The failure of Medical Education?

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Are medical schools and specialty training programs adequately preparing doctors for the complexity of modern medical practice? The Health LEADS Framework is shown here. This is a framework for professional development in healthcare that has been widely adopted in both Canada and Australia. A template for the types of professional skills we need in healthcare. Domains include Leads self, Engages others, Achieves outcomes, Drives innovation, Shapes systems.

When we map assessment criteria for medical graduates at intern, RMO and registrar training level, approximately 60% of these relate to the ‘Leads self’ and ‘Engages others’ domains. Almost 50% do in senior doctor performance reviews.

If we value professionals who have skills such as self-awareness, articulate communication, and graded assertiveness, who are strong collaborators, adaptable and empathic - how are we actually training for these qualities? Are medical schools doing a good job? Do the curricula of structured specialty training programs reflect this? On the job training? Or do we largely stick to medical knowledge and procedural skills?

From my own experience as a clinical leader looking to appoint a new specialist, I don’t care if you’ve done 100 or 1000 hysterectomies. Of course, your Fellowship and safe practice are expected. But I want to know that you’ll get on well with your colleagues, support the doctors in training, be self-aware, engage harmoniously with the wider clinical team and be compassionate with your patients. The rest you can learn - these core skills are critical to a successful department and safe clinical care.

I just sense there’s a gap between what medicine trains for, and what it expects from its doctors.

24 cognitive biases that are warping your perception of reality

We all have our own world view but when dealing with others - and particularly if we need to build healthy workplace relationships - we need to be aware of our own cognitive issues.

These aren’t personal weaknesses, they’re simply a result of being human. But if we aren’t aware of them, and don’t make allowances for them in our daily interactions, that’s when they can become an issue - and impact on our ability to do our best work.

Courtesy of: Visual Capitalist

Support after traumatic experiences

When disaster strikes, we need to support one another through the aftermath. Everyone deals with trauma and grief differently and there is no ‘right’ way to react to what’s happened. People need reassurance that individual responses are unique, and that what they are experiencing is a normal response to an abnormal situation.

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In the past following traumatic events, routine and formal group debriefing was recommended. Published research however fails to support this as a positive intervention (1,2) and it may in fact be harmful.

Team leaders can still use meetings to help staff understand the range of emotions that may surface after an event, normal responses and support available to them. 

Psychological First Aid (PFA) is the preferred approach to reduce the risk of long term harm. Group debriefing involves each member sharing experiences, whereas PFA is one-on-one, individual support, as needed. It helps individuals bring a language to their experience and is framed around recovery and growth, looking toward the future.

A recommended guide for PFA has been published by Red Cross Australia (2). This guide carries endorsement of the Australian Psychological Society and is adaptable to a range of situations, including major disasters and critical incident scenarios. The principles include promotion of safety, calm, connectedness, self-efficacy and hope: growth through adversity.

Psychological First Aid encourages empathy rather than sympathy (3), and helps supporters provide space and options for others to decide what they need. It helps us to remain in role, ensures provision of accurate information and encourages self-care and support-seeking behaviours, including access to professional help.

We don’t need have all the answers or know how to fix everything, but people do need to be heard.

Post-traumatic distress
In the months after an event, a small number of people may develop adverse symptoms. Keep an eye out for social withdrawal, obsessive conversations about the event, or other unusual changes in their baseline behaviour. This could indicate a need for professional help.  Guidance toward support such as Employee Assistance Programs would be appropriate at that stage.

Trauma affects us all, and the pillars of support remain our family and friends, exercise, sound sleep, good diet and a guided return to routine lifestyle. Most people have the resilience to travel through without the need for professional help; however, a small number may need extra support. Our role is to help others understand the normal responses to adversity, and guide those who need professional assistance to the resources available.

1.      Psychological debriefing for post-traumatic stress disorder. American Psychological Association.
https://www.div12.org/treatment/psychological-debriefing-for-post-traumatic-stress-disorder/

2.      Guideline for provision of psychological support to people affected by disasters. Australian Psychological Society (link)

3.      Psychological First Aid. An Australian guide to supporting people affected by disaster.
http://bit.ly/pfa-redx

4.      Empathy vs Sympathy. Brené Brown
https://www.youtube.com/watch?v=1Evwgu369Jw

5.      Looking after children who have been affected by floods. Australian Psychological Society (link)

Thanks to Melissa Freestun MAPS for assistance preparing this post.