9. Self-improvement Flashcards
Describe principles of clinical governance x5
Set of principles and behaviours that all doctors should adhere to ensure patients receive the best quality clinical care
- Ensure practice is COMPLIANT with the latest evidence –> adjust practice to match new guidelines and evidence
- Provide SAFE CARE to patients and ensure they don’t put patients at risk –> own up to and learn from mistakes; report incidents for investigations
- Ensure they recognize when they have reached their LIMITATIONS, and ask for help when necessary
- Ensure they constantly DEVELOP their skills, train and educate others
- Attentive to patient NEEDS and take into account FEEDBACK –> constantly improve services
Auditing
- Choose topic for audit i.e. practice to investigate
- Define standard that you would like to achieve
- Collect data
- Compare results of analysis against standard
- Identify changes to reach standards
- Implement changes
- Re-audit after sufficient time
- Identify WEAKNESSES in practice, increase quality of service provided
- Identify INEFFICIENCIES and ultimately may lead to a better use of resources
- Used to provide information about quality of care to outside agencies for e.g. league tables
- Opportunities for training and education
How do you research something you know nothing about?
- This is something I did during my law degree, and I found the best way to research is through a pyramid method, whereby you acquire a solid base and work your way up to more specialised literature.
- Taking a subject such as contract law as an example, I normally start off by consult a textbook which provides introductory knowledge to the subject, explaining for example statutory law and some of the leading cases. This is a baseline, since it helps me map out my research plan.
- With cases, I can then research legal databases, read judgements in full and understand not only the main quotes from the case but also why the judge arrived at that particular conclusion. I also take into account dissenting judgements, since this gives me another perspective on how the same facts and precedent could have yielded a different judgement.
- I then read legal journals, which delves into the debates that I am after: for example, was this case rightly decided, can the judge be accused of judicial activism, trying to read literature on both sides of the debate so I can form a holistic opinion.
- This process means my research has structure, is holistic, and that at every stage I’m bringing a strong amount of background knowledge to effectively engage with the complex legal terminology and nuances in the legal literature.
How do you know what you don’t know?
- Through experience. For example, there have been times when mooting where the judge has presented me with a perspective that challenges my analysis of the law, that I hadn’t encountered before.
- Through discussion. If you think about the occasions on which you’ve had a debate with a friend and they point out a misconception you had.
- Through using benchmarks for example assessing yourself against your counterparts or against what is common practice
- Through gaining feedback and being attentive to it. This is something I did when I started off as a mooter, through asking the judge how I could be more well-researched and how I could improve the quality of my oral delivery.
- Taking the initiative to get involved in courses, retraining or activities that will provide further experience. A commitment to developing skills and retraining is of course a principle of good clinical governance.
For example, my volunteering experiences at St. Mary’s Hospital informed me that I could do with more experience in health and social care settings and inspired my decision to volunteer at KEEN London.
Why admit when mistakes are make?
1) One guiding principle of the NHS, is accountability to the public, communities and patients that it serves, and part and parcel of that is taking responsibility for mistakes
2) Not only that, but a pillar of the doctor-patient relationship is trust, which is maintained through giving apologies when warranted. In this case, doctors should admit to mistakes, given that it involves something as sacred and personal as a patient’s ill health and their bodies. This is reflected through the Statutory Duty of Candour.
3) Owning up to mistakes helps to address an imbalance in power between doctors and patients, thereby making the relationship less hierarchical. In the same way you would expect your equal to apologise to you, so too should doctors apologise to patients
4) It encourages doctors to be critical about themselves to improve future performance, it might have a knock on effect on other doctors and therefore encourage collective learning.
Disadvantages
- -> Might perpetuate the idea of doctors being incompetent, thus diminishing patient confidence in doctors
- -> Make a patient aware of an error they otherwise would not have known about means more complaints may be levied against doctors, and upon investigation this could mean being sacked, sued or struck off
What is your main weakness?
If you could change 2 things about yourself, what would they be?
(1) Intimidated by competition
-I come from a comprehensive school in Wales, where amongst us high achievers, there was never a competitive spirit. Actually we believed in helping another, forming study groups and sharing notes so we could all excel, and we did.
In my first year of my Law degree, I found the competitive spirit difficult to deal with: it made me feel demoralised, intimidated and I lacked confidence in my own academic abilities.
-The way I overcame this was by battling what I realised was my own insecurity. For example, I started participating in mooting competitions (mock court trials) and worked my way up into representing my university in Moots. This helped me develop into a more optimistic, confident person, able to rise to any challenge, who is driven by competition instead of feeling daunted by it.
-I tried to frame competition as opportunity instead. For example, I applied to a silver circle law firm to get real world experience in interviews and assessment centres, and in embracing the opportunity, ended up securing the internship.
-All in all, competition initially intimates me, but I’ve been working on rising to it instead of being subdued by it.
(2) Wish I prioritised hobbies more
- In university, my week was incredibly busy: I was either studying, participating in extracurriculars or socialising, but this meant I didn’t have enough me time to commit to hobbies I once enjoyed, like fashion design. Having gone back to this during lockdown, I realised that I missed that creative flair. I hope that moving forward I can accommodate this more, since I’d love to reach a point where I can design my own clothes, but this requires being disciplined and committed to my hobbies.
How do you cope with criticism?
- I think I cope well with criticism when delivered constructively: its an opportunity for me to improve my skills, qualities and techniques in order for me to become my best academic self. This is important in Medicine, since being attentive to feedback is a principle of Good Clinical Governance.
- For example, after competing in mooting competitions, I proactively ask the judge for feedback. Suggestions I received at the start of my mooting journey was delivering a more structured argument, and speaking with greater conviction. Without this feedback, I wouldn’t have been able to perfect my performance to represent LSE in Mooting competitions.
- In other occasions, I my have felt like the criticism wasn’t delivered unprofessionally, or was unjust. For example, in the Law Society the President told me I wasn’t delegating to my subcommittee enough, but this is only because I knew their workload was busy at the time.
- However, I tried to see value in his criticism, realising that this was in fact a good opportunity to teach them management. So, even when receiving unjust criticism, I think its worthwhile being open-minded, see the value in the criticism and incorporate those aspects.
How do you cope with conflict?
- I think I deal well with conflict, largely because through experience in working in different situations with different demographics, I’ve learned how to effectively manage it.
- For example, as a PALS Officer, my role is to chat to the patients on the ward and give them company. I try to steer conversation away from anything political, but on a few occasions patients have made offensive comments for example about immigrants or how multiculturalism is harming London
- It was difficult to navigate how to react, especially because patients put in a lot of trust in volunteers and I didn’t want to tarnish that relationship.
- I’ve overcome these situations by showing empathy and emotional resilience
- Empathy in understanding in recognizing that its not a personal attack, but vulnerable people may not have the insight to judge what is an appropriate comment and what isn’t. This requires the ability to detach the comment from the patient by understanding context.
- Emotional resilience is exemplified by having the resolve to not letting swearing or offensive comments affect your mood. Often PALS Volunteers are the only people that will speak to a patient that week, so I wouldn’t want a negative experience with one patient ruin that opportunity for another.
Dealing with conflict requires intuition on which skills to apply to de-escalate a situation. In this scenario, and when dealing with vulnerable patients, I found that de-escalation was achieved through being understanding and emotionally resilient.