102 11 13 ppt
TRANSCRIPT
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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)
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Key questions
1. ?
2.
3.
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?
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Outcome based Education
Structure and process Competency
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?
UNESCO, 1996 4The Four Pillars of Education
1.Learning to know
2.Learning to do
3.
Learning to live together
4.[] Learning to be
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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
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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.
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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.
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Civil Society : VS
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:
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Patient Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
System-Based Practice
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System-Based Practice
1.
2.
3.
4.
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V.S
Knowledge, skill communication skills
innate factors Lowe M, Kerridge I, Bore M, Munro D and Powis D. J Medical Ethics 2001
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Knowledge Skill Attitude
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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 ----
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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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HREC
IRB103
82 REC
(Research Ethics Committee)
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(1)
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(2)
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(clerkship)
(OSCE)(mini-CEX, p-MEX,
Kalamazoo )
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(formative assessment):
Kalamazoo
Consensus Scale
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Kalamazoo Consensus Scale
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Jefferson Scale of Physician Empathy
JSPE-s
IRS
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JSPE-s:
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51
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2.57 2 2
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JSPE-s JSPE-s
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()
(Kalamazoo)(p-MEX)
:
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(JSPE-s)
(Mini-CEX)
(SPOSCE)
Jefferson Scale of Physician Empathy
Mini-CEX
Kalamazoo Consensus Statement
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McGill
University Prof. Cruess Professionalism mini Evaluation ExerciseP-MEXProf. Cruess
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! !
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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
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1>2>3>4>5>
Stretching and pulling out the rice shoot so that they can grow faster.
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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.
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MedEdPORTAL AAMC
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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
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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
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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
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treatment optionshealth strategies
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CanMEDS
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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.
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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
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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
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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
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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
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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.
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hidden curriculum
formal curriculum
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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
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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
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First, Purified your heart Put othes benefit at the upper most.
Master YinSune
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Medical
humanities
Dr Pt
communication
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7
1
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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
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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
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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 )
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Teaching communication across 7 years
Med 1 Med 7
Interact with
society
Interact with
science
Interact with
patient
Interact with
difficult situation
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Med year 1-2
Diary/ twice a week Intrapersonal communication
Training for self reflection
()
2
2,
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Med Year 5 - 6 Standardize patient / video record general examination, angry paient truth telling ()
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Medical ethics in Med Year 4 (past)
Role model
Illness literature
Film : 1/ The right to die 2 () 3 The wit 4Doctor
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Video used in medical ethics lecture
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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).
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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
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Clinical ethics Patient center decision - 3 E
Evidence based medicine
Experienced based
Ethical based
Decision making
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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
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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..)
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Health enhancement Risk avoidance Risk reduction Early identification Complication reduction
Enhancing the patient-doctor relationship Compassion power Healing Self-awareness
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The Patients Perspective
Disease Illness Disease Illness
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Reflection practice
Reflection In Action
Reflection On Action
Reflection For Action
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Reporting
Reasoning
?Reconstructing
Reflective cycle5 R
Relating
Responding
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Experience and explanation cycles
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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
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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
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(Appreciating Inquiry AI)
In Tzuchi Foundation
Always say the good word, Lotus coming from your mouth
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Bad things spread immediately to the whole world
Good things never know out of the doors
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Attributes of the physician
R. Cruess & S. Cruess
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Healer
Professional
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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
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