Developing an outcomes-based charter to direct teaching and assessment of medical professionalism

Background. Components of professionalism in undergraduate medical studies at the University of  Pretoria (UP) were previously defined as nine ‘Golden Threads’. Although specific outcomes were  formulated for the threads, the need for more explicit professional standards became increasingly evident. The restructuring of the health system in South Africa contributed to the need for more explicit standards. The Charter for Medical Professionalism was developed during 2006 - 2008 as a reference document within the local context to serve as a standard for professionalism in the medical curriculum. Another aim was to guide academics in medical studies to act as good role models of professional behaviour.Objective. To document the development of the Charter for Medical Professionalism and to evaluate  lecturer and student perceptions on the formulation of the Charter to make appropriate changes and increase acceptance.Methods. The project took the form of action research, and a working group comprising academics from UP’s Faculty of Health Sciences developed the Charter from relevant source documents, employing thematic and content analysis and recursive abstraction. An online survey was conducted to assess lecturer and student acceptance of the Charter.Results. The outcomes-based approach was perceived as acceptable and appears to broaden the scope of assessment of professionalism.Conclusion. Inclusion of outcomes proposed by other work groups relating to research, practice   management, teaching, mentoring and leadership roles of the medical doctor may be considered in future

Communication skills for medical/dental students at the University of Pretoria: lessons learnt from a two-year study using a forum theatre method

Background: This study describes the lessons learnt from using a novel method for teaching communication skills to second-year medical/dental students.Methods: Medical and drama teachers designed this action research project to serve the educational interests of secondyear medical/dental and drama students. The drama students enacted problematic doctor-patient scenarios for their forum theatre course. The interactive enactment was done for groups of 60-70 medical/dental students. The latter interrupted the actors to suggest improved communication skills. The drama students then re-enacted the scenarios, incorporating the improvements. The medical/dental students\' knowledge of communication skills was assessed before the enactment, three weeks later, and again four months after that. Their semi-structured feedback was analysed thematically. In the next year, the feedback was used to improve the methodology for the new second-year students. Results: In both years, the medical/dental students\' knowledge showed a statistically significant improvement after the enactment, and this was sustained for four months. In year 1, the feedback revolved around language problems and disrespectful attitudes. In year 2, visual cue cards of the communication skills were displayed during the act, and the drama students emphasised these rather than attitudinal problems. However, feedback showed that caricaturing the doctors\' attitudes still detracted attention from the desired focus on communication skills. Conclusions: Although the forum theatre method can transfer knowledge of communication skills, the focus of the acting should be on the demonstration of inappropriate communication skills rather than inappropriate attitudes. One limitation of this study is that assessment was limited to knowledge and did not progress to skills. South African Family Practice Vol. 47(6) 2005: 60-6

Medical students' perceptions of their development of ‘soft skills' Part II : The development of ‘soft skills' through ‘guiding and growing'

BackgroundThis paper reports on medical students' views on the ways in which their ‘soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills, communication skills, and professional and ethical attitudes.MethodsAs symbolic interactionism was used as the theoretical framework to guide the research, qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups, individual in-depth interviews and autobiographical sketches. ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught, but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that, in the end, they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators, fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed, as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups, except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect. The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between ‘being' and ‘becoming'. Instead of using the word ‘acquisition' of soft skills, ‘development' seemed to be more appropriate. The metaphor of ‘guiding' and ‘growing' also captures the development of these skills better than the terms ‘teaching' and ‘learning'.ConclusionTeaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated.For full text, click here: SA Fam Pract 2006;48(8):15-15

Medical students on the value of role models for developing 'soft skills' - "That's the way you do it

Objective: The Soft Skills Project examined the professional development of medical students at the University of Pretoria, especially their doctor-patient interaction skills and professional socialisation. This paper reports on one of the findings of the project, namely the importance that medical students attach to role models in the development of soft skills. Methods: We used a qualitative method with symbolic interactionism and grounded theory as framework. Fourty two final-year students from the last cohort following the traditional curriculum at the University of Pretoria in 2001, and 49 final years from the first cohort following the reformed curriculum in 2002 were recruited. Data were collected by applying focus groups, in-depth, individual interviews, as well as autobiographical sketches. Data were captured by means of audio tape recordings, transcripts of the tapes, researchers' field notes, and written accounts by students, and were analysed by using a general inductive approach. Results: There were no striking differences between the comments of the two groups. Students considered registrars to be the most influential role models in the clinical teaching context, followed by specialist consultants. Their idea of a good role model was a clinically and academically competent doctor that cared about patients, had good interpersonal skills, and who could inspire students. Students needed and appreciated good role models to help them to develop their own soft skills. They expected guidance and behavioural examples from clinical teachers. Although there were competent role models, the students were exposed to poor role models. Poor role models mainly affect students negatively. Students tend to imitate and perpetuate unacceptable behaviour. Furthermore, poor role models have a negative emotional effect on students and are detrimental to their moral and learning environment. Sometimes, poor role models have a paradoxical positive effect in the sense that they inform students how not to behave. Conclusion: Medical schools and medical doctors working with medical students should be consciously aware of the importance of role models both when allocating clinical teachers to students, and while performing duties with students. It is especially necessary to realise that poor role modelling has important detrimental effects on students. Therefore, an attempt should be made to ensure that not only clinical examination skills, but also soft skills, are demonstrated at the bedside. Measures to ensure adequate exposure of students to positive role models could include: staff development; the identification of good role models to guide registrars; and a reallocation of tasks, where possible, to increase the exposure of students to the ‘natural' role models. Keywords: soft skills, role models, medical students, professionalism South African Psychiatry Review Vol. 9(1) 2006: 28-3

The conceptualisation of "soft skills" among medical students before and after curriculum reform

Objective: This paper reports on the conceptualisation of "soft skills" as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. Methods: Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). Results: Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients' well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. Conclusion: The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations. Keywords: soft skills, interpersonal skills, doctor-patient relationship, professional socialisation South African Psychiatry Review Vol. 9(1) 2006: 33-3

Eplerenone attenuates pathological pulmonary vascular rather than right ventricular remodeling in pulmonary arterial hypertension

BACKGROUND: Aldosterone is a mineralocorticoid hormone critically involved in arterial blood pressure regulation. Although pharmacological aldosterone antagonism reduces mortality and morbidity among patients with severe left-sided heart failure, the contribution of aldosterone to the pathobiology of pulmonary arterial hypertension (PAH) and right ventricular (RV) heart failure is not fully understood. METHODS: The effects of Eplerenone (0.1% Inspra® mixed in chow) on pulmonary vascular and RV remodeling were evaluated in mice with pulmonary hypertension (PH) caused by Sugen5416 injection with concomitant chronic hypoxia (SuHx) and in a second animal model with established RV dysfunction independent from lung remodeling through surgical pulmonary artery banding. RESULTS: Preventive Eplerenone administration attenuated the development of PH and pathological remodeling of pulmonary arterioles. Therapeutic aldosterone antagonism - starting when RV dysfunction was established - normalized mineralocorticoid receptor gene expression in the right ventricle without direct effects on either RV structure (Cardiomyocyte hypertrophy, Fibrosis) or function (assessed by non-invasive echocardiography along with intra-cardiac pressure volume measurements), but significantly lowered systemic blood pressure. CONCLUSIONS: Our data indicate that aldosterone antagonism with Eplerenone attenuates pulmonary vascular rather than RV remodeling in PAH

Manual / Issue 5 / Unfinished

Manual, a journal about art and its making. Unfinished.The fifth issue. Loose threads unknotted. Ideas unrealized. Outlines left bare. Function unperformed. Patterns uncut. Luster removed with time and wear. We rarely examine unfinished things. The unfinished is easily overlooked in favor of the fully rendered and complete, but consider those sketchy lines, those fraying ends: the unfinished has potency. The unfinished offers evidence of process, reveals traces of technique, trembles with latent possibility. The essays, images, and projects presented in the fifth issue of Manual attend to the fluid potential of objects that are in some way incomplete. Softcover, 68 pages. Published 2015 by the RISD Museum. Manual 5 (Unfinished) contributors include Jen Bervin, Jean Blackburn, Gina Borromeo, Laurie Brewer, A. Will Brown, Bolaji Campbell, Dennis Congdon, Jeremy Deller, Jan Howard, Kate Irvin, Maureen C. O’Brien, Emily J. Peters, Siebren Versteeg, Elizabeth A. Williams, and C. D. Wright.https://digitalcommons.risd.edu/risdmuseum_journals/1004/thumbnail.jp

Manual / Issue 10 / Polychrome

Manual, a journal about art and its making. Polychrome. In art, especially, polychrome invites us to the dialogue that colors are always having amongst themselves. A history of polychrome could be a series of poems exchanged among colors. The exchange might exhibit something like perpetual newness, again and again revealing differently bent hues and movingly novel blends. It would be a short-line poetry, excruciatingly sensitive to tone. Its speakers would have no names, so it would confuse the psychology of human orientation. In this connection, a warning against rendering polychrome as a pure positive seems in order: the parties to this dialogue talk at cross-purposes, always on the brink of divorcing. Polychrome can offend and destroy. It conscripts discrete colors in order to sacrifice them. Does polychrome offend by mocking our own failure to connect? In any case, polychrome has an advanced idiom for dealing with conflict. It’s at home with uncertainty. —Darby English, from the introduction to Issue 10: Polychrome. Softcover, 80 pages. Published 2018 by the RISD Museum. Manual 10 (Polychrome) contributors include David Batchelor, Gina Borromeo, Nicole Buchanan, Catherine Cooper, Darby English, Mara L. Hermano, Elon Cook Lee, Josephine Lee, Evelyn Lincoln, Dominic Molon, Maureen C. O\u27Brien, RISD Museum 2017 Summer Teen Intensive Students, and Elizabeth A. Williams.https://digitalcommons.risd.edu/risdmuseum_journals/1036/thumbnail.jp

Manual / Issue 14 / Shadows

Manual, a journal about art and its making. Shadows. This anti-visibility is not the same as being invisible, rather it is the power to operate against systems of imperial domination, including the gaze. It asks: How do we force the gaze to surrender? What if explanation were off the table? By enabling a petit marronage that can be expressed in the visual and symbolic use of shadow, the gaze is challenged. This issue of Manual and the accompanying exhibition (opening at the RISD Museum Fall 2020) posit that the right to opacity de-burdens contemporary work by artists who identify as Black and/or queer and/or feminist and/or non-binary and/or OVER IT—whatever sociocultural constriction “it” signifies. Opacity extends to artists who are simply not interested in explaining themselves or offering the emotional labor that is expended for inclusion. This right says, “I have given enough.” It also legitimizes and reclaims the shadow as a place of refuge, instead of being a place from which to escape. –Anita N. Bateman The RISD Museum’s fourteenth issue of Manual shines a light on the shadow, centering the black body as a site of possibility, liberatory self-awareness, radical non-conformity, and joyful defiance. This issue serves as a companion to the exhibition Defying the Shadow. Manual 14: Shadows opens with an excerpt on the shadow from W. E. B. Du Bois’s The Souls of Black Folk, followed by an introduction by Dr. Anita N. Bateman, who elucidates: “Operating in the shadow comes with a legacy of resistance, both in spiritual and ideological forms.” Softcover, 108 pages. Published Fall/Winter 2020 by the RISD Museum. Manual 14 (Shadows) contributors include: Andrea Achi, Emanuel Admassu, Anita N. Bateman, Makeda Best, Gina Borromeo, Rashayla Marie Brown, Shuriya Davis, Akwaeke Emezi, Tayana Fincher, Melanee C. Harvey, Kate Irvin, Sade LaNay, Kelly Taylor Mitchell, Dominic Molon, Oluremi C. Onabanjo, Kevin Quashie, Matthew Shenoda, and Leslie Wilson. This issue complements the RISD Museum exhibition Defying the Shadow, curated by Dr. Anita N. Bateman.https://digitalcommons.risd.edu/risdmuseum_journals/1040/thumbnail.jp

Manual / Issue 8 / Give and Take

Manual, a journal about art and its making. Give and Take. The eigth issue. Manual 8 (Give and Take) explores interaction, transaction, and social exchange and indebtedness. The earliest known use of the expression “give and take” can be traced to horse racing. It referred to races in which larger, stronger horses carried more weight, and smaller ones, less. Implied therein is an accounting for relative capacities. In such a race, the goal remains the same—crossing the finish line first—but introducing this variable highlights the relationship between the competing horses. A win is only meaningful if each horse can be considered in relation to the others. We . . . find ourselves in a historical moment that makes our interconnectedness both more visible and more complex. Boundaries—physical, geographical, ideological—have become more porous, and the institutions that have provided structure—while always deeply flawed—have shown themselves to be more vulnerable than some of us would have liked to believe. Old systems are breaking down, giving way. New ones will take hold. —Mary-Kim Arnold, from the introduction to Issue 8: Give and Takehttps://digitalcommons.risd.edu/risdmuseum_journals/1034/thumbnail.jp