The second edition of this concise, easy-to-read title is designed for clinical teachers looking to refine their approach to teaching professional attitudes and basic skills to medical students. The core sections on communication skills, physical examination, and clinical reasoning have been fully updated; and the book has been expanded to cover such topics as the role of the social and behavioral sciences in clinical care, quality assurance of patient care, and the rationing of medical resources in clinical practice. On all topics, the renowned author clearly and adroitly offers keen insights gleaned from his long career, explaining the importance of these topics and how students form their own opinions about them. For example, writes the author, the primary goal of teaching the social and behavioral sciences is to raise awareness that age, low socioeconomic status, recent life events, drug dependence, mental illness, high body mass index, and belonging to an ethnic minority are risk indicators for morbidity. Second, the author address second opinions, outlining how not getting a second opinion is a cause of health care disparities. In addition, the author discusses how unexpected study results should not be ignored, nor should they be considered definitive evidence, but rather hypotheses that should be tested by further studies. Teaching Professional Attitudes and Basic Clinical Skills to Medical Students: A Practical Guide, 2nd Edition will be of great assistance to teachers who must provide an approach not only to teaching patient interviewing and the physical examination but to teaching key, clinically relevant topics of the behavioral and social sciences that are so vital to developing an effective, well-rounded physician.
Author(s): Jochanan Benbassat
Edition: 2
Publisher: Springer
Year: 2023
Language: English
Pages: 181
City: Cham
Preface to the Second Edition
Preface to the First Edition
Contents
Chapter 1: Paradigmatic Shifts in the Theory, Practice, and Teaching of Medicine Since the 1970s
1.1 Introduction
1.2 Doctor–Patient Relations (See Chap. 2)
1.3 Clinical Reasoning (See Also Chap. 5)
1.3.1 From Denial to Acceptance of Uncertainty
1.3.2 From Intuitive to Analytic Decision-Making
1.3.3 From Pathophysiologic Rationale to Evidence-Based Reasoning
1.3.4 From the Biomedical to the Bio-psycho-social Model of Clinical Practice (See Also Chap. 6)
1.4 Doctor–Society Relations (See Also Chap. 8)
1.4.1 From Accountability to Peers to Accountability to Laymen and Lay Institutions
1.4.2 From an Unrestricted to a Parsimonious Use of Resources
1.4.3 From a Lone Professional to a Member of a Healthcare Team
1.4.4 Change in the Public’s Trust in Health Services
1.5 Medical Education (See Also Chap. 9)
References
Chapter 2: Communicating with Patients
2.1 Introduction
2.2 Learning How to Talk with Patients
2.3 Teaching How to Talk to Patients
2.4 Coping with Barriers to Learning and Teaching Patient Interviewing
2.4.1 Learning Objectives and General Approaches to Achieving Them
2.4.2 The Integrated Learner- and Teacher-Centered Approach
2.4.3 Shifts in Teaching Patient Interviewing
2.4.4 Assessment of Communication Skills
2.5 Proposed Teaching Program
2.5.1 Step I: The Problem
2.5.2 Step II: Discussion of Possible Solutions
2.5.3 Step III: Demonstration of Various Interviewing Techniques and Discussion of Their Advantages and Disadvantages
2.5.4 Step IV: Supervised Practice
2.5.5 Advantages of the Proposed Approach
2.6 Barriers to Doctor–Patient Communication
2.6.1 Doctor–Patient Differences in Age, Race, Gender, Language, and Socioeconomic Status: Underprivileged Patients
2.6.2 Mismatch Between the Patient’s and the Doctor’s Preferences
2.6.3 Doctors’ Failure to Gain Insight into the Patient’s Concerns
2.6.4 Interviewing Habits That May Discourage Patients from Sharing Their Concerns
2.6.4.1 Writing Up the Patient History During Interviewing
2.6.4.2 Focusing on the Chief Complaint Early in the Interview
2.6.4.3 Performing Systems Review
2.6.5 Angry Patients
2.7 Coping with Barriers to Communication with Patients
2.7.1 Language Mismatches
2.7.2 Doctors’ Self-Awareness
2.7.3 Encouraging Patients to Share Their Concerns
2.7.4 Management of Patient Aggression
2.8 Shared Decision-Making
2.8.1 Teaching Shared Decision-Making
2.8.2 Proposed Learning Objectives of Shared Decision-Making
2.8.2.1 Gain an Insight into the Patient’s Concerns
2.8.2.2 Elucidate the Role That the Patient Wants to Assume in Decision-Making
2.8.2.3 Match the Patient’s Preferred Involvement in Decisions
2.8.2.4 Present Options; Discuss Pros, Cons, and Uncertainty
2.8.2.5 Offer the Patient the Option of Obtaining a Second Opinion and Suggest Reliable Websites
2.9 Patient Counseling
2.10 Patients’ Adherence to Doctors’ Advice
2.10.1 Estimating Patients’ Adherence to Doctors’ Recommendations
2.10.2 Reasons for Nonadherence
2.10.3 Ways to Improve Patient Adherence
2.11 Managing Difficult Encounters and Delivering Bad News
2.11.1 Patients’ Preferences
2.11.2 Care-Providers’ Preferences
2.11.3 Suggested Guidelines
2.11.4 Teaching How to Disclose Bad News
References
Chapter 3: The Physical Examination
3.1 Introduction
3.2 Barriers to Teaching and Learning Physical Examination Skills
3.2.1 Attitudes to the Physical Examination
3.2.2 “Inherited” Errors
3.3 Coping with Barriers to Learning the Physical Examination
3.3.1 Teaching the Reflective Physical Examination
3.3.2 Learning for Mastery
3.3.3 Integrating Hand-Held Devices into Teaching the Physical Examination
3.3.4 Teaching Physical Signs by Context and Importance
3.3.5 Use of Simulations
3.4 Diagnostic Utility of the Physical Examination and Ancillary Tests
3.4.1 Test Properties
3.4.2 Sources of Bias in Determining the Validity of Diagnostic Tests
3.4.3 Clinical Prediction Rules
3.4.4 Assessment of the Pretest Probability of a Disease
References
Chapter 4: Recording the Clinical Database
4.1 Introduction
4.2 The Problem-Oriented Record
4.3 The Electronic Medical Record
4.4 Teaching the Recording of the Clinical Database
4.4.1 The Personal and Psychosocial History
4.4.2 Chief Complaint
4.4.3 Symptoms
4.4.4 Problems
4.4.5 Statement of the Patient’s Present Problem(S)
4.4.6 Statement of the Present Problem(S) (Continued)
4.4.7 Statement of the Present Problem(S) (Continued)
4.4.8 Listing Active and Inactive Problems, Past and Family History, Review of Systems
4.5 Common Errors in Recording the History of a Patient’s Present Illness
4.5.1 Overemphasis on Objective History Data
4.5.2 Inadequate Description of the Patient’s Symptoms
4.5.3 Failure to Identify Main Symptoms
4.5.4 Unclear Presentation of Chronological Evolution of Symptoms
4.6 Providing Feedback on Students’ Records of a Patient’s History
References
Chapter 5: Clinical Reasoning
5.1 Introduction
5.2 Reasoning Strategies of Experienced Clinicians
5.2.1 Pattern Recognition and Hypothetico-Deduction
5.2.2 Additional Paths of Clinical Reasoning
5.2.3 Cognitive Task Analysis
5.3 Heuristics and Biases in Clinical Reasoning
5.4 Barriers to Learning Clinical Reasoning
5.5 Teaching and Assessing Clinical Reasoning
5.5.1 Learning Objectives
5.5.2 Assessment
5.6 Decision Support
5.6.1 Decision Analysis
5.6.2 Evidence-Based Medicine
5.7 Interpretation of Research Findings
References
Chapter 6: The Behavioral and Social Sciences in Medical Education
6.1 Introduction
6.1.1 Stress and Stressors
6.1.2 Psychological Distress
6.1.3 Life Events
6.1.4 Social Support
6.1.5 Socio-Economic Status
6.1.6 Personality Traits
6.2 Barriers to Teaching the Behavioral and Social Sciences
6.3 Overcoming Barriers to Student Learning
6.3.1 Risk for Disease and Ability to Cope with It: The Patient’s Personal/Psychosocial History
6.3.2 Implications for Clinical Practice
6.3.3 Who Should Teach Medical Students the Clinically Relevant Aspects of the Behavioral and Social Sciences?
References
Chapter 7: Medical Errors and Quality Assurance of Healthcare
7.1 Introduction
7.2 Medical Errors
7.2.1 Prevalence of Medical Error and Doctors’ Attitude to Mistakes
7.2.2 Prevention of Medical Errors
7.2.3 Patients’ Complaints and Medical Litigation
7.2.4 Disclosure of Medical Errors to Patients
7.3 Incapacitated Doctors
7.3.1 Incidence
7.3.2 Response to the Awareness of Doctors’ Dysfunction
7.3.3 Dealing with Doctors’ Dysfunction
7.4 Quality Assurance of Healthcare
7.4.1 Physicians’ Attitudes to Quality Assurance of Healthcare
7.4.2 Promoting Physician Support for Quality Assurance in Healthcare
7.4.3 Promoting Physician Self-Disclosure of Errors
References
Chapter 8: Shifts in the Structure of Health Care and Doctor–Society Relations
8.1 Introduction
8.2 Managed Care
8.2.1 Bureaucracy: Definition and Negative Connotations
8.2.2 Desirable Facets of Managed Care
8.3 Fair Distribution of Healthcare Resources
8.3.1 Fair Distribution of Resources: Ethical Dilemmas
8.3.2 Controversial Norms
8.3.3 The Need for a Policy of Rationing Resources
8.3.4 Implementing a Policy for Fair Allocation of Medical Resources
8.4 Trust in Medicine
8.4.1 Decline in Patient Confidence in Health Care
8.4.2 Possible Reasons for the Decline of Trust in Health
8.4.3 Impact of Changes in the Status of the Physician in Society
8.5 Medicine and the Media
8.5.1 Media Coverage of Medical Issues: Targets
8.5.2 Media Coverage of Medical Issues: Biases
8.5.3 Medical Recommendations in the Media
References
Chapter 9: Changes in Medical Education
9.1 Ongoing Changes in Medical Education
9.1.1 From Memorization to Self-Directed Learning and Information Management
9.1.2 From Knowledge to Competency-Based Education
9.1.3 From the Biomedical Model to Engel’s Bio-Psycho-Social Model for Clinical Reasoning and Practice
9.1.4 From Intuitive to Analytic Decision-Making
9.1.5 From Hospital to Community Settings
9.1.6 External Reviews of Teaching and Accreditation of Medical Schools
9.1.7 Quality Assurance of Patient Care
9.2 Challenges of Medical Education
9.2.1 Promoting Student Well-being
9.2.2 Personalizing Medical Education and Reducing Its Duration
9.2.3 Selection of Applicants for Medical Training
References
Index
