Medicine as a Profession

1. Medicine as a Profession Lindy Samson Ian McDowell

2. Objectives • List the eight roles of the physician as outlined in the University of Ottawa medical curriculum • Outline the historical origin of the development of these eight roles • Describe the purpose and design of the e-portfolio, including assignments • Discuss the interface between ethics and the law in medicine

3. Objectives cont’d • Explain the continuum of health advocacy from patient to family, to community, to policy development • Demonstrate the ability to write clearly by preparing a brief reflective essay on the role of the physician as 'Advocate' and at least one other role discussed in today's session

4. CBL summary • Mrs. Smith, a 36 year-old woman presents with a sore, bruised, and swollen right arm. When asked how she hurt her arm she says that two days ago she fell onto a coffee table at home and twisted it. She has been taking acetaminophen for the pain but it is not helping. Today, she is finding it difficult to use her right hand. • She is otherwise completely healthy.

5. Physical Examination • Mrs. Smith does not appear anxious or otherwise distressed.She is quiet but co-operative and appears systemically well. • Her right forearm is edematous from the wrist to the elbow and is exquisitely painful to palpation just above the wrist. Bruising is also noted just above the wrist. The remainder of the examination is unremarkable.

6. Social History • Mrs. Smith lives with her husband of 15 years and three children. She is a computer engineer and currently unemployed. Both she and her husband have been having difficulty finding permanent work. • Her family lives in Winnipeg. They moved to Ottawa because of job opportunities.

7. Things have been difficult in the last 4 years with her husband. She implies that he might be abusive when he drinks too much but she has no thoughts of leaving him. He has been rough with the children on one or two occasions, but she does not think of these as major events.

8. Mrs. Smith asks you not to speak to her husband, who is drinking a cup of coffee in the waiting room. • She tells you that she does not need or want any help.

9. What is a physician?

10. Webster’s Dictionary Physician: • (1) a person legally qualified to practice medicine and • (2) one who is skilled in the art of healing

11. Wikipedia http://en.wikipedia.org/wiki/Physician • A physician, medical practitioner or medical doctor is a person who holds a medical degree, practices medicine, and is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease and injury. This is accomplished through a detailed knowledge of anatomy, physiology, diseases and treatment— the science of medicine — and its applied practice — the art or craft of medicine.

12. Back to the CBL…. • What roles must the physician take on in order to effectively help this woman? • Identify the role and why • (class discussion)

13. History of the Physician roles: EFPO (Educating Future Physicians of Ontario) • 1970s – 1980s growing sense that the medical profession was out of favour with the public • Ontario physicians initiated a strike over whether they could “extra-bill” patients • the lack of public sympathy indicated that the profession was out of tune with public attitudes • pressure increased for medical education to become more responsive to the health needs of populations • EFPO was launched to determine what Ontarians expected of their physicians and to propose how training programs should be changed • five Ontario medical schools • Council of Ontario Faculties of Medicine (COFM) • The Ministry of Health

14. History of Physician Roles • EFPO supported the development of a medical curriculum based on meeting defined societal needs • defined eight roles for future physicians • proposed ways to train faculty in teaching these new roles • recommended new ways of testing clinical skills • Identified new curricular themes • medical ethics • critical appraisal of the literature • the health of minority groups • role of families in health • and communication skills. • theme of physician roles was taken up by the Royal College of Physicians and Surgeons of Canada • “CanMEDS” roles.

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16. Back Attributes of the Physicianas Healer and Professional Competence Commitment Confidentiality Altruism Trustworthy Integrity / Honesty codes of ethics Morality / Ethical Behavior Responsibility to profession Autonomy Self-regulation associations institutions Responsibility to society Team work respect for team Caring / compassion Insight Openness Respect for the healing function Respect patient dignity / autonomy Presence /Accompany Healer Professional Based on the Literature

17. Physician as….. • Clinician • (students to contribute ideas here)

18. Physician as….. • Professional • (students to contribute ideas here)

19. Physician as….. • Manager • (students to contribute ideas here)

20. Physician as….. • Health Advocate • (students to contribute ideas here)

21. Physician as….. • Scholar • (students to contribute ideas here)

22. Physician as….. • Communicator • (students to contribute ideas here)

23. Physician as….. • Collaborator • (students to contribute ideas here)

24. Physician as….. • Person • (students to contribute ideas here)

25. Integrating the roles….. • The ongoing challenge

26. The curriculum: Ensuring skill acquisition and learning across the roles at U of O

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28. Clinician The clinician role forms the core medical competency and forms the major part of your learning experience. The formal objectives include: -demonstrate the ability to obtain a complete history and perform a physical examination on patients in all age groups; -demonstrate the knowledge, skills and attitudes needed to identify persons at risk for, to diagnose, and to initiate appropriate management of the most common and the life-threatening health problems; -demonstrate the ability to obtain and record, on paper and electronic format, patient information in an accurate, concise and organized manner in a variety of clinical settings; -develop learning strategies to maintain competence as a clinician in his/her chosen field of practice. Back

29. Professionalism Professionalism involves being able to demonstrate a commitment to patients, health professionals and society through behaviours reflecting honesty, integrity, compassion, empathy, respect and altruism Teaching will be via an introductory lecture followed by a series of discussion seminars throughout the first two years. Back

30. Manager The modern physician inevitably becomes involved in administering components of the health system, whether in their own practice, or as part of a clinic or hospital team. Objectives include understanding health systems at local, regional, provincial, and national levels, and considering appropriate use of health care resources when making clinical decisions Teaching includes lectures on the Canadian health care system and worked examples during CBL sessions. Back

31. Health Advocate The Royal College suggests that physicians should: Respond to individual patient health needs and issues as part of patient care; Respond to the health needs of the communities that they serve; Identify the determinants of health of the populations that they serve; Promote the health of individual patients, communities and populations. Teaching of health advocacy roles derives from the population health module on health determinants, leading into a series of sessions on health behaviour change Back

32. Scholar Role The faculty’s objectives include: demonstrate the ability to acquire and apply evidence-based concepts and knowledge to clinical scenarios; demonstrate the ability to access and critically appraise the appropriate information and literature related to advancing knowledge in health care; develop the skills to effectively facilitate the learning of persons or groups including colleagues, patients and families, and other health professionals.  Teaching begins with foundations in epidemiological and statistical methods to learn how new clinical knowledge is collected. We then run a series of seminars on Evidence-Based Medicine. Back

33. Communicator Communication is central to the art of medicine. Our objectives demand that the student will be able to establish therapeutic, patient-centered communication through shared decision-making; achieve effective interactions with patients, families, colleagues and caregivers; convey information appropriately to patients, families, caregivers and colleagues Practical teaching occurs chiefly through the Physician Skill Development component. Topics such as cultural awareness are covered in the SIM curriculum. Back

34. Collaborator Medicine must be practiced as a team venture, and our objectives cover knowledge of the roles, skills and responsibilities of other members of the health care team; the ability to work effectively and to share decision-making in an interprofessional team; the ability to access community resources for the benefit of patients. Teaching is via CBL cases, supplemented by some exercises on interprofessionalism Back

35. Person Physician, first know thyself. Medicine is a stressful career, and we have made explicit objectives concerning maintenance of personal well-being, plus the ability to support colleagues: identify and appreciate the determinants of health for self and for colleagues on the health care team; identify strategies and resources to promote health and well being of physicians and their families; apply skills and strategies to promote personal and professional health and well being. The teaching is through introductory lectures, Faculty support resources, and through the small-group discussions that form the core of the Professionalism curriculum. Back

36. Introduction to the E-portfolio Pippa Hall