MEU WORKSHOP

The AT – Com Booklet :

Structure, content

and

requirements

Socrates: “Tell me: is a doctor in the precise

sense…a money-maker or someone who

treats the sick? Tell me about the one who

is really a doctor.”

Thrasymachus: “He’s the one who treats the

sick.”

Plato, The Republic

“A profession…is an occupation that regulates

itself through systematic, required training

and collegial discipline; that has a base in

technical, specialized knowledge; and that

has a service rather than a profit orientation,

enshrined in its code of ethics…”

Starr

Ideal Foundational Value Reality

Evidence-based Truth/Science Uncertainty

Caring, healing Curing Risk-harming

Open heart/mind Accepting, Empathetic Arrogant, unmoved

Error-free Right action Mistake-prone

Analytic Reflective Hassled, knee-jerk

Self-sacrificing Altruistic Avaricious

Formal – what we say

Hidden – what we do

Empathy

Compassion

Altruism } What we

say

Most of the critical determinants of

physician identity operate not within

the formal curriculum but in a more

subtle, less officially organized hidden

curriculum

The hidden curriculum functions at

the level of organizational structure

and culture

Weariness

Strong distrust of emotions

Failure of communication

“Today’s culture of medicine is

hostile to altruism, compassion,

integrity, fidelity, and self-

effacement”

Coulehan

Current strategy is inadequate

Production of highly skilled

technicians but not necessarily true

professionals

Must strike a balance between

explicit teaching and experiential

learning incorporating the values of

professionalism

Faculty development critical

System of evaluation

Professional tone and awareness set

from the top!

Strong institutional support

Cognitive base

Experiential learning

Continuity

Role Modeling

Mentorship

Case based module

Case scenarios with discussion

points

Structured program

Distributed over all years

? Assessment

Competency Pattern in UG curriculum

Introduce Attitude and Communication Module

Introduce Revised basic course

Share Implementation Plan

Medical Council is keen on introducing

Competency pattern

Professionalism – ATCOM module

The contents of the programme include teaching

learning, assessment (formative and summative) as

well as proposed curricular changes (Integrated

teaching, early clinical exposure, internal assessment

and E-learning).

Basic course:

Deliverable: ability to plan and take a good lecture/

practical/bedside teaching

Challenges: competency based education is being

introduced

Requirements:

Framing learning objectives from

competencies

Assessment using direct observation methods

Ability to give good feedback

Walking through AT-Com:

Teaching AT-Com:

Who

What

When and

How

AT itutde and COM munication module

MCI – Implement the AT-COM module in

all medical colleges across the country

Over next two years

Forerunner of the transition to the

competency based medical education

program envisaged by MCI

Defines ‘Indian Medical Graduate”

(IMG)Possessing• Requisite knowledge

• Skills

• Attitudes

• Values

• Responsiveness

Function appropriately and effectively as the

physician of first contact of the community

While being relevant globally

Enumerates the roles of the IMG• Clinician

• Leader and member of the core health care

system

• Communicator

• Life long learner

• Professional

Clinician

Leader and member

of the core health care

system

Communicator

Life long learner

Professional

15 core competencies

6 core competencies

3 core competencies

5 core competencies

5 core competencies

Number of modules 5 Number of hours 34

Sessions are interdependent Self guided learning Interactive discussions Closure session with reflection Assessment

What does it mean to

be a doctor

8 (6 +2 hrs of self

directed learning)

Assessment not

required

What does it mean to be

a patient

8 (6 +2 hrs of self

directed learning

Formative assessment –

Written and oral

Summative - SAQ

The doctor patient

relationship

7 hours (5 +2hrs for self

directed learning)

Formative

Summative

Foundation of

communication

7 hours (5 +2hrs for self

directed learning

Formative

Summative may be

deferred

The cadaver as our first

teacher

4 (2+2)hrs Formative

Summative may not be

required

Number of modules 7

Number of hours 35

The foundation of communication – 2

The foundation of bioethics

1. Health care as a right

2. Working in a health care team

3. Bioethics contd - The cover up. Case

study on patient autonomy and decision

making

4. Bioethics contd – Life machine.

5. Bioethics contd – Who is the doctor?

6. What does it mean to be family member

of the sick patient

Number of modules 5

Number of hours 25

Foundation of communication 3

1. Case studies in bioethics – Disclosure of

medical errors

2. Seeking immunity

3. The foundation of communication -4

4. Case study in bioethics - Confidentiality

5. Case study in bioethics – Fiduciary duty

Number of modules

Number of hours 45

The foundation of communication 4

1. Case study in medical –legal and ethical situations – Child’s child

2. Case study in medical –legal and ethical situations - The angry brick kiln owner

3. Case studies in ethics empathy and the doctor patient relationship

4. Case studies in ethics and the doctor –industry relationship

5. Case studies in ethics and the doctor – The offer

6. Case studies in ethics and patient autonomy –The cruel parents

7. Dealing with death

Additional list of desirable competencies in

attitudes and communications

Non core

Suggested log book pattern

These may be included in whole or in part

of the formative assessment of the student

List of competencies in AT COM

1 – 39 Core competencies

40 -53 non core (Desirable) competencies

Communication skills rating scale from

Kalamazoo consensus statement