Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy 2. Italian Society of General Practice/Family medicine, Rome, Italy

Transcription

1 early clinical exposure as the foundation for developing medical professionalism in the medical undergraduate Curriculum. Rome, Sapienza Sant Andrea Experience G. Familiari 1, L. De Biase 1, P.Falaschi 1, M. Relucenti 1, R. Heyn 1, R. Benvenuto 1, L.Carini 1, G, Nati 2, G. Grasso 2, G. Tarsitani 1 and V. Ziparo 1 In collaboration with SISM Sant Andrea Students 1 Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy 2 Italian Society of General Practice/Family medicine, Rome, Italy

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3 Early clinical exposure and vertical integration: Clinical and communication skills Basic and clinical sciences Social, community and population health Personal and professional development In an integrated curriculum, education and clinical service are mutually enhanced! Pagina 3

4 The Early Clinical Exposure program at Sapienza, University of Rome, since In the hospital setting at bedside and ambulatory care Pagina 4

5 First Year Course At Sapienza, Early Clinical Exposure program comprised: A six-ects integrated course devoted to medical-patient-nurse communication skills, in which students had a practical hospital setting module with tutorial guided student-patient contact ( psycho-social anamnesis ). Recently, an additional module has been introduced in general practice, carried on the community setting in collaboration with Italian Society of General Practice (SIMG); Familiari, Med. Chir. 2000; Familiari et al., Med. Chir Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000; Pagina 5

6 Second Year course At Sapienza, Early Clinical Exposure program comprised: A six-ects integrated course concerning elements of clinical methodology and EBM principles. Students had basic medical and surgical practice modules as well as basic life support using skill-lab. Familiari, Med. Chir. 2000; Familiari et al., Med. Chir Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000; Pagina 6

7 Third Year course at Sapienza, Early Clinical Exposure program comprised: a twelve-ects integrated course concerning elements of clinical methodology, EBM principles, the appropriate patient-doctor relationship, student s communication skills, clinical epidemiology, diagnostic reasoning, anamnesis, physical examination, clinical and instrumental semeiotics (Skills lab and bedside) Students had basic medical and surgical practice modules in small groups with skills lab and bedside teaching. Familiari, Med. Chir. 2000; Familiari et al., Med. Chir Familiari et al., AMEE Conference 2008, 2009; Torsoli et al. MEDIC, 2000 Pagina 7

8 Fourth- sixth years ACTIVITIES OF PROFESSIONAL APPRENTICESHIP in the hospital setting at bedside, ambulatory care and in the community Curricular clinical clerkships (Hospital ambulatory care and bedside teaching) in all medical and surgical disciplines; A clerkship in General Medicine (2 Weeks in the private office of general practitioner and lessons at University), mandatory since Pagina 8

9 NEW!!! Early Clinical Exposure in General Medicine, Since 2008 General structure 3 years long (first, second and third year courses) Each year: 1-2 introductory lesson six half/days of participation in the private office of the GM tutor Pagina 9

10 NEW!!! Early Clinical Exposure in the APPROACH TO DISABILITY Since 2010 (organized by SISM) General structure 3 years long (first, second and third year courses) Each year: 1-2 introductory lessons 2-4 half/days of participation in the hospital setting at the Opera Don Guanella Section discussion Pagina 10

11 Teaching objectives (A.A ): To sensitize medical students on the topic of disability, from the very first years of the core curriculum, showing them alternative models of interpersonal communication. To promote in students motivation and care on the topic of social distress associated with mental and/or physical disability. To trigger in the students reflections on the assistance and understanding of people showing any kind of distress (specular image regarding the physician-patient relationship). To learn how to interpret different behaviours in disabled persons and their helpers, learning how to manage inhospital meeting situations. Pagina 11

12 ECE Student s perceived satisfaction at Faculty of Medicne and Psichology, Sapienza University of Rome: Students anonymous questionnaires (n=6537, years ) revealed a positive feedback: mean percentage satisfaction for ECE integrated courses (1-2-3 Years course) = 87.4±4.8; mean percentage satisfaction for all integrated courses of School of Medicine = 78.3±14.3; P % CI of the difference: from to Pagina 12

13 Early Clinical Exposure and ethics values: authentic human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional occurring in the early or preclinical years of undergraduate education (usually the first two years) An innovative curriculum planning promotes the use of case studies, small group teaching, community teachers, critical self reflection, interviewing skills and moral decision making frameworks, in first year medicine Dornan et al. Med. Teach, 2008; Littlewood et al., BMJ 2005; Brunger and Duke, Med Teach. 2012) Pagina 13

14 How can experience in clinical and community setting contribute to early medical education? Early experience helps medical students socialize to their chosen profession. It can help learners attain a number of affective outcomes and acquire communication and basic clinical skills. It can help make students more satisfied with their curriculum (motivate them) and confident to meet patients (reduce the stress of meeting patients). It gives insight into psychosocial aspects of medical care and strengthens learning of both the biomedical and behavioural/social sciences. It contextualizes students learning. It can influence career choices. It has potential benefits for teachers, healthcare organizations, patients and populations. Dornan et al., Med. Teach. 2008; Littlewood et al., 2005 Pagina 14

15 Why clerkship in General Medicine For beginnig medical students? It is the setting in which the doctor-patient relationship acquires a higher relevance It allows to observe the evolution of diseases within their own context, considering the associations among health, family and society. It allows the contact with patients suffering the most common clinical conditions (hypertension, diabetes, bronco-pulmonar diseases, etc.), usually coexistent in a single patient, thus designing highly complex cases. It allows to learn some simple semiologic manoeuvres. Pagina 15

16 Why clerkship in Disability for beginning medical students? It is the setting in which the doctor-patient relationship acquires a higher relevance this experience could be a catalyst for personal growth, change, and a greater openess to the complexities of medicine. The initial feedback from the students was that the module had been a good experience. This format has been very successful in that the smal groups of students begin animated and ofted passionate discussions. Pagina 16

17 Conclusions Students clearly enjoyed this type of precocious experience and perceived it as an important tool. Take home message The ECE program reinforces the social responsiveness of clinical education, students attitudes, clinical and study skills, orientating medical curriculum towards society s needs. Pagina 17

18 Thank You for your attention Pagina 18