Category Archives: Individuals

Physician Accountability After Critical Events

Molly Jackson, Elizabeth Kaplan

1) Read Article

Read the Medical error: the second victim. The doctor who makes the mistake needs help too (Wu, AW., 2000)

GOAL: Appreciate the idea of aftermath of medical error and idea of provider as second victim..

Context and Instructions: Read article to begin to appreciate medical errors can have on providers and get introduced to a way of thinking of how to support ourselves and colleagues who experience the aftermath of a medical error.

2) Read Article

Read Patient Safety Primer – Debriefing for clinical learning (as a pdf).

GOAL: Gain more familiarity with tool of debriefing especially as it might pertain to the aftermath of an adverse clinical event.

Context and Instructions: Read article to learn about the definition of debriefing, the components of debriefing, and special considerations.

Review these Key Ethics Terms:

Read: Excerpts from Aristotle’s Nicomachean Ethics

Reading Aristotle is hard! But we think you can do it! It will create some discomfort for everyone. We do NOT expect you to master these concepts – it is more important in this session to be open, brave, vulnerable, and interested in growth than it is to be ‘right’. See what you can gather from the reading and use the PDF’s highlighting and prompts to guide you if you’re having trouble.

Consider: the role of empathy in medical student education while reading Walking a mile in their patients’ shoes:empathy and othering in medical students’ education. The article discusses the barriers for medical education to promote empathy and offers up a paradigm that may help trainees deal with these barriers and possible ideas of how they could be surmounted.

 

Read over this Facebook Post and reflect on how values and virtues can or cannot be demonstrated on social media. This was a post by a fellow student.

 

If you’re feeling eager for more… explore this article on How to Teach Doctors Empathy which talks about the growing emphasis on empathy training for health care professionals and describes a few such trainings across the country.

Socialization of the Individual

Review the lexicon (covers important terms and definitions),explore socialization, watch a TED Talk on bias, and complete readings on narrative humility and reflection in medical education. 

Learn about socialization.  Ready all the sections in 3.2 Understanding the Meaning of Socialization and 3.6 Social Interactions in Daily Life.

This TED Talk reviews one woman’s experience with bias and an approach to address it.

This article discusses the concept of narrative humility in patient interactions.

Consider how reflection in medical education helps us learn.

Supplemental readings:

Honoring the Individual: Narrative and Cultural Humility

This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.

To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan

This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.

The stigma of being young, black and Republican, by Kamaria Roberts

Watch this compelling YouTube video by Director Vivian Chavez.  Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.

Cultural Humility, by Vivian Chavez

Social Ecological Model

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care.  A quick Google search for the social ecological model will reinforce how widely it has been adopted.  There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history.  How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)

Carrier Testing and Genetic Counseling

Review the following key ethics terms:

Read Genetic Screening by Burke, et al.  Focus on the content found on pages 154- 156.

Then watch Nathan’s Story:  Tay-Sachs Disease in the Irish Population followed by Dr. Fullerton’s introductory video.

Dr. Fullerton introduces the following case:

“A young couple who are interested in starting a family come to you to discuss undergoing genetic carrier testing prior to trying to conceive.  Both members of the couple are healthy and there is no known history of genetic disease in either patient’s background.  However, the husband does have a younger brother affected by Down Syndrome who lives semi- independently in a group home.  They each self-identify as being of Caucasian (not Irish or French Canadian) ethnicity and report no known Ashkenazi or Jewish Ancestry.”

“They are now aware of a wide range of recessive genetic conditions for which they could be tested.  They simply want to avoid having a child with a truly devastating prognosis such as Tay-Sachs disease.  Therefore, they request a test of the HEXA gene only.”

Should you honor this request or recommend that the couple consider carrier testing for additional genetic conditions instead?

COMPLETE the 4-boxes – use this 4-Box worksheet for guidance.

HOW SHOULD YOU RESPOND? use some of these ethics concepts to guide your answer:

  • CONSEQUENCES: What are the harms and benefits?
  • RULES: What are the norms, laws, standards of practice, legal and ethical rights, obligations and responsibilities?
  • VIRTUES: What might it mean to manifest sympathy, empathy, courageousness, trustworthiness, openness, respectfulness, or other virtues in this case?
  • SOCIAL RELATIONS:  Consider the interpersonal relations, social norms, and power structures.

 

If you’re interested in further investigation… (not required)

These two links are optional and are intended for the student who has prior experience with the topic and/ or a strong desire for additional information.

For more information about genetic testing we would refer you to “Carrier testing for Ashkenazi Jewish disorders in the prenatal setting” by Ferriera et al.  This article was published in the American Journal of Obstetrics and Gynecology.  It is above the level of the average foundations phase student.

For more information about ethical issues around genetic testing in Ashkenazi Jewish populations read “A young couple tests compatibility” and then explore the Dor Yeshorim website.