Exam 2 Flashcards
(76 cards)
1
Q
Professionalism Definition
A
Professionalism is demonstrated through a foundation of competence,
communication skills, and ethical and legal understanding upon which is built the aspiration too and wise application of the principles of: excellence,
humanism, accountability, and altruism.”
2
Q
3 fundamental principles in medical professionalism
A
Primacy of patient welfare
Patient autonomy
Social justice
3
Q
What is Empathy?
A
The ability of one person to relate and
understand the situational circumstances
of another human being
4
Q
Strong correlation between empathy and ______
A
professionalism
5
Q
What is professional integrity?
A
One who willingly “adopts” and consistently applies the
knowledge, skills, and values of a chosen profession. Integrity may be the most appropriate word used to describe the person who willingly and consistently acts in accordance
with social standards or moral values of society. Professional integrity thus defines the professional who consistently and
willingly practices within the guidelines of the mission of a chosen profession under the obligation of a Code of Ethics and societal expectations
6
Q
What is research misconduct and reporting mechanism?
A
Fabrication, falsification,
or plagiarism in proposing,
performing or reviewing
research or in reporting
research results
-Obligation to report
-Honest differences of
opinion are not considered
as misconduct
-Officer for Research
Standings (ORS)
-Students report to ORS,
Provost or Student Life
7
Q
Moral vs. Ethical
A
-Similar but not the same
-Ethics > a set of rules, principles, or ways of thinking that guide
or claim authority to guide the actions of a particular group
* Has no particular religious basis or connection
* Often based on the profession you are in: medicine, business, etc.
-Morality > a doctrine or system concerned with conduct or duty;
habits of life with regard to right or wrong
* Often conflated with religion; also embedded in a society’s values
8
Q
Moral Dissonance
A
- A clash
- Inconsistency between
the beliefs and values of
the parties to the
decision-making process
9
Q
Moral Distress
A
- Moral distress occurs when one knows the ethically correct action
to take but feels powerless to take that action (Jameton, 1984) - Initially described in nursing profession
- Demonstrated to impact ALL healthcare professionals, including
physicians - Students are especially vulnerable due to power imbalance
Moral Distress
10
Q
Constraints Involved in Moral Distress: Internal vs External
A
-Internal: self-doubt, fear, lack of assertiveness
-External: hierarchies in health care system, not enough staff, fear of litigation
11
Q
What is the cost of moral distress? How can we fix it?
A
-physician burnout, moral outrage/injury, leaving the profession
-speak up, deliberate decisions, support networks, working as a team, acknowledge struggles
12
Q
What is moral dilemma?
A
- A situation involving choice
between equally
(un)satisfactory alternatives - A problem seemingly
incapable of a satisfactory
solution
13
Q
Decision making process for ethical choices
A
1) Gather Information
2) Define the Value Conflict
3) Identify the Decision
Makers
4) Weigh the Alternative(s)
and Decide
5) Carry Out the Decision
6) Live With the Decision
7) Learn from the Decision
14
Q
What are boundary crossings and violations?
A
-Crossing: deviation from classical therapeutic activity that is harmless, non-exploitive, and possible supportive of the therapy
itself
* Not all boundary crossings are boundary violations
-Violation: deviation from classical therapeutic activity that is harmful (or potentially harmful) to the patient and therapy alike
b/c it constitutes exploitation of the patient, using the health care
provider-patient relationship as its vehicle
15
Q
What are dual relationships?
A
- Two distinct types of relationship with the same person
- HCP PLUS friend, business affiliate, coworker, family member, romantic
partner,….
-Dual relationships are discouraged because: - Allow for possible conflicts of interest, May lessen clinical objectivity, Ultimately impair professional judgment
-Iowa Board of Medicine has guidelines re: romantic involvement with
patients/parents of patients: - Cannot date any patient you have ever seen for mental health problem
- Cannot date current patient (best to wait at least a year)
- Cannot date parent of a minor patient
16
Q
What is Resilience?
A
-Process of adapting well
-A person’s capacity to resist adversity
-Capacity of a material or body to suffer stress or the imposition of
external pressure and return to its original state
17
Q
What is moral courage?
A
Moral courage is the courage to take action for moral reasons despite the
risk of adverse consequences
18
Q
5 pillars of resilience
A
- Physical resilience: aims to maintain and improve physical health
- Mental resilience: aims to maintain and improve emotional and cognitive state
- Social resilience: aims to maintain and improve social situation and relationships
- Financial resilience: aims to maintain and improve financial foundation
- Spiritual/existential resilience: aims to provide meaning in life/role
19
Q
Stress management HALT acronym
A
Don’t let yourself get too
* Hungry
* Angry
* Lonely
* Tired
* (Sick)
20
Q
TeamSTEPPS
A
-Team Strategies & Tools to Enhance Performance
& Patient Safety
-gives team a common language
bridges the divide and levels hierarchy
-includes patients as core to care
21
Q
Standards of Effective
Communication
A
-complete
-clear
-brief
-timely
-respectful
22
Q
What is SBAR
A
-A framework for team members to effectively communicate information to one another
-situation
-background
-assessment
-recommendation or request
23
Q
What is call-out?
A
- A strategy used to communicate important or critical
information: - It informs all team members simultaneously during emerging
situations. - It helps team members anticipate next steps
24
Q
What is a check-back?
A
-Confirming medication, procedure etc.
-Confirms right treatment
25
What is hand-off?
-shift change
-"rounds"
-patient clarity and information
-gives opportunity to ask questions about patients
-transfers responsibility of patient
26
What is the I-PASS handoff tool?
-I = illness severity (stability)
- P = patient summary (treatment plan, ongoing assessments etc.)
-A = action list (to-do list)
- S = situation awareness and planning (whats going on and plan for what might happen)
- S = synthesis of receiver (summary, ask questions)
27
Team Leader Role
* Ensure the patient’s needs and preferences are understood and prioritized.
* Define, assign, share, monitor, and modify a plan.
* Review the team’s performance.
* Establish “rules of engagement.”
* Manage and allocate resources effectively.
* Provide feedback regarding assigned responsibilities and progress toward the goal.
* Facilitate information sharing.
* Encourage team members to assist one another.
* Facilitate conflict resolution.
* Model effective teamwork
28
What is a team brief?
* A team brief is an effective strategy for
sharing the plan.
* Briefs should help:
* Form the team.
* Designate team roles and responsibilities.
* Establish climate and goals.
* Engage team in short- and long-term
planning.
29
What is the huddle?
*monitoring or modifying the plan
* Hold ad hoc, “touch base” meetings to
regain situation awareness.
* Discuss critical issues and emerging
events.
* Anticipate outcomes and likely
contingencies
30
What is the debrief?
*fosters process improvement:
* Brief, informal information exchange and
feedback sessions
* Occur after an event or shift
* Designed to improve teamwork skills
* Designed to improve outcomes
31
I'm safe checklist
-I = illness
-M = medication
- S = stress
- A = alcohol and drugs
- F = fatigue
E = eating and elimination
32
Situational monitoring with STAR
* Stop: Pause to focus on the immediate task.
* Think: Think methodically and identify the correct action.
* Act: Perform the act.
* Review: Confirm anticipated result has occurred or apply contingency if
required
33
CUS words
- I am Concerned
- I am Uncomfortable
- This is a Safety concern
34
DESC script
-used for interpersonal conflicts
-Describe the specific situation or behavior; provide
concrete data.
-Express how the situation makes you feel/what your
concerns are.
-Suggest alternatives and seek agreement.
-Consequences should be stated in terms of impact on
the patient and established team goals; strive for
consensus.
35
Two challenge rule
-used for informational differences conflicts
-Team members assertively voice a concern at least 2 times to ensure it has been heard. If the concern is not resolved, the provider needs to take stronger action
36
What can I do?
* First do no harm= Make safety a priority
* Use system safety tools like TeamSTEPPS
* Report safety concerns
* Practice/simulation
37
National Demographics
* Increasingly Diverse Population Growth
* Hispanic/Asian population in U.S. will triple by 2050
* The Black/African American Population will double by 2050
* A huge increase of diverse immigrant populations all across the U.S.
* Multi-racial population growing rapidly
38
Cultural Competency
-a developmental process in which individuals or institutions achieve increasing levels of awareness, knowledge and skills along a continuum
-knowing your community
-understanding people have a unique world view
-being alert to the ways cultural affects who we are
-examining systems and structures for their impact
39
Cultural awareness
being sensitive to issues
related to culture, race, gender, sexual
orientation, social class, and socioeconomic
factors.
40
Cultural Humility
“Lifelong process of self reflection and self critique‐ .
The starting point for such an approach
is not an examination of the client/patients belief
system, but rather having health care/service
providers give careful consideration to their own
assumptions and beliefs that are embedded in
their own understandings and goals of their
encounter with the client/patient”
41
Structural Competency
* Definition: Structural Competency emphasizes
diagnostic recognition of the economic, social, and
political conditions that produce and racialize
inequalities in health, and healthcare.
* Structural competency looks at how various structures
as part of institutions (e.g. economics, zoning laws,
courts, schools etc.) and how these institutions and
structures perpetuates healthcare disparities to various people from marginalized communities.
42
Benefits of learning your patient's different cultures
-By understanding, valuing, and incorporating the
cultural differences of America’s diverse
population and examining one’s self health
related values and beliefs, health care
organizations, practitioners, and others are able
to learn to RESPECT, COMMUNICATE, UNDERSTAND
and ENGAGE patients whose cultures may be
different from the prevailing culture” (Katz, 2008)
- know the capitalized words
43
Inter-cultural Awareness
-awareness of difference
-acceptance/acknowledge
-understanding cultural difference
-cultural adaptation
-intercultural skillfulness
44
Evidence based practice
-Evidence-Based Practice (EBP) is a
thoughtful integration of the best available
evidence, coupled with clinical expertise.
-Using evidence-based practice enables
health practitioners of all varieties to
address healthcare questions with an
evaluative and qualitative approach
45
DHHS regulations research definition
DHHS regulations define research as a
“systematic investigation, including
research development, testing, and
evaluation, designed to develop or
contribute to generalizable knowledge.”
A "systematic investigation" is an activity
that involves a prospective plan that
incorporates data collection, either
quantitative or qualitative, and data
analysis to answer a question. It’s the intent
that counts.
Research
46
What is an IRB and What Does It Do?
Review and approve research
involving humans
Ensures compliance with all
federal, institutional, and ethical
guidelines
Responsible for protecting the
rights, safety, and welfare of
research subjects
The IRB must comply with HHS and
FDA regulations for the protection
of human subjects in research
47
When and How of Informed Consent
Must be obtained before participation - including screening
questions
Provide a thorough overview, give them time to ask
questions and have them answered, and decide if they
want to participate
Presented in a language understandable to the participant
Concise and focused presentation of the critical information
that will help them decide if they want to participate,
including any reasons they might not want to
Not just a list of isolated facts – the explanation must
facilitate their understanding
No exculpatory language that waives or appears to waive
the subject’s legal rights or release the investigator, the
sponsor, or the institution of liability for negligence
48
Nuremberg Code – 1947
“The voluntary consent of the human subject is
absolutely essential”
Capacity to consent
Voluntary participation
Freedom from coercion
No penalty for not participating
Knowledge of risks and benefits
49
Belmont Report (1979)
-Three basic ethical principles that should
govern human subject research
-respect for persons,
-beneficence
-justice
50
What is a case report?
Clinical case reports document and serve as a vital
record of unusual and rare cases of diseases, disorders,
and injuries. They provide the details of a given topic,
briefly include background, and establish the broader
significance of a case in the medical literature
51
Observational studies
Cohort study
◦ Prospective cohort
◦ Retrospective cohort
◦ Ambidirectional cohort study
Case-control study
Cross-sectional study
52
Three types of cohort studies
◦ Prospective cohort
Selected in the present and followed into
the future.
◦ Retrospective cohort
Investigators go back in time to identify a
group
◦ Ambidirectional Cohort Study
A cohort study that is ambidirectional is said to
be both prospective and retrospective
53
Case-control study
Case-control studies
are used to identify factors that may
contribute to a medical condition by
comparing subjects who have that condition
(the 'cases') with patients who do not have
the condition but are otherwise similar (the
'controls').
54
Cross-sectional study
A cross-sectional study examines the
relationship between disease (or another
health-related state) and other variables of
interest as they exist in a defined population at a single point in time or over a short period of time (e.g., calendar year).
55
Treatment studies
A randomized controlled trial (RCT) - a form of a clinical trial – is most commonly used in
testing the safety (or, more specifically,
information about adverse drug reactions
and adverse effects of other treatments)
and efficacy or effectiveness of healthcare services (such as medicine or nursing) or health technologies (such as pharmaceuticals, medical devices or
surgery).
56
Double-blind randomized trial
Double-blind: a
study in which both the investigator or the
participant are blind to (unaware of) the nature of the treatment the participant is receiving. Double-blind trials are thought to produce objective
results
57
Single-blind randomized trial
experimental
procedure in which the experimenters but not the subjects know the makeup of the test and control groups during the actual course of the
experiments
58
Non-blind trial
neither experimenter or subjects are blind to the treatments
59
Nonrandomized trial
Interrupted time series design (measures on
a sample or a series of samples from the
same population are obtained several times
before and after a manipulated event or a
naturally occurring event) - considered a
type of quasi-experiment
Nonrandomized trial
(quasi-experiment)
60
Clinical Trials
-Pre-clinical: Phase 0 is a recent designation for
exploratory
-Phase 1: Designed to assess the safety
(pharmacovigilance), tolerability,
pharmacokinetics, and pharmacodynamics
of a drug
-Phase 2:
◦ Performed in a larger group (20-300)
◦ Designed to assess how well the drug works
-Phase 3:
◦ Aimed at being the definitive assessment of the
effectiveness of the drug in comparison to a gold
standard treatment
-Phase 4:
◦ Ongoing technical support of a drug after it
receives permission to be sold
-Phase 5:
◦ Phase V is a growing term used in the
literature of translational research to refer to
comparative effectiveness research and community-based research; it is used to
signify the integration of a new clinical
treatment into widespread public health
practice
61
Research ethics guidelines to follow
honesty, accuracy, objectivity, efficiency
62
Informed consent
-"The duty and responsibility for ascertaining the
quality of consent rests upon each individual who
initiates, directs or engages in the experiment
63
Null hypothesis
* Predication that there will be no effect
or no relationship between variables
being examined
* Ex: Student exam performance is not
affected by amount of time spent studying
64
Alternative Hypothesis
* Predication that there will be an effect
or relationship between variables being
examined
* Ex: Students who study more will perform
better on exams
65
How to begin research PICO
* Observation and interest/curiosity- PICO
* P- Patient or Population
* I- Intervention
* C- Comparison
* O- Outcomes
66
Rating quality research
-high: Systematic summary of high-
quality, patient studies
Single high-quality, patient-based
study
-low: Case report, expert opinion or
anecdote
67
Primary vs secondary sources of evidence
* Primary Sources:
* Documents or records in science that report on: a study, an experiment, a trial
or a research project.
* Primary sources are usually written by the person(s) who did the research,
conducted the study, or ran the experiment, and include hypothesis,
methodology, and results.
* Secondary Sources
* Summarize, compare, and evaluate primary information, aiming to draw
conclusions on or present current state of knowledge on a subject.
* Secondary sources may include a bibliography which may direct you back to the
primary research reported
68
Types of clinical research studies
* Diagnosis: Determination of a disease/condition causing a patient’s
symptoms
* Diagnostic tests and measures: Imaging, labs, vitals, physical exam, history
* Prognosis: Predicting course of a disease/condition
* Prognostic factors: Variables that affect the course of the disease/condition and
ultimately, the outcome
* Can be protective or risk factors
* Intervention: Procedure, technique that may improve patient’s
condition
* Outcome: End results of test, measure or intervention
69
Study Design: Direction and Timing
* Retrospective: Uses historical data from
sources such as medical records,
insurance claims, or outcomes databases.
* Prospective: Follows subjects forward
over a period of time.
* Cross-sectional: Collects data about a
phenomenon during a single point in
time (One-time data collection).
* Longitudinal: A research design that
looks at a phenomenon occurring over
time
* multiple data collection points
* Ex: baseline, 1 mo., 3 mo., 6 mo
70
Alpha Level vs. p-value
Alpha, the significance level, is the probability that you will make the mistake of rejecting the null hypothesis when in fact it is true. The p-value measures the probability of getting a more extreme value than the one you got from the experiment. If the p-value is greater than alpha, you accept the null hypothesis
71
Limitations of research
* Always acknowledge a study's limitations.
* Keep in mind that acknowledgement of a study's
limitations is an opportunity to make suggestions for
further research.
* Acknowledgement of a study's limitations also provides
you with an opportunity to demonstrate that you have
thought critically about the research problem.
72
What is evidence based medicine?
* Aims for the ideal that healthcare professionals should
make "conscientious, explicit, and judicious use of current
best evidence" as they provide care for patients
* The practice of evidence-based medicine uses systematic
reviews of the medical literature to evaluate the best
evidence on specific clinical topics, while including the input
of the patient.
* Evidence-based medicine practitioners engage in life-long
learning and are committed to the continuing education of professionals and patient communities.
73
What is EBM based off of?
-clinical expertise
-best evidence
-patient values
74
Primary vs secondary literature
Primary sources can be described as those sources that are closest to the origin of the information. (1st report of original research) They contain raw information and thus, must be interpreted by researchers. Secondary sources are closely related to primary sources and often interpret them (textbook)
75
Foreground questions vs background questions
-Background:
* Background questions are broadly worded
* Generalized need to better understand a problem or condition
How do you diagnose a sesamoid fracture?
-Foreground:
* Foreground questions require previous, specific knowledge
* Can find answer with primary sources of evidence
Does open reduction with internal fixation result in quicker
recovery than non-weight bearing in sesamoid fractures?
76
Systematic Review vs Meta-analysis
-Systematic Review:
A specific, rigorous, exhaustive
research methodology where authors ask a specific
clinical question (PICO), perform a comprehensive
literature search, eliminate the poorly done studies and
attempt to make practice recommendations based on the well-done studies. May included a Meta-analysis
-Meta-analysis:
A statistical technique that pools the results of
several individual studies in a single weighted estimate to provide an estimate of the effect. May be conducted as part of a Systematic Review
