How to become a "Great Health Professional"?
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Introductory Keynote at the ICF course in Israel. Video recording is available with Hebrew subtitles here: https://qrcodes.pro/healthprofessional
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How to become a "Great Health Professional"?
- 1. How to become a “Great Health Professional”? Olaf Kraus de Camargo @DevPeds Ronen, G. M., Kraus de Camargo, O., & Rosenbaum, P. L. (2020). How Can We Create Osler’s “Great Physician”? Fundamentals for Physicians’ Competency in the Twenty-first Century. Medical Science Educator, 30(3), 1279-1284. https://doi.org/10.1007/s40670-020-01003-1
- 3. Osler’s Definition “The good physician treats the disease; the great physician treats the patient who has the disease.” William Osler (1849 – 1919)
- 4. How to know the patient? https://www.mentimeter.com/app/presentation/alveazr6baorv5rbu2 r255zoehxida3d/sffbzmos2jm9/edit
- 5. Diseases & Patients §Disease §Patient
- 6. Diseases & Patients §Disease §Pain §Fever §Dysfunction §Structural lesion §Health professionals §Health system §Patient
- 7. Diseases & Patients §Disease §Pain §Fever §Dysfunction §Structural lesion §Health professionals §Health system §Patient §Suffering §Fear §Activity limitation §Participation restriction §Family §Work/School
- 8. Please rank by importance! What characteristics of a med school do you think help to make great physicians? https://www.mentimeter.com/app/presentation/alveazr6baorv5rbu2 r255zoehxida3d/9xmus64wn4e7/edit
- 9. Medical School Ratings 1. Research Activity 0.40 (Dollar$) 2. Quality Assessment 0.30 (rated by peers and residency directors) 3. Student Selectivity 0.20 (MCAT, GPA) 4. Faculty Resources 0.10 (ratio faculty/students) https://www.usnews.com/education/best-graduate-schools/articles/medical-schools-methodology
- 10. A Brighter Future PBL Barrows, H.S., Mitchell, D.L.M., 1975. 1887 1975 Mac
- 11. A Brighter Future PBL Barrows, H.S., Mitchell, D.L.M., 1975. 1887 1975 Oxman,A.D.,Sackett,D.L., Guyatt, G.H., 1993 1993 EBM Mac
- 13. Best External Evidence Research EBM Scientist • Scientific method • Skepticism • Critical Appraisal
- 15. Individual Clinical Expertise Best External Evidence EBM Scientist Clinician • Signs & Symptoms • Techniques • Practical Experience
- 16. Individual Clinical Expertise Best External Evidence EBM Scientist Clinician The “Good Physician” • Signs & Symptoms • Techniques • Practical Experience
- 18. Individual Clinical Expertise Best External Evidence PatientValues & Expectations EBM EBM Scientist Clinician Patient The “Great Physician”
- 20. A Brighter Future PBL Barrows, H.S., Mitchell, D.L.M., 1975. 1887 1975 2001 Oxman,A.D.,Sackett,D.L., Guyatt, G.H., 1993 1993 EBM ICF World Health Organization, 2001 Mac
- 21. The Foundation § ICF (International Classification of Functioning, Disability & Health)
- 22. Health Condition (disorder/disease) Body functions & structures (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors ICF – Biopsychosocial Model
- 23. Health Condition (disorder/disease) Body functions & structures (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors ICF – Biopsychosocial Model
- 24. Health Condition (disorder/disease) Body functions & structures (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors ICF – Biopsychosocial Model
- 25. Health Condition (disorder/disease) Body functions & structures (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors ICF – Biopsychosocial Model Pain Fever Dysfunction Structural lesion Health professionals Health system Suffering Fear Activity limitation Participation restriction Family Work
- 26. Health Condition (disorder/disease) Body functions & structures (Impairment) Activities (Limitation) Participation (Restriction) Environmental Factors Personal Factors ICF – Biopsychosocial Model Pain Fever Dysfunction Structural lesion Health professionals Health system Suffering Fear Activity limitation Participation restriction Family Work
- 27. The Patient’sVoice § Narrative Medicine § PROs (Patient Reported Outcomes)
- 28. Narrative Medicine § ”Narrative knowledge is what one uses to understand the meaning and significance of stories through cognitive, symbolic, and affective means.” Charon R. Narrative Medicine A Model for Empathy, Reflection, Profession, andTrust. JAMA - J Am Med Assoc. 2001;286(15):1897-1902.
- 29. Narrative Medicine § ”Narrative knowledge is what one uses to understand the meaning and significance of stories through cognitive, symbolic, and affective means.” § “Unlike its complement, logicoscientific knowledge, through which a detached and replaceable observer generates or comprehends replicable and generalizable notices, narrative knowledge leads to local and particular understandings about one situation by one participant or observer.” Charon R. Narrative Medicine A Model for Empathy, Reflection, Profession, andTrust. JAMA - J Am Med Assoc. 2001;286(15):1897-1902.
- 30. Narrative Medicine § ”Narrative knowledge is what one uses to understand the meaning and significance of stories through cognitive, symbolic, and affective means.” § “Unlike its complement, logicoscientific knowledge, through which a detached and replaceable observer generates or comprehends replicable and generalizable notices, narrative knowledge leads to local and particular understandings about one situation by one participant or observer.” § ”Medicine can, as a result, better understand the experiences of sick people” Charon R. Narrative Medicine A Model for Empathy, Reflection, Profession, andTrust. JAMA - J Am Med Assoc. 2001;286(15):1897-1902. https://jamanetwork.com/journals/jama/fullarticle/194300
- 31. PROs § PROs embrace any aspect of a personal report of the individual’s health that comes directly, unfiltered, from that person Valderas JM,Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008;17(9):1125-1135.
- 32. PROs § PROs embrace any aspect of a personal report of the individual’s health that comes directly, unfiltered, from that person § Help healthcare providers to focus on a person’s individual health goals and guide diagnostic and management decisions Valderas JM,Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008;17(9):1125-1135.
- 33. PROs § PROs embrace any aspect of a personal report of the individual’s health that comes directly, unfiltered, from that person § Help healthcare providers to focus on a person’s individual health goals and guide diagnostic and management decisions § PROMs can teach us whether, in their own eyes, our patients are truly better after interventions, by following the ethical principle of doing more good than harm within the context of their own lives. Valderas JM,Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res. 2008;17(9):1125-1135.
- 34. Ethics § consider beneficence (doing good), non-maleficence (not doing harm), autonomy (independence of the person), and justice (fairness) § moral issues that often arise in clinical practice: decisions about investigations, therapies, intensity of treatment, and whether and how to incorporate patients’ voices. § knowing the narrative, understanding the biopsychosocial connections helps to engage in ethical shared decision-making
- 35. A Brighter Future PBL Barrows, H.S., Mitchell, D.L.M., 1975. 1887 1975 2001 Oxman,A.D.,Sackett,D.L., Guyatt, G.H., 1993 1993 EBM ICF World Health Organization, 2001 Mac 2010 #Chronic Diseases Ed. Reform Frenk, J., et al. 2010. Allotey, P., et al., 2010
- 36. A Brighter Future Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376(9756):1923-1958. doi:10.1016/s0140-6736(10)61854-5 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61854-5/fulltext?_eventId=login
- 37. A Brighter Future PBL Barrows, H.S., Mitchell, D.L.M., 1975. 1887 1975 2020 2001 Oxman,A.D.,Sackett,D.L., Guyatt, G.H., 1993 1993 EBM ICF World Health Organization, 2001 Mac “InMEd” (Integrated Medical Education) 2010 #Chronic Diseases Ed. Reform Frenk, J., et al. 2010. Allotey, P., et al., 2010 Ronen, G.M et al., 2020
- 38. Science: Biomedical Research & Evidence-based Medicine The Patient’sVoice: Narrative Medicine & Patient-reported outcomes Clinician’s Tools: ICF Framework & Ethics principles Integrated Model §ICF as the foundation to organize the narrative provided by patients §Ethical reflection on investigation and therapy options within a shared decision-making process §Exploring and choosing patient- relevant outcomes understanding that enabling participation is the main goal of health care (ICF!) ØLearning in interprofessional teams
- 39. “Great Health Professional” “The good clinician treats the impairment; the great clinician treats the patient who has the impairment.” after William Osler (1849 – 1919)
- 40. Acknowledgements § Gabriel M. Ronen § Peter Rosenbaum § Karen McAssey § Bernard Dan https://link.springer.com/article/10.1007/s40670-020-01003-1
- 41. Q & A Session Q A & ThankYou! Contact: krausdc@mcmaster.ca