ethics/portfolio Flashcards
Different forms of teaching you have done
Informal teaching - bedside teaching - for medical students
Lectures
Workshops - CBLs
Presentations - fertility work to nurses
Simulation for clinical skills
Collected feedback
I enjoy teaching - it helps me learn, helps me to develop my teaching and mentoring skills
I am hoping next year to get my post graduate certification in medical eduction to further develop my skills
What are good Qualities of a teacher?
Sets appropriate, specific and chellenging goals
Has a clear plan to achieve their goal and has a clear delivery of the topic
Involves the students and contiually assesses their learning and provides feedback
To be positive and encouraging
Promote enthusiasm in students
able to adapt to students and alter their methods accordingly
Respects students
Gathers feedback and reflects on negative feedback
a teacher plays a pivotal role in shaping competent, compassionate, and confident professionals. The right blend of these qualities ensures that learners not only acquire knowledge but also develop the skills and attitudes necessary to provide exceptional patient care.
which teaching methods do you know ?
one to one interactive teaching
- you can tailor the session to the needs of the student.
- cons - the student can not learn from their peers
Small group teaching
- good as there can be interaction between different member of the groups
- can’t always meet the needs of every student - some may sit back and relax and some do all the work
Formal - lectures
- good because you can reach a big audience quickly
- cons - communication is mostly one way limited options for interactions
Within each of the above
Interaction discussion
Practical simulation
Role play
Observation followed by related practice
PBL
lecture followed by assessment
What is PBL - pros and cons
Process best describes by the Mastricht ‘seven jump’ process
PBL tutor is a facilitator - they do not participate actively in the discussion. Role is to guide them.
Advantages - self directed, students discover information for themselves - tends to lead to better retention
Encourages students to develop Problem solving skills, communication na dteamwokr
it allows students to make mistakes and learn from them
PBL promotes initiative, focus on specific goals and research
Disadvantages
- requires more resources than traditional teaching
- many students are not used to this way of learning
- requires good teamwork and therefore may not function well if all students are not contributing
- students may research in too much detail
You have been asked to organise a weekly educational meeting for your colleagues - how would you approach this?
I have actually recently been asked to organise a 2x monthly journal club for the cardiology team
So I would approach this in a similar way
- what would they like to learn
- who would they like to hear from
- what is the objective
- finding out which is the best day for everyone to attend
- organising different people to give the teaching
- ensuring there is a room available for the teaching
Important to communicate and work with others
Important to involve senior colleague
ensure the meeting is chaired appropriately
make sure I know how to use the computer/projector
collect feedback
Tell us about teaching feedback
the feedback I have received has always been positive and encouraging
medical students also appreciate the effort I have put in and how I make the teaching sessions interactive. May of them say they feel much more confident on the topic afterwards
‘Dr Charlotte played the largest role in our training and development. Charlotte gave her time and considerable effort to helping us find training and practice’
I was doing teaching for 2nd years induction to clinical placements
- initial feedback - could have slowed down - given more detail on clinical examinations
- I re-did this teaching for the other half of the year and changed it and had much better feedback
what is clinical Audit?
Clinical audits is a review of current health practices against agreed standards designed to ensure that as clinicians we provide the best level of care to our patients and that we constantly seek to improved our practice when it is not matching those standards.
What is the audit cycle ?
Identify and issue or problem
Identify a standard (from NICE or relevant Royal Colleges or local trust standards)
Collect data on current practice
collect data on current practice - a pre agreed period of clinical practice for a specific group of individuals
Assess conformity of clinical practice with the standard
compare results to standard to determine how well it has been met
Implement change
Closing the loop - re-audit
Tell us about an Audit you did?
DOACs
NICE guidelines - baseline bloods including FBC, clotting screen renal and liver nuncio
monitoring of bloods at least 3 mon
Insufficient monitoring could lead to inappropriate dosing and adverse events.
99 patients
started on ODAC between 2018 and 2022
baseline bloods noted
started DOAC noted
Checked if follow up bloods completed at 3 months - hospital and GP record
If doses were changed
patients with impaired renal function were analysed separately
Results
83% of patients were started on the correct initial dose when factoring in indication and CrCl
76% of patients with impaired renal function were on correct initial dose when factoring indication and CrCL
80% of patients had bloods after 3 months
11% had DOAC levels
45% had dose changing
Previously DOAC Audit was in 2016 - 30 patients - 90% of patients had follow up bloods and 30% had DOAC levels (this audit suggested they should be performed as routine bloods
Why is this important - from 2015 16% of patients on anticoagulation were on DOAC - in 2019 62% of patients on DOAC were on anticoagulation (average increase of 18% per year)
Recommendations
- ensure CrCl used to calculate dosing of DOAC
- close monitoring of patients with renal impairment
- All patient should be referred to anticoagulation clinic after starting on DOAC
- potential role for monitoring of DOAC levels in patients with higher risk of complications
QIP
No set guidelines for monitoring DOAC levels
(DOAC levels are anti-Xa levels that are converted to DOAC levels)
41% of patients had complications - 35% bleeding, 5% thrombosis
Data analysis looked at factors that identify patients at a high risk of developing complications
no strong correlation between risk factors and complications
likely multifactorial
-ve correlation between DOAC levels and CrCl
- those who experienced bleeding events - DOAC level > 198
ongoing further data collection
Because DOACs have predictable pharmacokinetic and pharmacodynamic responses at a fixed dose, they do not require monitoring. However in specific clinical situations and for particular patient populations, testing may be helpful for patient management.
We looked specifically at the patients who had DOAC levels and analysed this data
Currently involved with another Audit on lipid lowering therapy. Clear guidelines set on lipid lowering therapy.
Tell us about your Audit experience
I led this audit
My consultant had the idea
I planned it
Did the data collection - had a team of 4 people - who helped with the data collection
Delegated tasks
Statistical analysis - I had help with someone more experience
Presented it at local Audit meeting and presented some of the results on Cr Cl and DOAC levels with risk of adverse events
Why are Audits important?
one of the key pillars in clinical governance - audit ensures that quality of care is maintained at an agreed standard.
Allows identification of problems and ensure that salutations are implemented
Audits encourage services to make better use of resources
Problems associated with audit process?
Problems generally
- audits are often local processed - may not be transferable to other trusts or units
- based on retrospective dats, data may be missing
- can be difficult to identify a solution to the problem
- done by clinicians who have other duties so may not focus fully on the audit
problems with junior doctors carrying out audits
- may rotate frequently so audits don’t get finished / re-audit can not be performed.
- tend to choose topics which are easier and shorter - may not have great importance
Audit Vs research?
Audit - a process which compares clinical practice against set standards, are you following established guidelines, are you aligned with best practice.
Research - does not check if you are complying with standards. It aims to create new knowledge that can be used to develop new standards of care. determines if treatments work and to what extent they do.
Research is based on a hypothesis
essentially - research helps to establish best practice and audit checks that best practice is being applied.
Research experience ??
DOAC - looking at DOAC levels
Masters Degree - comparing frozen embryo trasfer to transfer in ormone mediated cycle - retrospective cohort study, systematic review and meta analysis
Scoping review of spontaneous regression of thyroid neoplasia
Ventral mesh rectopexy for rectocele
Predictive factors for outcomes of trial phase sacral nerve stimulation
Publication
Pelvic floor dysfunction after obstetric anal sphicter injury - effects of physiotherapy
Attended journal clubs
Done a practical statistics for medical research course
Why is research important?
- enable you to understand the evidence on which decisions are based
EBM involves an ability to crucially appraise current medical evidence - having an insite into what constitutes good and bad research as well as the structure of medical evidence and statistical concepts
Since medical practice is constantly evolving - it is essential to keep up t date with current published research.
Develop critical thinking - Participating in research helps junior doctors learn how to critically appraise medical literature, interpret data, and assess the quality of evidence. These skills are essential for practicing evidence-based medicine and delivering the best possible care.
Important for improving patient care
