Physicianship Goals and Objectives
Introduction:
Physicianship represents: (1) an orientation or mindset for the M.D.,C.M. curriculum; (2) a set of targeted attributes for our graduates; and (3) a specific curricular component.
Physicianship is a noun, and like the word friendship, refers to a state. The OED defines it as “a state wherein one possesses the knowledge and skills necessary for the function and office of physicians.” Note: In this context, the term ‘office’ refers to an obligation, or, that which one ought to do. As understood at McGill, physicianship also speaks to the dual roles of the physician: as healer and professional.
Our underlying premise is that the primary mandate of medicine is the care of sick persons and relief of their suffering; this is the focus of the healer role. Professionalism refers to the manner in which the profession is organized to deliver its services.
Physicianship is enacted, in part, through a clinical method, the toolbox of skills necessary for the physician to accomplish the clinician’s mandate. The clinical method comprises the following skills: observation, listening, communication, physical examination, clinical thinking and reasoning, narrative competence and description, self-reflection.
Goals:
We expect our graduates to:
· demonstrate the behaviours and attitudes necessary to serve the professional and healer roles of the physician
· become competent in the McGill clinical method
· role-model and promulgate the values of physicianship
· be patient-centered in their clinical approach
· strive for self-reflection in all phases of the educational continuum and practice
Useful Abbreviations
A. For courses (current and old) and teaching modules:
PC = Physicianship Component
P1, 2A, 2B, 3, 4 = Physicianship courses
PA = Physician Apprenticeship
CHAP = Community Health Alliance Project
ICS = Introduction to Clinical Sciences
EBM = Evidence Based Medicine
M&S = Medicine & Society
X = content is not currently covered in a systematic manner
B. For themes:
AL = Attentive Listening
BEHL =Bioethics and Health Law
CM = Clinical Method
CO = Clinical Observation
CS = Communication Skills
CT = Clinical (and critical) Thinking
HR = Healer role
IP = Inter-professionalism
LC = Life Cycle
MD-Pt = Doctor-patient relationship and alliance building
NC = Narrative Competence
PE = Physical Examination
PCM = Palliative Care Medicine
PM = Population Medicine
PR = Professional role
SR =Self-reflection
Nota bene:
· The list below is not intended to be “exhaustive”; it is meant to cover the highlights and core objectives.
· There has been an attempt to formulate and articulate the objectives as ‘behaviours’.
· It is understood that many of the objectives listed below will also be covered in non-physicianship courses – especially the clerkships. This is particularly true of ‘skills objectives’ (e.g. C12, F1, F2, F3). However, the purpose of this document is to focus on the physicianship component.
· The assignment of a specific objective to a particular theme or themes is, by necessity, somewhat arbitrary (but hopefully not capricious).
Specific Objectives
A1 / HR / discuss fundamental concepts of physicianship i.e. ‘person’, ‘health’, ‘disease’, ‘illness’, ‘healing’, medicine’s mandates’ / P1,P3,PA
A2 / HR,PCM / discuss the nature of suffering; identify other sources of suffering apart from physical symptoms (e.g. spiritual and psychological distress) / P1,P3,PA
A3 / HR / discuss patient expectations regarding the physician as healer and the attributes required for the creation/maintenance of a healing relationship / P1,P3,PA
A4 / HR / recognize different types of interactions with team members in medicine and demonstrate awareness of content, context, interlocutor perspectives, self perspectives and one’s own contribution to the situation. / P3,PA
A5 / HR / recognize the contributions or impact of physicians’ self-knowledge and self-care on interactions in the clinical setting / P3,PA
A6 / HR / discuss the various types of MD/pt relationships and the many forms that alliance building can take; discuss the role of the power differential / P3,PA
A7 / HR / discuss the impact of the life cycle on alliance building / P1
B1 / PR / discuss the concept of physician obligations using the framework of Physicianship / P1
B2 / PR, BEHL / define the attributes of professionalism and apply this understanding to specific practical problems, including those facing medical students / P1,PA
B3 / PR / discuss the historical roots and primary tenets of professionalism, including the International Charter on Medical Professionalism / ?
B4 / PR / define the ‘social contract’ between the profession and society and discuss the tensions that exist / P4
B5 / PR,PM, BEHL / identify physician responsibilities to patient, profession, community, and society at large, and convergences and conflicts among these responsibilities / P1,P4
B6 / PR,BEHL / identify the genesis and features of the self-regulation of professional medicine, and the role of clinicians in sustaining their professional status / PA,P1,P4
B7 / PR,IP / relate medicines’ professionalism to that of the other health care professions by demonstrating mutual respect; understanding the principles of teamwork within and between professions; and understanding issues related to leadership / P3,P2A
B8 / PR / demonstrate personal behaviours consistent with the standards of professionalism as defined by the “International Charter”; the “Code de déontologie des médecins du Québec”; and the MD,CM program’s “Code of Conduct” / P1,P4,PA
C1 / CM / define the clinical method; list and discuss its various elements / P1
C2 / CM,CO / list and discuss the core principles of clinical observation / P1
C3 / CM,CO / demonstrate clinical observation (using static images) using the modified Berger Hierarchy; discuss how this framework addresses the ‘part-whole’ conundrum / P1
C4 / CM,CO / observe effectively and reliably and provide detailed written descriptions, separating observation from inference / P1
C5 / CM,AL / discuss the various roles of listening in the doctor-patient interaction / P1
C6 / CM,AL / identify fundamental elements of language (spoken and non-verbal) in actual MD-pt interaction; identify elements of paralanguage / P1,P2A
C7 / CM,AL / explain how language works to reveal patient’s emotions and relationships to self, illness, physician and others; demonstrate how this skill is used as a therapeutic tool / P1
C8 / CM,AL,CS / demonstrate the technique of interviewing using the Calgary-Cambridge approach / P1, P2A,P4
C9 / CM,CS / discover the trajectory from ‘healthy’ status to ‘patient’ status in a medical history and identify changes in function and its meaning / P2A
C10 / CM,CS / document a case history using the revised McGill case report template / P2A,PA
C11 / CM,CS / demonstrate appropriate sensitivity and effective techniques in situations of communicating across cultural boundaries / P2A, P4
C12 / CM,CS,
PCM / demonstrate an ability to discuss ‘bad news’ with a patient, and family, in an empathic manner; discuss code status and advance directives / P3,P4,
C13 / CM,CS,
PCM / discuss the impact of cultural, religious and spiritual beliefs on patient responses to illness and medical recommendations / P1,P3,P4,PA
C14 / CM,CS,HR / discuss ‘What is complementary and alternative medicine?’ and contrast this to conventional medicine and integrative medicine; discuss the nature of evidence; identify various explanatory models and discuss its impact on the MD-pt relationship / PA
C15 / CM,PE / perform a complete physical examination including attention to patient comfort / ICS
C16 / CM,PE / write an accurate and valid description of the physical appearance, speech and behaviour of patients / ICS
C17 / CM,PE / assess a patient’s capabilities in key aspects of personal function (physical, cognitive, emotional) / X
C18 / CM,PE / demonstrate compliance with universal precautions and hand-washing / ICS
C19 / CM,CT,NC / explain the reasoning process physicians apply in eliciting clinical information and in formulating clinical problems; explain and utilize the abductive method in clinical reasoning; explain the difference between making a diagnosis and constructing the ‘story’ or ‘narrative’ of illness / P1,P2A
C20 / CM,CT / in a context of understanding ‘medicine as a conjectural art’, contrast different modes of inference (i.e. deduction, induction and abduction) / P1
C21 / CM,CT / calculate conditional probabilities using the natural frequency method and 2 by 2 tables; convert odds to probabilities / P1,EBM
C22 / CM,CT / calculate relevant measures of effect and accuracy arising from both randomized controlled trials (number needed to treat, relative risk) and studies of diagnostic test performance (sensitivity, specificity and likelihood ratios) / P1,EBM
C23 / CM,CT / apply a simplified version of Bayesian theory to clinical scenarios likelihood ratios (pre-test probability) and relative risk reduction (baseline risk) / P1,EBM
C24 / CM,CT / demonstrate an understanding of core principles in EBM by: formulating an answerable question; selecting and navigating the appropriate electronic resources; applying the methods of structured critical appraisal to delineate bias in clinical research reports, appreciate measures of association and uncertainty around those measures as well as issues of applicability to a specific clinical context / EBM
C25 / CM,CT,
BEHL,PM / explain the relevance of population-based evidence (such as that derived from epidemiologic studies or clinical trials) to individual-level and population-level interventions. / EBM,P4
C26 / CM,NC / formulate a narrative perspective of the patient’s illness highlighting the sources of meaning / X
C27 / CM,NC / demonstrate basic textual skills (e.g. identify tense, voice and common archetypes) / X
C28 / CM,NC / demonstrate basic skills of narrative medicine, in particular, apprehending a story, being open to writing exercises, and identifying core elements of narrative structure / X
C29 / CM,SR / recognize personal values, biases, strengths and liabilities / PA
C30 / CM,SR / demonstrate respect and openness, in activities (e.g. apprenticeship group discussions) intended to foster insights into the impact of the transition to physicianhood / PA
C31 / CM,SR / demonstrate engagement and commitment (with professionalism, sincerity and thoughtfulness) to the school’s attempts at fostering self-reflection / PA
D1 / BEHL / discuss clinically relevant ethical concepts and principles, at an introductory level, and apply ethical decision-making methodology to cases / P1,P2B
D2 / BEHL / review and discuss the following ethical issues: informed consent; confidentiality; medical error; competency assessment; autonomy; dignity; conflict of interest; abortion, euthanasia; pharmaceutical development, advertising and medicalization; ethical issues facing medical students (e.g. responsibility exceeding capacity, limits of compassion, lack of integrity, truth telling) / P1,P2B,
PA
E1 / BEHL,PM / define and identify core theories associated with: population health, public health, and population medicine / P1,P4,
CHAP
E2 / BEHL,PM / discuss health care resource allocation under normal and emergency situations / X
E3 / BEHL,PM / identify determinants of health on a population level, including socioeconomic status, race, ethnicity and aboriginal status, country of origin, gender, and geographic location / P4,M&S,PA
E4 / BEHL,PM / identify major Canadian, North American, and international health inequalities / P4,M&S
E5 / BEHL,PM,PR / identify individual- and population-level interventions to address health inequalities / X
E6 / PM,BEHL,
PR / in partnership with community organizations, participate in a project that serves a disadvantaged population / CHAP
E7 / PM,PR,CT / identify and analyze social dimensions of medical judgment (focusing on: issues such as objectification and clinical trials, medical variation and its regulation, human experimentation, medicalization and risk, medicine as a commodity) / P4,M&S
F1 / PCM / recognize when a patient is in the dying stage, both through prognostic factors and symptom evolution / P3
F2 / PCM / assess a patient’s pain and make a correct diagnosis of this pain / P3
F3 / PCM / demonstrate an ability to prescribe opioids and appropriate co-analgesics corresponding to the underlying pathophysiology; manage the common side-effects of analgesic treatment / P1,P3
F4 / PCM / recognize a normal from a pathological grief reaction / P3
F5 / PCM / identify, assess, and treat commonly encountered symptoms in terminally ill patients (e.g. anorexia-cachexia syndrome, constipation, nausea & vomiting, mouth care, fatigue, delirium, dyspnea) / P3
F6 / PCM / identify issues specific to palliative care in a pediatric context / P1
F7 / PCM / identify and demonstrate respect for the perspectives of patients at the end-of-life; discuss patient issues in an actual patient encounter / PA
F8 / PCM / demonstrate an ability to present and discuss ‘bad news’ with a patient, and family, including the discussion of code status and advance directives / PA,P1, P3,P4,
P2A
F9 / PCM / discuss the issue of ‘when to consult the palliative care team’ / P3
Date: August 5, 2009