinal Hernia # of opportunities= 16 Correct & not abbreviated= 9 Wrong & abbreviated= 1 Correct & abbreviated= 4 Missed= 2

Patient (6) Procedure: Mesh repair for Right Inguinal Hernia # Of opportunities = 10 Correct & not abbreviated= 2 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 1

Fig 4: Findings of laterality opportunities in 6/33 patients

LEFT

RIGHT

(Fig 5a)

(Fig 5b)