PPD Flashcards
what is diversity education?
understanding ourselves!
What is the goal of cross cultural education?
understand how culture influences our thoughts, perceptions, biases and values
Why is diversity education important?
- reduce health inequalities
- enhance all doctor patient encounters
- improves patient safety
- develop professionalism
- better health outcomes for patients
What are the challenges that diversity present in healthcare?
- effortful
- assumptions more likely to be wrong
- humour/rapport
- language
- different expectations for roles for doctor and patient
- different explanatory models
Name 2 explanatory models of illness
- hellmans folk model
2. Kleinmans model
Describe hellmans folk explanatory model of illness
what has happened? why has it happened? why has it happened to me? why now? what would happen if nothing were done? what should i do?
Describe kleinmans explanatory model of illness
- what do you think has caused the problem?
- why do you think it started when it did?
- what do you think the sickness does?
- how severe is the sickness?
- what kind of treatment do you think i should receive
- what are the chief problems this sickness causes
- what do you fear most about this sickness
Define culture
socially transmitted patterns of shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life
Define individual culture
an individuals identity may be based on their heritage as well as individual circumstances and personal choice - DYNAMIC ENTITY
Define ethnocentrism
the tendency to evaluate other groups according to the values and standards of ones own cultural groups, especially with the conviction that ones own cultural group is superior to the other group
Define medical ethnocentrism
the belief that health care providers, educated and socialised within a bio-medical contact, have a superior value system and correct, accurate approach to health care
What are the negative consequences of medical ethnocentrism?
- patient refusal to communicate his/her beliefs and behaviours for fear of negative reaction
- significant info for patient care not obtained
- health care provider may use his/her own beliefs only and be totally incorrect
Define stereotype
involve generalisations about the typical characteristics of members of a group
Define prejudice
attitude towards another person based solely on their membership of a group
Define discrimination
actual positive or negative actions towards the object of prejudice
Explain Hofstedes cultural dimensions theory
a framework for cross-cultural communication
describes the effects of a society culture on the values of its members and how these values relate to behaviour
uses a structure derived from facto analysis
Define epigenetics
how our genetic predisposition can be altered depending on our life experiences
Define “discipline of patient safety”
the coordinated efforts to prevent harm, caused by the process of healthcare itself,
List the human factors that can risk patients safety
loss of situational awareness perception and cognition team work - no clear leader culture - hierarchy of the team lack of resources distraction pressure/stress fatigue lack of knowledge lack of communication
List the red flags of evolving error chains
conflicting information broken communication confusion/ uncertainties missing information/ incomplete debrief not following standard procedures unease/fear/ denial
What is the conformity problem?
it is more common for people to move towards working in ways that they know to be wrong or that break the rules if greater the benefits and lower the likely consequences
over time these ways become normalised and integrated into culture
“this is how we do it here”
List the 3 leadership styles
- Transactional
- transformational
- delegative “laissex faire”
Describe transactional leadership
the leader taps into his followers higher needs and values, inspires them with new possibilities and raise their confidence
“ill do something for you, if you do something for me”
Describe transformational leadership
proactive, takes responsibility for oneself, for patients and for colleagues
provides support and recognition of others
raises moral and motivation
= F1 LEVEL LEADERSHIP!
describe delegative leadership
leaders are hands off and allow the group members to make the decisions
Define rationing
resource refused because of lack of affordability rather than clinical ineffectiveness
Why have rationing needs increased?
shift from acute illness to chronic long term
normal physiological events medicalised
increase in choice and increase in expensive drugs
What are the allocation theories based on?
- egalitarian principles
= NHS was founded on a requirement to provide all care that is necessary and appropriate to everyone - maximising principes
= criteria that maximises public utility - libertarian principles
= each is responsible for their own health, well being and fulfilment of life plan
Define human rights act
forms part of the decision making process when making decisions about peoples rights
What are the problems with human rights?
are they universal?
which interests are significant enough to justify ennobling a human right?
all basic rights are claim rights?
can absolute claims conflict?
Define health
the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
List some rights that are frequently engaged in healthcare and relevant to clinical practice
ACT 2 = the right to life
ACT 3= the right to be free from inhuman and degrading treatment
ACT 8= the right to respect for privacy and family life
ACT 12= the right to marry and found a family
List the absolute rights
- right to protection from torture, inhuman and degrading treatment and punishment
- the prohibition on slavery and enforced labour
- protection from retrospective criminal penalties
Define judicial review
the opportunity for an individual to challenge the exercise of power by a public body
List the 3 concepts of teaching and learning
- transmissive didacticism
- cognitivitism
- humanism
Describe Kobs learning cycle
- experience = activist
- review, reflect on experience = reflector
- conclusions drawn= theortist
- what can I do differently next time= pragmatist
Describe the tripartite model
- SURFACE
= fear of failure, desire to complete course - STRATEGIC
= desire to be successful, leads to patchy/variable understanding - DEEP APPROACH
= making links across material, deeper understanding
Describe analytical thinking
good at measuring and calculating odds which is the basis of evidence based medicine
What are the pros and cons of analytical thinking?
pro= reliable, accurate
cons= slows, resource intensive, cognitively demanding
Describe intuitive decision making
ability to understand something instantly without conscious reasoning
Recognition primed and heuristic (cognitive shortcut that we use all the time)
What are the pros and cons of intuitive decision making?
pros= fast, frugal
cons= prone to bias and error
List the biases of intuitive thinking
- ERROR OF OVER ATTACHMENT
confirmation bias, premature closure, sunk costs
2.ERROR DUE TO FAILURE TO CONSIDER ALTERNATIVE
multiple alternative bias, search satisfaction
- ERROR DUE TO INHERITING THINKING
diagnosis momentum, framing effect - ERROR IN PREVALENCE PERCEPTION OR ESTIMATION
availability bias, base rate neglect, gamblers fallacy
How do we reduce the risk of intuition?
- decision, environment and process
- personal debiasing techniques
e. g. acknowledge bias, slow and stop technique, cognitive forcing strategies - structural debasing
e. g. training, checklists, group decision strategies
Define error
unintended outcome
How can human error be divided?
- INTENDED ACTIONS
2. UNINTENDED ACTIONS
How are intended errors classified?
- mistakes
rule based , knowledge based, skills based - violations
routine, reasoned, reckless and malicious
How are unintended errors classified?
- lapses
memory failure, losing place, omitting items - slips
attentional failures, intrusions, omissions, disordering
How are errors classified on outcome?
near miss death/injury/ loss of function prolonged intubation/ stay in ICU cost of litigation unplanned transfer
Which tools can be used to identify risks?
incident reporting complaints and claims audit, service evaluation and benchmarking external accreditation active measurement/ compliance
List some strategies that can be used to reduce error
simplification/ standardisation of clinical process checklist aide memories team training risk management programmes
What are the 3 key duties of a doctor?
KNOWLEDGE, SKILLS AND PERFORMANCE
making the care of your patient your first concern
SAFETY AND QUALITY
take prompt action if you think that patient safety, dignity or comfort is being compromised
MAINTAINING TRUST
be honest and open and act with integrity
How can things go wrong?
human error neglect poor performance misconduct system failure judgement failure
List the types of human error
communication judgement error omissions, lapses, violations teamwork problems working environment decision density
List types of neglect
falling below accepted standard repeated minor mistakes necessary care if withheld safeguarding nutrition and personal care medical care
Describe the features of poor performance
a problem with attitude
often rudeness, tardiness, scruffiness and laziness
failure to learn from mistakes and listen to advice
affects patients care
List the types of misconduct
- deliberate harm
- lack of candour
= hiding own or others mistakes, ignoring mistakes, altering medical records - fraud/theft
= false expense claims, sickness, drug/alcohol problems - improper relationships
= with patients, relative or colleagues
define medical negligence
legal entity / outcome of a court case
Describe the 4 tests of medical negligence
- was there a duty of care?
- was there a breach in the duty of care?
Bolam and bolitho test - did the patient come to harm?
e. g. harm from injury, periods of discomfort, recognised complications - did the breach cause the harm?
onus on patient to prove it
How is a breach in the duty of care assessed?
Bolams test = would a group of reasonable doctors do the same?
Bolitho test = would it be reasonable of them to do so?
How do courts award costs if their is a medical negligence claim?
- loss of income
- costs of care
- pain and suffering
Define never events
Never Events are serious incidents that are entirely preventable because guidance or safety recommendations providing strong systemic protective barriers are available at a national level, and should have been implemented by all healthcare providers.
List some examples of never events
wrong site or implant of surgery retained foreign object in surgery suicide entrapment in bed rails misidentification falls from windows death due to PPH
What should happen in a never event?
- report
- investigate
- root causes
- learn
- implement
- measure
- change
What are the mechanisms underlying inhuman behaviour?
- bystander effect
e. g. number of bystanders, ambiguity of situation - pressing situational factors can over ride explicitly enouched value systems
- conformity
= unwillingness to speak against prevailing view - ill chose targets
e. g. 4 hour waiting time
