PPS Flashcards
1
Q
HUMAN RIGHTS ACT 1998
What is the WHO definition of health?
How does this link to the HRA?
A
- The state of complete physical, mental + social wellbeing + not merely the absence of disease or infirmity.
- The highest attainable level of health is the fundamental right of every human being.
2
Q
HUMAN RIGHTS ACT 1998
When did the HRA come into force?
What is the importance of it?
A
- 2000 + is set out in the European Convention on Human Rights.
- (Should) form part of an organisations decision-making process to ensure people’s rights are respected + is part of all policy making.
3
Q
HUMAN RIGHTS ACT 1998
What are the underlying assumptions with the HRA?
A
- State/organisations have a duty to uphold these rights + they’re universal.
- All basic rights are claim rights i.e. others wanting things.
- The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status.
4
Q
HUMAN RIGHTS ACT 1998
What are some issues with the HRA?
A
- ?Universal or Western concept (FGM, judicial executions).
- Which interests are significant enough to justify it being a human right?
- Can absolute claims conflict? All rights are interdependent + inter-related.
5
Q
HUMAN RIGHTS ACT 1998
What are the 5 articles that are frequently engaged in healthcare?
A
Art 2 – the right to life.
Art 3 – the right to be free from inhumane + degrading treatment.
Art 8 – the right to respect for privacy + family life.
Art 12 – the right to marry + found a family.
Art 14 – the protection from discrimination (sex, race, sexuality etc).
6
Q
HUMAN RIGHTS ACT 1998
What is meant by absolute rights?
Give some examples
A
They’re never limited i.e. they hold under ALL circumstances.
- Art 3, Art 4 (prohibition on slavery + enforced labour), Art 7 (protection from retrospective criminal punishments).
7
Q
HUMAN RIGHTS ACT 1998
What is meant by limited/qualified rights?
Give some examples
A
They are limited under explicit + finite circumstances.
- Art 2 (limited), Art 5 (the right to liberty), Art 8 (qualified).
8
Q
HUMAN RIGHTS ACT 1998
Explain why some rights may be limited/qualified.
A
- Art 5 – if your freedom affects other’s safety.
- Art 2 – medical Tx a pt requests is not a right. Obligation upon state to take appropriate steps to safeguard life but cannot impose a disproportionate burden on the authorities to provide unlimited resources.
9
Q
HUMAN RIGHTS ACT 1998
What is the exceptionality criteria with the HRA?
A
Applicable to public bodies like NHS trust where they adopt a general policy for the exercise of ‘administrative discretion’, to allow for exceptions from it in ‘exceptional circumstances + leave those circumstances undefined’.
10
Q
HUMAN RIGHTS ACT 1998
What are some topics in individual rights vs. collective groups?
A
- Should vaccines or blood/organ donation become compulsory?
- Is screening a form of collectivism?
- Wearing a face mask to prevent spread of disease despite disagreement.
11
Q
RESOURCE ALLOCATION
What is rationing?
A
Where resource is refused because of lack of affordability rather than clinical ineffectiveness.
12
Q
RESOURCE ALLOCATION
Why have rationing needs increased in terms of resource allocation?
A
- Shift from acute>chronic complex conditions.
- Increase in choice + availability of more expensive drugs.
- Medicalising what used to be ‘normal’ physiology (childbirth, menstruation).
- Ageing population with increasing demand on services.
- Funding has barely increased.
13
Q
RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?
A
- Egalitarianism.
- Maximising/Utilitarianism.
- Libertarian.
14
Q
RESOURCE ALLOCATION
What is the concept of egalitarianism?
A
- Provide all care that is necessary + required to everyone.
15
Q
RESOURCE ALLOCATION
What are the pros/cons of egalitarianism?
A
Pros:
- equal for everyone (supports belief people deserve equal rights/opportunities)
Cons:
- economically restricted,
- tension between egalitarian aspirations + finite resources.
16
Q
RESOURCE ALLOCATION
What is the concept of maximising/utilitarianism?
A
- Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).
17
Q
RESOURCE ALLOCATION
What are the pros/cons of maximising/utilitarianism?
A
Pros:
- resources allocated to those most likely to receive most benefit.
Cons:
- those with ‘less need’ receive nothing.
18
Q
RESOURCE ALLOCATION
What is the concept of libertarian?
A
Each individual is responsible for their own health, wellbeing + flourishment i.e. incentives for behaviour change, screening participation paid (all paid with savings made from better health outcomes).
19
Q
RESOURCE ALLOCATION
What are the pros/cons of libertarianism?
A
Pros:
- onus on pt therefore may be more engaged.
Cons:
- not all diseases are self-inflicted,
- should people be held accountable for their current/future health?
20
Q
RESOURCE ALLOCATION
What is the harm principle in relation to Libertarian theory?
What is the con to this principle?
A
- People should have autonomy in life so long as it doesn’t affect anyone else, even if others see actions as being wrong
- BUT doesn’t appreciate the impact choices has on others
21
Q
RESOURCE ALLOCATION
What is Johnson’s rule of rescue?
A
A tension sometimes arises between the injunction to do as much good as possible with scarce resources + the injunction to rescue identifiable individuals in immediate peril, regardless of the cost.
22
Q
RESOURCE ALLOCATION
Give an example of Johnson’s rule of rescue.
A
It’s a perceived duty to save endangered life through disproportionate efforts regardless of cost + usually seen in vulnerable groups like children.
- E.g. treat rare cancer in child with experimental drug that may be effective.
23
Q
RESOURCE ALLOCATION
What is meant by a sustainable process?
A
One that meets the needs of the present without compromising the ability of future generations to meet their own needs.
24
Q
RESOURCE ALLOCATION
What are the aspects of sustainability
A
- Economic factors.
- Social factors.
- Environmental factors.
25
RESOURCE ALLOCATION
Explain how the NHS can contribute to unsustainable practice
- NHS emissions come directly from everyday clinical practice.
- E.g. inefficient use of resources which can lead to clinical waste (over investigating, overprescribing, over intervention).
26
RESOURCE ALLOCATION
How can we respond to the unsustainable practices in the NHS?
- Reduce clinical waste via appropriate prescribing, pt education to improve adherence.
- Requires system-level action i.e. changes through legislation.
- Encourage active travel (improved air quality + reduced risk of CVD).
27
RESOURCE ALLOCATION
What is the ladder of interventions?
- Starts at doing nothing/monitoring.
- Next steps are education or enabling choice (can be via changing the default).
- Ends with incentives, disincentives + then restricting/eliminating choice.
28
MEDICAL NEGLIGENCE
Define negligence
A breach of duty of care which results in damage.
- There is failure to take proper care over something.
29
MEDICAL NEGLIGENCE
What 4 questions should be asked when negligence is suspected?
- Was there a duty of care?
- Was there a breach in that duty?
- Did the patient come to any harm?
- Did the breach cause the harm?
30
MEDICAL NEGLIGENCE
What 2 tests can be used to decide if there was a breach in a duty of care?
- Bolam test = would a group of responsible doctors do the same?
- Bolitho test = would it be reasonable of them to do so?
31
MEDICAL NEGLIGENCE
What factors influence how much money a patient may get from a successful negligence claim?
- Loss of income.
- Cost of extra care.
- Pain + suffering.
32
MEDICAL NEGLIGENCE
What are 6 broad factors which contribute to negligence?
- System failure.
- Human factors.
- Judgement failure.
- Neglect.
- Poor performance.
- Misconduct.
33
MEDICAL NEGLIGENCE
Explain what is meant by system failure.
- Computer system may shutdown > losing notes.
- Pt may be unconscious + unable to communicate so important info lost at critical moment.
- Hackers could access computer systems = remove confidential information.
– Confidentiality breaking in this way could be negligent.
34
MEDICAL NEGLIGENCE
Explain what is meant by human factors?
- Personal factors (having a bad day>mistakes).
- Teamwork problems (miscommunication, tensions between staff).
- Working environment (lighting, space).
- Decision density (leaving one person to make all decisions = pressure so more likely to make a mistake).
35
MEDICAL NEGLIGENCE
Explain what is meant by judgement failure?
- Defective decision making, bias.
- Analytical or intuitive.
- Wrong amount or type of information, wrong decision making strategy.
36
MEDICAL NEGLIGENCE
Explain what is meant by neglect.
- Not showing enough care.
- Falling below expected standard.
- Often chain of minor failures which may/may not lead to harm.
- Can be multidisciplinary (communication + assumptions).
37
MEDICAL NEGLIGENCE
Explain what is meant by poor performance.
- Repeated minor mistakes or not learning from mistakes.
- Usually extends beyond attitude to pt care (timekeeping, reliability, illness).
38
MEDICAL NEGLIGENCE
Explain what is meant by misconduct.
- Deliberate harm, covering up errors, improper relationships (staff/pts).
- Fraud/theft/abuse i.e. falsely claiming sickness, substance misuse.
39
ERROR
Define error?
A preventable event that can cause or lead to an unintended outcome.
40
ERROR
What can medical error lead to?
Medical error is a preventable event that can lead to pt harm.
41
ERROR
What should you do in the event of a Patient Safety Event?
Notify, inform patient, explain + apologise under the Duty of Candour policy
42
ERROR
What are 2 types of medical error?
- ADVERSE EVENT = incident that results in pt harm.
- NEAR MISS = event which had potential to cause harm but didn't develop further thereby avoiding harm.
43
ERROR
What are some different types of human (individual) errors?
- Omission (required action delayed/not taken).
- Commission (wrong action taken).
- Sequence (action taken in wrong order).
- Fixation (regular act so don't recognise if something goes wrong).
- Negligence (actions/omissions do not meet standard of an ordinary, skilled person).
44
ERROR
What are 4 broad classifications of errors?
- Intention.
- Action.
- Outcome.
- Context.
45
ERROR
What is meant by intention?
- Failure of planned actions to achieve desired outcome.
46
ERROR
What are 3 types of intention error?
- SKILL-BASED (action made is not what was intended i.e. performing well-known task>little attention>error if distracted).
- RULE-BASED (incorrect application of a rule/incorrect plan or course of action taken i.e. in emergencies).
- KNOWLEDGE-BASED (lack of knowledge in a certain situation.
47
ERROR
What are the issues with knowledge based errors?
- Automatically make us prone to actions not as planned.
- Memory may contain mini-theories rather than facts (liable to confirmation bias).
- Limited attentional resources.
48
ERROR
What is meant by action?
- Generic factors (omission, intrusion, sequence).
- Task-specific factors (wrong blood vessel/organ/side, bad knots in surgery).
49
ERROR
What is meant by outcome?
- Near miss.
- Death/injury/loss of function.
- Successful detection + recovery.
- Prolonged intubation/stay in ICU.
50
ERROR
What is meant by context?
- Equipment + staffing issues.
- Accumulation of stressors.
- Interruptions + distractions.
- Team/organisation factors.
- Nature of procedure.
51
ERROR
What are some red flags for errors?
- Anomalies.
- Broken communication, missing information or confusion.
- Departures from normal practice.
- Stress.
52
ERROR
What are the 10 types of basic error?
- Sloth.
- Fixation + loss of perspective.
- Communication breakdown.
- Poor team working.
- Playing the odds.
- Bravado + timidity.
- Ignorance.
- Mis-triage.
- Lack of skill.
- System error.
53
ERROR
What is sloth?
not bothering to check results accurately, inadequate documentation.
54
ERROR
What is fixation + loss of perspective?
early unshakable focus on Dx, inability to see bigger picture.
55
ERROR
What is communication breakdown?
unclear instruction of plans, not listening to/considering other's opinions.
56
ERROR
What is poor team working?
some out of depth, some under-utilised.
57
ERROR
What is playing the odds?
choosing the common + dismissing rare.
58
ERROR
What is bravado + timidity?
working beyond competence/without adequate supervision (opposite for timidity).
59
ERROR
What is ignorance?
lack of knowledge, not knowing what you don't know.
60
ERROR
What is mis-triage?
over/underestimating the seriousness of a situation.
61
ERROR
What is lack of skill?
lack of appropriate skills, teaching or practice.
62
ERROR
What is a system error?
environmental, technology, equipment or organisation features. Inadequate safeguards build into system.
63
ERROR
What behaviour is lacking in each basic error?
- Sloth (conscientiousness).
- Fixation + loss of perspective (open mindedness, situation awareness).
- Communication breakdown (effective communication).
- Poor team working (good teamwork).
- Playing the odds (probability assessment).
- Bravado + timidity (humility).
- Ignorance (self-awareness).
- Mis-triage (prioritisation).
- Lack of skill (effective technical skills.
- System error (good system deisgn).
64
ERROR
Give an improvement for...
i) sloth.
ii) fixation + loss of perspective.
iii) communication breakdown.
iv) poor team working
v) playing the odds.
i) attention to detail, full documentation.
ii) recognition of clinical patterns but considering facts that don't fit.
iii) being approachable + open, listening, clear explanations.
iv) clear team structure, leadership + roles.
v) evaluation based on scenario features as well as likelihood.
65
ERROR
Give an improvement for...
i) bravado + timidity
ii) ignorance.
iii) mis-triage.
iv) lack of skill.
v) system error.
i) accurate self-evaluation, open communication of mistakes.
ii) aware of own abilities + limitations.
iii) appreciation of the relative importance of each situation.
iv) being properly trained in your role.
v) system designed to be easy to use, complete + with design features that identify potential risk.
66
ERROR
Define a never event.
A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented.
67
ERROR
Give some examples of never events.
- Medical = wrong route for chemo (i.e. intrathecal vincristine scenario).
- Surgical = wrong site or retained object.
- Mental health = escape of transfer pt, suicide.
68
ERROR
What organisations must the hospital trust report never events to?
- National Reporting and Learning Systems (NRLS).
- CQC.
- Strategic Executive Information System (StEIS).
69
ERROR
What are the consequences of never events?
- Financial penalties.
- Reputation loss.
- CQC visit.
- Fitness to practice meetings.
70
ERROR
What are the 2 perspectives on error?
- Person approach = focus on the individual at fault.
- System approach = focus on the working conditions/organisations at fault.
71
ERROR
What is the concept of the person approach to error?
- Looks at + blames an individual/group of individuals.
- States errors are the product of unpredictable mental processes (inattention, distraction, negligence).
- Focusses on the unsafe acts of people on the frontline.
72
ERROR
What are the cons with the person approach to error?
- Anticipation of blame promotes 'cover up' + need for a detailed analysis to prevent recurrence (retraining, discipline).
73
ERROR
What is the concept of the system approach to error?
- Adverse events are the products of many causal factors.
- The whole system has some kind of flaw at fault to blame.
- Adapt system to prevent recurrence (recognise errors + implement defences).
- Errors occur due to interaction between active failures + latent conditions.
74
ERROR
How can errors + harm be reduced?
- Simplification + standardisation of clinical processes.
- Checklists + aide memories (SBAR).
- Team training.
- Risk management programmes to remedy latent factors.
- Mechanisms to improve uptake of evidence-based Tx patterns.
75
ERROR
What tools can be used for risk identification?
- Incident reporting.
- Complaints + claims.
- Audit, service evaluation + benchmarking.
- External accreditation.
- Active measurement/compliance.
76
ERROR
Name the 2 models for errors.
- Swiss Cheese model.
- Three bucket model.
77
ERROR
Explain the concept of the Swiss Cheese model
- An organisations defences against error are modelled as a series of barriers, represented as slices of cheese.
- The holes in the slices represent weaknesses in individual parts of the system.
- The holes are continually varying in size + position across the slices.
- System failure occurs when a hole in each slice momentarily aligns.
78
ERROR
What is the difference between latent failures and active failures?
- Latent failures = flaws to the system e.g. organisational influences (culture, politics), unsafe supervision (oversight, Mx issues), preconditions for unsafe acts (lack of training, system + tools used).
- Active failures = unsafe acts that are mistakes + errors at the frontline – the sharp end of the stick.
79
ERROR
What is the concept of the three bucket model?
- Error evolves due to interaction between personal, environmental + physical factors as well as organisation – this tool can help stratify risk.
80
ERROR
What do the 3 buckets represent in the 3 bucket model?
Self, context + task.
81
ERROR
Three bucket model – what comes under self?
- Level of knowledge (newly qualified, senior support available, unaware of current protocols).
- Level of skill (competence + experience).
- Level of expertise (confidence, automaticity, expectations/assumptions).
- Current capacity to do task (fatigue, stressors, illness, life events).
82
ERROR
Three bucket model – what comes under context?
- Equipment (maintenance, availability, usability, power sources).
- Physical environment (lighting, surfaces, noise, temperature).
- Workspace (working environment, handovers, layout).
- Team + support (leadership, trust, briefing + reflection).
- Organisation + Mx (communication, safety culture + reporting, workload).
83
ERROR
Three bucket model – what comes under task?
- Errors (omission, commission, fixation, sequence).
- Task complexity (calculations, double checking).
- Novel task (unfamiliar events, rare events, new ways of working).
84
ERROR
What are some common issues with accidents/safety in healthcare?
- Wrong Dx>wrong plan.
- Medication reconciliation (if forget to reconcile the meds list then pts may end up with duplicates, interactions).
- High concentration medication solutions.
- Pt identification.
- Pt care handovers.
85
ERROR
Why is safety compromised so often in healthcare?
- Complex, high risk environment.
- Responsibilities are often shared.
- Practitioners often take risks unknowingly.
- System, pt + practitioner interaction.
- Resource intensive.
86
ETHICS
Define ethics.
system of moral principles + a branch of philosophy that defines what is good for individuals + society.
87
ETHICS
Define morality.
concerned with the distinction between good + evil or right + wrong.
88
ETHICS
What are the 4 pillars of medical ethics?
- AUTONOMY (respecting pt's right to make informed decisions about their own medical care).
- BENEFICENCE(duty to 'do good' i.e. provide benefits to the pt).
- NON-MALEFICENCE (duty to 'do no harm' i.e. not doing bad.
- JUSTICE (ensuring all pts treated equally + equitable i.e. fairness in distribution of Tx).
89
ETHICS
What is the concept of Utilitarianism?
- An act is evaluated solely in terms of its consequences to maximise good + minimise harm.
90
ETHICS
What are the cons of utilitarianism?
treats minorities unfairly to promote majority happiness,
how do you define what is good?
91
ETHICS
What is the concept or virtue ethics?
- Focuses on the person who is acting – do they express good character?
- An act is only virtuous if the person is acting with the genuine intention of doing the right thing – are they integrating reason + emotion.
92
ETHICS
What are the cons of concept or virtue ethics?
- virtues are culture-specific + too broad for practical application,
- no focus on consequences i.e. compassion may lead to not telling harmful truth = lying.
93
ETHICS
What are the 5 focal virtues that are acquired?
- DISCERNMENT (ability to judge well).
- CONSCIENTIOUSNESS (being thorough, careful + vigilant).
- COMPASSION (showing concern for others).
- TRUSTWORTHINESS (ability to be relied on).
- INTEGRITY (being honest + having good moral principles).
94
ETHICS
What is the concept of deontology?
- Features of the act determines worthiness.
- Teaches that acts are right/wrong + people have a duty to act accordingly (treat others how you would like to be treated).
95
ETHICS
What are the cons of deontology?
consequences not looked at, duties can conflict.
96
ETHICS
What are categorical imperatives?
- Version of deontology.
- Categorical imperative is a rule that is true in all circumstances.
- Act in a way you would be willing it to become universal law.
97
GMC DUTIES AS A DR
What are the 4 domains encompassing duties of a doctor?
1) Knowledge, skills + performance.
2) Safety + quality.
3) Communication, partnership + teamwork.
4) Maintaining trust.
98
GMC DUTIES AS A DR
Give some examples of the varying duties of a doctor.
- Provide a good standard of practice i.e. keep professional skills updated (1).
- Recognise + work within limits of competence (1).
- Take prompt action if think pts safety/dignity/comfort is being compromised (2)
- Protect + promote the health of pts + public (2).
- Tx patients as individuals + respect their dignity + confidentiality (3).
- Work in partnership with pts (3).
- Work in collaboration with colleagues to best service pts interests (3).
- Be honest, open + act with integrity (4).
- Never discriminate unfairly against pts/colleagues (4).
99
GMC DUTIES AS A DR
What are the benefits of doctors using social media?
- Facilitating public access to accurate health information.
- Improving patient access to services.
- Establishing wider + more diverse social + professional networks.
- Engaging with the public + colleagues in debates.
100
GMC DUTIES AS A DR
What are the risks of doctors using social media?
- Loss of personal privacy.
- Potential breaches in confidentiality.
- Online behaviour that may be perceived as unprofessional, offensive or inappropriate by others.
- Risks of posts being reported by the media or sent to employers.
101
DIVERSITY EDUCATION
Define culture.
a socially transmitted pattern of shared meanings by which people communicate, perpetuate + develop their knowledge + attitudes about life.
102
DIVERSITY EDUCATION
Define acculturation.
Adapting to a new culture.
103
DIVERSITY EDUCATION
Define stereotypes.
generalisations about the 'typical' characteristics of members of a group.
104
DIVERSITY EDUCATION
Define ethnocentrism
the tendency to evaluate other groups according to the values + standards of one's own culture group, especially with the conviction that one's own culture group is superior to others.
105
DIVERSITY EDUCATION
Define prejudice.
attitudes towards another person based solely on their membership of a group.
106
DIVERSITY EDUCATION
Define discrimination.
actual positive or negative action towards the objects of prejudice.
107
DIVERSITY EDUCATION
What makes up someone's individual culture?
- May be based on heritage, as well as individual circumstances + person choice – it's a dynamic entitiy.
108
DIVERSITY EDUCATION
Explain the iceberg model of culture.
- Parts of culture which are visible from the surface (can be deducted from appearance e.g. you can have idea of their age, nationality, ethnicity, gender).
- Parts of culture which you cannot possibly see from the surface (more embedded within the person e.g. socioeconomic status, occupation, health, religion, education, sexual + political orientation).
109
DIVERSITY EDUCATION
How can we bridge cultural distance?
- Self-awareness = being aware of your own feelings + reactions.
- Respectful curiosity = suspend judgement, don't assume – ask.
- Greater the culture distance, more likely it is that any assumptions you make will be wrong.
110
DIVERSITY EDUCATION
What are the benefits of diversity training?
Pts – adherence more likely as more satisfied with their care, fewer diagnostic tests + referrals, pt Sx burden is reduced.
Drs – fewer complaints, more time efficient.
111
DIVERSITY EDUCATION
What are some challenges + solutions concerning diversity in healthcare?
- Language barriers (longer appts, interpreters).
- Fasting + needs for medications (speak to religious leader ?exemption).
- Health beliefs such as different expectations in Dr/Pt relationship (paternalistic), Jehovah Witnesses' refusing blood (talk to pts + understand their beliefs, education).
- Expectations of healthcare system private vs. NHS (education).
- Taboos (i.e. sexual health in some cultures).
112
COMM DIFFICULTIES
From a SALT perspective, what is meant by...
i) speech?
ii) language?
iii) pragmatics?
iv) comprehension?
v) expression?
i) converting language into an audible form.
ii) can be spoken, writing, gestures. It's to do with words + how we put them together.
iii) how language is used (turn taking, eye contact).
iv) aka receptive language – understanding language.
v) aka expressive language – producing language.
113
COMM DIFFICULTIES
What happens in speech impairment?
- Words are unaffected, output is affected
114
COMM DIFFICULTIES
How may speech impairment present?
- Dysarthria (imprecise/slurred speech),
- Apraxia (speech sounds in the wrong order),
- Stammer/stutter (dysfluent speech)
115
COMM DIFFICULTIES
What are some causes of speech impairment?
- Stroke,
- Cerebral palsy,
- Acute brain injury,
- MND.
116
COMM DIFFICULTIES
What happens in language impairment?
Can relate to written or spoken language + is where ability to understand concepts unaffected just ability to understand the means of the message.
117
COMM DIFFICULTIES
How may language impairment present?
- There may be trouble understanding some words, longer phrases or grammar etc.
- May present as unreliable yes/no, no language produced, word-finding difficulties.
118
COMM DIFFICULTIES
What are some causes of language impairment?
- Stroke,
- Dementia (primary progressive aphasia),
- Acute brain injury.
119
COMM DIFFICULTIES
What happens in a pragmatic impairment?
- May be a feature in many conditions (Autism-spectrum disorders).
- May present as atypical body language, difficulties with turn-taking.
120
COMM DIFFICULTIES
What happens in voice disorders?
- Acute vs. chronic.
- Causes – laryngectomy, common cold, GORD, Parkinson's, environmental pollutants.
121
COMM DIFFICULTIES
What are the impact of communication disorders?
- Everyday activities (difficulty with work, shopping, transport).
- Social engagement (difficulties ordering food).
- Relationships (both parties may get frustrated, may lead to isolation).
- Healthcare (more vulnerable to medical errors, may face prejudice).
122
COMM DIFFICULTIES
What are some strategies to support communication?
- Simplify language, use visual aids, check the person has understood, don't rush.
- E.g. break down into smaller chunks, gestures, recap, speak slowly, one Q at a time, different methods of communication, repeat yourself.
123
TEACHING SKILLS
How should a skill be taught?
- Breaking the task down into smaller components.
- Utilising an internal commentary.
- 'See one, do one, teach one'.
124
TEACHING SKILLS
What is Peyton's 4 step procedure for skill training?
- Trainer demonstrates without commentary./
- Trainer demonstrates with commentary.
- Learner talks through + trainer does.
- Learner talks through + does.
125
TEACHING SKILLS
What are some critiques of Peyton's 4 step procedure?
- Insufficient time for learner to practice.
- Insufficient feedback.
- Lack of clarity + thoroughness.
126
TEACHING SKILLS
What is a method used in small group teaching?
Give examples.
- Tutor facilitation rather than teaching.
- Micro-facilitation by dividing into smaller groups.
- E.g. rounds (each student has 1m to talk), circular interviewing (students ask each other questions), buzz groups.
127
TEACHING SKILLS
What are the key responsibilities of small group teachers?
- Manage the group, activities + learning.
- Facilitate the learning by leading discussions, asking open-ended Qs, guiding process + task, enabling active participation of learners + engagement with ideas.
128
TEACHING SKILLS
What fundamental questions should a small group teacher ask themselves?
- Who am I teaching? (Numbers, levels, names).
- What am I teaching? (Topic, type of expected learning i.e. knowledge, skill, behaviours).
- How will I teach it?
- How will I know if the students understand/understood?
129
TEACHING SKILLS
What are some question strategies?
- Evidence = how do you know that? Evidence?
- Clarification = can you give me an example? Explain this term?
- Explanation = why is that the case?
- Linking + extending = how does this idea support/challenge what we explored earlier?
- Hypothetical = what might happen if?
- Cause + effect = how is this response related to that?
- Summary + synthesis = what remains unsolved/uncertain?
130
TEACHING SKILLS
What is the tripartite model of types of learning?
- Surface.
- Strategic.
- Deep approach.
131
TEACHING SKILLS
What is meant by surface?
- Fear of failure.
- Desire to complete a course.
- Learning by rote + focus on particular tasks.
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TEACHING SKILLS
What is meant by strategic?
- Desire to be successful.
- Leads to a patchy + variable understanding (well organised form of surface learning).
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TEACHING SKILLS
What is meant by deep approach?
- Intrinsic, vocational interest, person understanding.
- Making links across materials, search for deeper understanding of the material, look for general principles.
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TEACHING SKILLS
What are 4 different types of learner?
- Theorist = complex situation, can question ideas, offered challenges.
- Activist = new experiences, extrovert, likes deep end, leads.
- Pragmatist = wants feedback, purpose, may like to copy.
- Reflector = watches others, reviews work, analyses, collects data.
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TEACHING SKILLS
What is Kolb's learning cycle?
- Conclusions from experience (theorist).
- Experience (activist).
- What can I do differently next time? (pragmatist).
- Review + reflect on experience (reflector).
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TEACHING SKILLS
What is the relevance of different types of learners?
Individuals should choose activities which best match their learning style + identify least dominant style so that they can strengthen these.
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TEACHING SKILLS
What is meant by intuitive thinking in decision making?
What are some biases?
- Ability to understand something instantly without conscious reasoning.
Biases: confirmation bias (tendency to favour information that confirms or strengthens their existing beliefs or theories).
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TEACHING SKILLS
What is meant by analytical thinking?
What are some cons?
- Lacks skills at estimating odds or values but excels at measuring + calculating them. This is the basis of evidence-based medicine.
Cons: slow, resource intensive, cognitively demading.
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TEACHING SKILLS
What is the dual process theory?
- Intuitive thinking with its irresistible combination of heuristics + biases, together with analytical thinking, using evidence-based medicine.
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LEADERSHIP
What are the 5 leadership styles?
- Authoritarian.
- Participative.
- Delegative (Laissez-faire).
- Transactional.
- Transformational (inspirational).
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LEADERSHIP
What is the concept of authoritarian leadership?
- Allows one leader to impose expectations + define outcomes.
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LEADERSHIP
What are the pros/cons of authoritarian leadership?
Pros:
- consistent results,
- time spent on crucial decision reduced.
Cons:
- v strict,
- lack of staff creativity/innovation,
- lack of group input.
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LEADERSHIP
What is the concept of participative leadership?
Rooted in democratic theory to involve team members in the decision-making process> feeling included, engaged + motivated to contribute.
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LEADERSHIP
What are the pros/cons of participative leadership?
Pros:
- encourages staff creativity,
- increases staff motivation.
Cons:
- decisions may be time-consuming,
- poor decisions may be made.
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LEADERSHIP
What is the concept of delegative leadership?
- Focuses on delegating initiative to team members, letting things take their own course without interfering.
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LEADERSHIP
What are the pros/cons of delegative leadership?
Pros:
- environment of independence,
- experienced staff can offer experience.
Cons:
- downplays role of leader,
- leaders avoid leadership,
- staff may abuse.
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LEADERSHIP
What is the concept of transactional leadership?
Leader sets clear goals + uses "transactions" such as rewards, punishments etc to get the job done. Staff know how their compliance is rewarded.
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LEADERSHIP
What are the pros/cons of transactional leadership?
Pros:
- staff motivation + productivity increased,
- reward system.
Cons:
- innovation/creativity minimised,
- less leaders created,
- seen as coercive.
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LEADERSHIP
What is the concept of transformational leadership?
- Leader inspires the followers with a vision + then encourages + empowers them to achieve it. The leader serves as a role model for the vision.
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LEADERSHIP
What are the pros/cons of transformational leadership?
Pros:
- high value on corporate vision,
- high morale for staff,
- not coercive.
Cons:
- leaders can deceive staff,
- may need consistent motivation/feedback.
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LEADERSHIP
What leadership model is best suited for healthcare and why?
- Transformational.
- It places the needs of pts, carers + families at the centre of all work + people can intervene when necessary.
- I.e. speak up if risk to pt, continually improve system, talk to seniors if lack of skill, knowledge or resources.
