Study Guide Med Com Semester II Tayang 22 Peb 2016

~ INTRODUCTION ~

Good communication skills are essential in the medical profession because doctors are dealing with humans, autonomous and social individuals. Today’s doctors are facing more and more demanding patients in their need to maintain health. Doctors need to be able to communicate effectively and sensitively with their patients and with their colleagues. There is no doubt that the ability to communicate is by far the most precious skill that a doctor can learn. Even in present-day complex and sophisticated world of medicine, the skills to communicate effectively remain to be of prime importance for developing a successful and gratifying medical profession and practice.

The Block Medical Communication (MC) has been designed to provide the medical students with enough opportunity to learn communication skills needed in medical profession. The first part of the Block curriculum deals with basic concepts of communication skills required to build effective interaction between doctor and patient/relative such as basic concepts in medical communication, taking history, reviewing the system, and approaching to specific patients such as different cultural background, paediatric, psychiatric and obstetric patients. There are also time allocation for student to rehearse their skill in communication through role play in basic clinical skill, comprising the skills in opening the session, gathering information, building relationship, giving explanation and planning, closing the session, and imparting bad news. In the later part of the curriculum, the programs concern with other aspects of communication skills such as writing medical notes and letters, techniques of paper presentation and discussion, communication in health promotion and education, and scientific writing. The forms of the teaching -learning activities include reading assignments, lectures, small group discussions, and exercises on self-assessment items to test students’ understanding on the main contents of lectures and reading material.

On having completed the Block’s programs at the first semester, we hope that the students will be reasonably proficient in the skills of effective communication that they can use throughout all stages of their medical training – especially the later clinical stages, as well as throughout their future medical career after qualification.

This small Study Guide manual has been written to aid students to get through the various teaching-learning activities without too much difficulty. As it contains all the necessary information such as time-table of learning activities, subjects/topics and tasks or assignments, the students will know in advance what to learn, when and how to do it and what to expect from them. In short, with this manual at hand, the students should be able to prepare themselves properly before participating in each teaching-learning activity.

We hope that this manual is useful not only for the students, but also for the lecturers and facilitators.

Team of Planners

~ CURRICULUM ~

Aims:

To introduce to the students the basic principles and skills of communication essential in medical profession: taking patient’s history, approaching patient with specific clinical situation or entity, and communicating with professional associates.

Learning Outcomes:

1. Understand and apply the basic principles of effective communication with patient and family

2. Understand and apply communication strategy for health promotion and education to lay community

3. Communicate effectively with professional associates in scientific meeting 4. Write professional letters, notes and curriculum vitae

5. Apply basic principles of scientific writing in professional communication

6. Apply specific approach or communication strategy to patient with specific clinical condition or entity

Curriculum contents:

1. Principles of communication between doctor and patient/family 2. Concepts of history taking and review of the body systems 3. Skills in communicating with patients

4. Communicating with patients from different cultural backgrounds 5. Approaching patient with specific situation or entity:

a. Questioning about sexual history and examining obstetric patient b. Communicating with child patients and their parents

c. Communicating with patients with psychological problem and disorder 6. Concepts and skills of paper presentation and discussion

7. Concepts and skills of communication in health promotion and education 8. Writing medical letters, notes and curriculum vitae (CV)

A Guide to Successful Study

Studying medicine is very hard and therefore severely demands that you have a strong determination to study, attend lectures and discussions as scheduled, read learning materials diligently and critically, and execute your assignments properly and on time. Although studying manner differs from one individual student to the other, there are things that have much in common to achieve success.

Here are some general “tips” for you to comply in order to reach success in your studies at this Faculty, including the Block Medical Communication.

1. Keep your enthusiasm high for your tasks

Your high scores you were able to obtain at High School that enabled you to enrol to this Faculty of Medicine tell that basically you have the basic potential to reach success in your present studies. Different from the school study, however, at university you are faced with more complex work, more wide and critical reading, and you must focus on issues in a more detailed and searching way. This means you should be able to manage yourself and your time wisely. Being a last minute crammer for lectures and assignments is a serious disadvantage and reflects poor self-motivation.

2. Increase your proficiency in reading, writing and speaking

You are given a great deal of reading material, so you have to be selective with which to read in-depth or superficially, know which is important and which is not, see beyond the details to the underlying principles, pay attention to similarities and differences, to note exceptions to general rules, to understand cause and effect relationships, tie in what you are reading with what you already know, etc. Similarly, you have to keep-up your writing and speaking ability to such a level required for university studies (in Bahasa Indonesia and/or in English). It is for all these purposes that this Faculty includes Academic Reading, Critical Thinking, Speaking in Conferences, and Scientific Writing courses in this Block and in a few other blocks. There are also both General English and Medical English courses offered by this Faculty. You must remember that reading, writing and speaking are three main elements of communication skills of great importance in almost all professions, including medicine in particular. So why not make the best out of these courses!

3. Have flexibility in thinking and learning

As a medical student, you are dealing with large bodies of information with which you gradually have to become familiar. In our medical school curriculum system, the first seven semesters are devoted to integrated learning of basic biomedical and clinical sciences, while the later five semesters are concentrated more on clinical studies with real patients. Generally, the teaching-learning activities of the early seven semesters consist of lectures, discussions on specific learning tasks or problems, and in some topics simulations/role-plays. Since early in your studies, you are introduced to the relation of biomedical knowledge to their clinical implications. In some of the learning tasks or model cases in the earlier semesters, you may not yet familiar with certain terms regarding diseases or other clinical disorders mentioned in the tasks/simulated cases. Each lecture takes only one hour for a topic, in which the lecturer explains more about concepts and principles rather than on details of factual information. In consequence, therefore, it is your responsibility to find out explanation to unknown terms or diseases and you have to read more extensively to get more information from your reading resources. In fact, unlimited amount of information is in existence in the library and on the internet about almost anything. Therefore, the

question lies not on where to find the information, but on whether or not you are willing to find it. So, make the best use of the library and Internet available in this School.

4. Ability to work by yourself

The present teaching and learning feature of this Faculty of Medicine is more “student-centered” than the old “teacher-centered” one. Thus, your success will be dependent greatly on how well or hard you drive yourself to studying. No teaching staff is assigned to checking on you or spying on your progress. Lecturers do not “teach” about details of information, but instead emphasize more about concepts and principles. The task of the tutors/facilitators is not to give you the answers to the learning tasks of the discussion sessions, nor to “teach” or “lecture” you about the topic of discussion. Their task is, by working together with you --students, to assure that you delve yourself into the discussion deeply and seriously. In fact, it should be relatively easy for you to make your day-to-day study plans, because you already have a somewhat well- structured learning time-line, as in this Study Guide for Block Medical Communication. If you always read your references before each lecture and discussion day, it means you get yourself ready for the block final examination. If you are building up a habit of delaying reading the references to the last minute, then take into account the heaving workload of the examinations, because you must take them very shortly after the end of each block. With careful planning, it is most likely that you will succeed in your study and, as a result, enjoy your life as a student.

~ PLANNERS TEAM ~

No Name Department Phone

1 dr. P. Siadi Purniti, Sp.A (Head) Pediatrics 08123812106 2 dr. IGA Ratnayanti, M.Biomed (Secretary) Histology 085104550344

3 dr. Yuliana, M.Biomed Anatomy 085792652363

4 Prof. Dr. dr. Gd Raka Widiana, Sp.PD

(KGH) Internal Medicine 0816297956

5 dr. I Putu Adiartha Griadhi, M.Fis, AIFO Fisiologi 03617811372

~ LECTURERS ~

NO NAME DEPT PHONE

1 Prof. Dr. dr. IB Tjakra Wibawa M, Sp.B.Onk Oncology Surgery 0811393779

2 Dr. dr. Made Ratna Saraswati,

Sp.PD-KEMD-FINASIM Internal Medicine 08123814688

3 Prof. Dr. dr. Gd Raka Widiana, Sp.PD (KGH) Internal Medicine 0816297956

4 dr. I Gusti Ayu Dewi Ratnayanti, M.Biomed Histology 085104550344

5 Prof. Dr. dr. I Putu Gede Adiatmika, M.Erg. Fisiologi 08123811019

6 dr. P. Siadi Purniti, Sp.A Pediatrics 08123812106

7 dr. I N Hariyasa Sanjaya,Sp.OG, MARS Obstetric and_Gynecology 081558314827

8 dr. Yuliana, M.Biomed. Anatomy 08579252363

9 dr. Lely Setiawati, Sp.KJ Psychiatry 08174709797

10 Prof. Dr. dr. Mangku Karmaya, M.Repro Anatomy 0811387105

11 dr. I Putu Adiartha Griadhi, M.Fis, AIFO _{Physiology 03617811372}

12 dr. Oka Negara Andrology 08123970397

13 Dr. dr. Dyah Pradnya Paramita D Public Health 0818357777

Regular Class

NO NAME GROUP DEPT PHONE ROOM

1 Dr.dr. I Made Jawi, M.Kes A1 Pharmacology 08179787972 2nd floor:_R.2.01 2 dr. Ni Ketut Putri Ariani,

Sp.KJ A2 Psychiatry 082237817384

2nd floor: R.2.02 3 dr. Anak Agung Ayu Yuli

Gayatri, Sp.PD A3 Interna 08123803985

2nd floor: R.2.03 4 dr. I B Darma Putra, Sp.B-_KBD A4 Surgery 08123600552 2nd floor:_R.2.04 5 dr. I Gde Haryo Ganesha, _S.Ked A5 DME 081805391039 2nd floor:_R.2.05 6 dr. Gusti Ngurah Mayun,

Sp.HK A6 Histology 08155715359

2nd floor: R.2.06 7 dr. I Ketut Wibawa Nada,

Sp.An A7 Anasthesi 087860602995

2nd floor: R.2.07 8 dr. I Wayan Weta, MS, _Sp.GK A8 Public Health 081337003560 2nd floor:_R.2.08 9 dr. Ni Luh Ariwati A9 Parasitology 08123662311 2nd floor: R.2.21 10 dr. Putu Patriawan, Sp.Rad,

MSc A10 Radiology 08123956636

2nd floor: R.2.22

English Class

NO NAME GROUP DEPT PHONE ROOM

1 dr. I Wayan Surudarma, _M.Si B1 Biochemistry 081338486589 2nd floor:_R.2.01 2 dr. I Wayan Losen

Adnyana, Sp PD B2 Interna 08123995536

2nd floor: R.2.02 3 Dr. dr. Sianny Herawati,

Sp.PK B3

Clinical

Pathology 081236172840

2nd floor: R.2.03 4 dr. Yuliana, M.Biomed B4 Anatomy 085792652363 2nd floor:_R.2.04 5 dr. Made Agus _{Hendrayana , M.Ked} B5 Microbiology 08123921590 2nd floor:_R.2.05 6 dr. I Nyoman Semadi,

Sp.B, Sp.BTKV B6 Surgery 08123838654

2nd floor: R.2.06 7 dr. I Wayan Eka Sutyawan,

Sp.M B7 Opthalmology 081338538499

2nd floor: R.2.07 8 dr. Kadek Budi Santosa, _Sp.U B8 Surgery 081339977799 2nd floor:_R.2.08 9 dr. Sri Laksminingsih Sp.

Rad B9 Radiology 08164745561

2nd floor: R.2.21 10 dr. I Gede Suwedagatha,

Sp.B (K) Trauma B10 Surgery 0811387720

2nd floor: R.2.22

~ TIME TABLE ~

Regular Class

LECTURE ROOM: 4.02

Day/

Date Time Activity Venue Conveyer

1

Mon

22 Feb

2016

08.00 – 08.15 08.15 – 09.00 09.00 – 10.30 10.30 – 12.30 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Blok Overview and Student Project explanation

Lecture 1: Basic concepts of communication with patient and family

Independent learning SGD

Break

Student Project 1 Plenary session Class room Discussion room Class room Dr. Ratnayanti Prof Tjakra Facilitator Prof Tjakra

2

Tues

23 Feb 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 2: Basic concepts of history taking

Independent learning SGD

Break

Student Project 2 Plenary session Class room Discussion room Class room dr. Ratna Saraswati Facilitator dr. Ratna S

3

Wed

24 Feb

2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 3: Review of the systems

Independent learning SGD

Break

Student Project 2 Plenary session Class room Discussion room Class room dr. Ratna Saraswati Facilitator dr. Ratna S

4

Thurs

25 Feb 2016

08.00 – 09.00

09.00 – 10.30 10.30 –12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 4: BCS: Skills in communicating with patients: Iniating the session and Gathering information

Independent learning

Basic Clinical Skill(BCS): Role play Break

Student Project 3/6 Plenary session Class room Discussion room Class room Dr. Adiartha Griadhi Facilitator Dr. Adiartha

5

Fri

26 Feb 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 5: BCS:Skills in communicating with patients: Building relationship

Independent learning BCS: Role play Break

Student Project 3/7 Plenary session Class room Discussion room Class room Prof. Mangku Karmaya Facilitator Prof. Mangku

6

Mon

29 Feb 2016

08.00 – 09.00

09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 6: BCS: Skills in communicating with patients: Explanation & planning, Closing the session

Independent learning

BCS: Role Play Break

Student Project 3/7 Plenary session Class room Discussion room Class room Dr. Ratnayanti Lecture Facilitator Dr. Ratnayanti

7

Mon

29 Feb 2016

08.00 – 09.00

09.00 – 10.30 10.30 – 12.00

Lecture 7: BCS: Skills in communicating with patients: Spesific Issue: Breaking bad news to patient and family

Independent learning SGD Class room Discussion room Prof. Tjakra Wibawa Facilitator

12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Break

Student Project 3/7

Plenary session Class room Prof. Tjakra W

8

Tues

1 March

2016

08.00 – 15.00 BASIC CLINICAL SKILL SKILL LAB

(R. 201 – 210) Facilitator(13.00 – 15.00)

9

Wed

2 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 8: Communication with patient from different cultural backgrounds

Independent learning SGD

Break

Student Project 3/7 Plenary session Class room Discussion room Class room Dr. Mita Duarsa Facilitator Dr. Mita D

2 March

2016

12.00 – 12.30 _{Representatives and Facilitators}Meeting with Students DME Planners

10

Thurs

3 March

2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 9: Communication approach in psychiatry/special emotional condition

Independent learning SGD

Break

Student Project 3/7 Plenary session Class room Discussion room Class room Dr. Lely Facilitator Dr. Lely

11

Mon

7 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 10: Communication approach to obstetric patient

Independent learning SGD

Break

Student Project 4 Plenary session Class room Discussion room Class room dr. Hariyasa Facilitator Dr. Hariyasa

12

Fri

11 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.30 13.30 – 14.00 14.00 – 15.00

Lecture 11: Communication with pediatric patient and parent

Independent learning SGD

Break

Student Project 4 Plenary session Class room Discussion room Class room dr. Siadi Purniti Facilitator dr. Siadi P

13

Mon

14 March

2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 12: Writing letters, notes and CV

Independent learning SGD (SP 4 Presentation) Break

Student Project 5 Plenary session Class room Discussion room Class room Dr. Yuliana Facilitator Dr. Yuliana

14

Tues

15 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 13: Basic concepts of scientific writing 1

Independent learning SGD

Break

Student Project 5 Plenary session Class room Discussion room Class room Prof Raka Widiana Facilitator Prof Raka

15

Wed

16

08.00 – 09.00 09.00 – 10.30

Lecture 15: Presentation & discussion in scientific meeting 1

Independent learning

Class room Prof.

March 2016

10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

SGD Break

Student Project 6 Plenary session Discussion room Class room Facilitator Prof. Adiatmika

16

Thurs

17 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 14: Basic concepts of scientific writing 2

Independent learning SGD

Break

Student Project 5

Plenary session (SP 5 Presentation)

Class room Discussion room Class room Prof Raka Widiana Facilitator Prof.Raka

17

Fri

18 March 2016

08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Lecture 16: Communication in Health Promotion and Education

Independent learning SGD

Break

Student Project 6 Plenary session Class room Discussion room Class room Dr. Okanegara Facilitator Dr. Okanegara

18

Mon

21 March 2016

08.00 – 10.30 10.30 – 11.30 11.30 – 13.30 13.30 – 14.00 14.00 – 15.00

Group Presentation (SP 6) Independent learning

Student Project 3 Presentation Break

Student Project 6/7

Discussion room Class room Facilitator Team

19

Tues

22 March 2016

08.00 – 11.00 11.00 – 12.00 12.00 – 13.00 13.00 – 15.00

Seminar Simulation (SP 6)

Independent learning Break

Student Project 7 Presentation

Theatre room Class room Prof. Adiatmika Dr. Okanegara

20

23 March 2016

Preparation for Exam

24 March

2016

EXAMINATION

SP: Student Project

~ TIME TABLE ~

English Class

LECTURE ROOM: 4.02

Day/

Date Time Activity Venue Conveyer

1

Mon

22 Feb

2016

09.00 – 09.15 09.15 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Blok Overview and Student Project explanation

Lecture 1: Basic concepts of communication with patient and family

Independent learning Student Project 1 SGD Break Plenary session Class room Discussion room Class room Dr. Ratnayanti Prof Tjakra Facilitator Prof Tjakra

2

Tues

23 Feb 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 2: Basic concepts of history taking

Independent learning Student Project 2 SGD Break Plenary session Class room Discussion room Class room dr. Ratna Saraswati Facilitator dr. Ratna S

3

Wed

24 Feb

2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 3: Review of the systems

Independent learning Student Project 2 SGD Break Plenary session Class room Discussion room Class room dr. Ratna Saraswati Facilitator dr. Ratna S

4

Thurs

25 Feb 2016

09.00 – 10.00

10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 4: BCS: Skills in communicating with patients: Iniating the session and Gathering information

Independent learning Student Project 3/7

Basic Clinical Skill(BCS): Role play Break Plenary session Class room Discussion room Class room Dr. Adiartha Griadhi Facilitator Dr. Adiartha

5

Fri

26 Feb 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 5: BCS:Skills in communicating with patients: Building relationship

Independent learning Student Project 3/7 BCS: Role play Break Plenary session Class room Discussion room Class room Prof. Mangku Karmaya Facilitator Prof. Mangku

6

Mon

29 Feb 2016

09.00 – 10.00

10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 6: BCS: Skills in communicating with patients: Explanation & planning, Closing the session

Independent learning Student Project 3/7

BCS: Role Play Break Plenary session Class room Discussion room Class room Dr. Ratnayanti Facilitator Dr. Ratnayanti

7

Mon

29 Feb 2016

09.00 – 10.00

10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00

Lecture 7: BCS: Skills in communicating with patients: Spesific Issue: Breaking bad news to patient and family

Independent learning Student Project 3/7 SGD Break Class room Discussion room Prof. Tjakra Wibawa Facilitator

15.00 – 16.00 Plenary session Class room Prof. Tjakra W

8

Tues

1 March 2016

09.00 -16.00 BASIC CLINICAL SKILL SKILL LAB

(R 301 – 310) (14.00 – 16.00)Facilitator

9

Wed

2 March

2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 8: Communication with patient from different cultural backgrounds

Independent learning Student Project 3/7 SGD Break Plenary session Class room Discussion room Class room

Dr. Mita Duarsa

Facilitator Dr. Mita D

2 March

2016 12.00 – 12.30

Meeting with Students

Representatives and Facilitators MEU Planners

10

Thurs

3 March

2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 9: Communication approach in psychiatry/special emotional condition

Independent learning Student Project 3/7 SGD Break Plenary session Class room Discussion room Class room Dr. Lely Facilitator Dr. Lely

11

Mon

7 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 10: Communication approach to obstetric patient

Independent learning Student Project 4 SGD Break Plenary session Class room Discussion room Class room dr. Hariyasa Facilitator Dr. Hariyasa

12

Fri

11 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 11: Communication with pediatric patient and parent

Independent learning Student Project 4 SGD Break Plenary session Class room Discussion room Class room

dr. Siadi Purniti Facilitator dr. Siadi P

13

Mon

14 March

2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 12: Writing letters, notes and CV

Independent learning Student Project 5

SGD (SP 4 Presentation) Break Plenary session Class room Discussion room Class room Dr. Yuliana Facilitator Dr. Yuliana

14

Tues

15 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 13: Basic concepts of scientific writing 1

Independent learning Student Project 5 SGD Break Plenary session Class room Discussion room Class room Prof Raka Widiana Facilitator Prof Raka

15

Wed

16 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00

Lecture 15: Presentation & discussion in scientific meeting 1

Independent learning Student Project 6 SGD Break Class room Discussion room Prof. Adiatmika Facilitator Prof. Adiatmika

15.00 – 16.00 Plenary session Class room

16

Thurs

17 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 14: Basic concepts of scientific writing 2

Independent learning Student Project 5 SGD

Break

Plenary session (SP 5 Presentation)

Class room Discussion room Class room Prof Raka Widiana Facilitator Prof.Raka

17

Fri

18 March 2016

09.00 – 10.00 10.00 – 11.30 11.30 – 12.30 12.30 – 14.00 14.00 – 15.00 15.00 – 16.00

Lecture 16: Communication in Health Promotion and Education

Independent learning Student Project 6 SGD Break Plenary session Class room Discussion room Class room Dr. Okanegara Facilitator Dr. Okanegara

18

Mon

21 March 2016

09.00 – 10.00 10.00 – 11.00 11.00 – 11.30 11.30 – 15.00 15.00 – 16.00

Student Project 3 Presentation Independent learning

Break

Group Presentation (SP 6) Student Project 6/7

Discussion room Class room Team Facilitator

19

Tues

22 March 2016

08.00 – 11.00 11.00 – 13.00 13.00 – 14.00 14.00 – 15.00

Seminar Simulation (SP6)

Student Project 7 Presentation Break

Independent learning

Theatre room

Class room Prof. AdiatmikaDr. Okanegara

20

23 March

2016

Preparation for Exam

24 March

2016

EXAMINATION

SP: Student Project

Basic Clinical Skill

Role Play Venue

Skill Lab

Jl. Pulau Serangan 1

English Class

Regular Class

B1

2.01

A1

3.01

B2

2.02

A2

3.02

B3

2.03

A3

3.03

B4

2.04

A4

3.04

B5

2.05

A5

3.05

B6

2.06

A6

3.06

B7

2.07

A7

3.07

B8

2.08

A8

3.08

B9

2.09

A9

3.09

B10

2.10

A10

3.10

Basic Clinical Skill Schedule

Time

Activity

A class

B class

08.00 – 10.00

09.00 – 11.00

Independent Role Playing

10.00 – 11.00

11.00 – 12.00

Break

11.00 – 13.00

12.00 – 14.00

Student Project 3/7

13.00 – 15.00

14.00 – 16.00

Role Playing with Facilitator

Seminar Simulation Schedule

Time

Activity

PIC

08.00 – 08.30

Preparation and registration

Committee

08.30 – 08.50

Presentation 1

B Student 1

08.50 – 09.10

Presentation 2

B Student 2

09.10 – 09.30

Discussion

Moderator

09.30 – 09.50

Presentation 3

A Student 1

09.50 – 10.10

Presentation 4

A Student 2

10.10 – 10.30

Discussion

Moderator

10.30 – 11.00

Feedback

Lecture

Student project 3 and 7 Presentation

Class room

Class room Date Class

room

Class room

Date

A6 B1 March 21st _{2016 A1 B6 March 22}nd ₂₀₁₆

A7 B2 March 21st _{2016 A2 B7 March 22}nd ₂₀₁₆

A8 B3 March 21st _{2016 A3 B8 March 22}nd ₂₀₁₆

A9 B4 March 21st _{2016 A4 B9 March 22}nd ₂₀₁₆

A10 B5 March 21st _{2016 A5 B10 March 22}nd ₂₀₁₆

~ MEETING OF STUDENT REPRESENTATIVES AND FACILITATORS

~

Meeting of student representatives and facilitators will be held on the 2nd _{of March 2016.}

This meeting will be organized by the planners and attended by lecturers, student group representatives and all facilitators. Meeting with the student representatives will take place at 12.00 until 12.15 pm and meeting with the facilitators at 12.15 until 12.30 pm. The purpose of the meeting is to evaluate the teaching learning process of the Block. Feedbacks and suggestions are welcome for improvement of the Block educational programs.

~ ASSESSMENT METHOD ~

Cognitive assessment will be carried out on Monday, 24th _{of March 2015. The test is a}

computer based test and will consist of 100 questions with 100 minutes provided for working. The assessment will be held at the same time for both Regular Class and English Class. SGD’s, role playing’s and student projects’s mark will be included in the final score as describe below. The overall passing score requirement is  70. More detailed information or any changes that may be needed will be acknowledged before the assessment.

Skill assessment will be carried out at the end of the semester using Objective Structured Clinical Examination (OSCE). The assessment will be based on Calgary Cambridge Observation Guide (CCOG) check list. The passing score requirement is  70.

SGD will be reviewed everyday by facilitator with a standard SGD assessment and it contributes 5 % to the final score. Student projects and role playing, as a sumative assessment account for 15% of the final score.

Lecture 1: Basic concepts of communication with patient and family

Lecture 2&3: Basic concepts of history taking & review of the systems

~ LEARNING PROGRAMS ~

Abstracts of Lectures

Prof. Dr. dr. Tjakra W. Manuaba

The lecture will begin with explanation of the definition, methods, and purposes of communication, especially as related to the field of medicine. By having a good communication with the patient, a doctor is more likely to: (1) make an accurate, comprehensive diagnosis of the patient’s problem (2) detect the patient’s emotional distress (3) have the patient more satisfied with the medical care and less anxious about his/her problem (4) have the patient agree and follow the advice given. Some studies have shown that patients preferred doctors who: (1) were warm and sympathetic (2) were easy to talk to (3) introduced themselves (4) were self-confident (5) listened to the patient and responded to their verbal cues (6) asked questions that are easily understood and were precise (7) did not repeat themselves. These basic communication skills of a doctor can be learned and retained, hence this topic of lecture.

The outcome of the doctor-patient communication is influenced by several factors, namely factors related to the patient, factors related to the doctor, and factors related to the environment. Factors related to the patient include physical symptoms, psychological conditions, and previous and current experiences of medical care. Factors related to the doctor include past training in communication skills, self-confidence in ability to communicate, personality, and physical and psychological conditions. The interview setting/environment requirements include privacy, comfortable surroundings and appropriate seating arrangement. General guidelines for conducting an interview with a patient are explained in detail, which include the beginning, main part, and end of the interview. The most basic skills of communication, which include the skill of questioning, listening, and facilitating the patient to tell more significant information, are explained. It is important to use open questions in most parts of the doctor-patient communication to obtain sufficient, clear and accurate information from the patient. Closed questions are used in certain specific situations such as in an emergency.

Dr Ratna Saraswati Determining the scope of assessment

When performing the history taking to the patient, at the first time we have to determine scope of the assessment, should it be comprehensive or focused. For patient who is coming at the first time in the office or hospital, usually we will choose to conduct the comprehensive assessment including all the element of health history. However in many situation, a more flexible focused or problem-oriented assessment is appropriate, particularly for patient you know well who are returning for routine office follow up care or patient with specific urgent care concern like chest pain or knee pain.

The history taking: comprehensive of focused?

Comprehensive Focused

Is appropriate for new patients in the office of hospital

Provides fundamental and personalized knowledge about the patient

Strengthens the clinician-patient relationship Helps identify or rule out physical causes related to patient concerns

Provide baselines for future assessments Creates platform for health promotion through education and counseling

Is appropriate for established patients, especially during routine or urgent care visits Addresses focused concerns or symptoms Assesses symptoms restricted to a specific body system

Table adapted from: Bickley LS, Szilagyi PG, 2009. Bates’ Guide to Physical Examination and History Taking, 10th _{edition. Lippincot William and Wilkins, Philadelphia.}

Most patients have specific worries or symptoms. The comprehensive examination including history taking will provide a more complete basis for assessing patient concerns and answering patient question. For the focused examination, the patient’s symptoms will lead us to a more specific history taking, and next will help us to be more focused during physical examination.

Components of the comprehensive adult health history

There are seven component of the comprehensive adult history taking:  Identifying data and source of the history

 Chief complaint (s)  Present illness  Past history  Family history

 Personal and social history  Review of the system

The review of the system may uncover problems that the patient has overlooked, particularly in area unrelated to the present illness. Some clinicians do the review of the system during the physical examination, for example: asking about ear as they examine them. If the patient has only few symptoms, this combination may be efficient, however in multiple problem, the flow of history taking and the examination may be disrupted.

Standard series of review of system question including the organ and system below:  general

 skin

 head, eyes, ears, nose, throat (HEENT)  neck

 breast  respiratory  cardiovascular  gastrointestinal  peripheral vascular  urinary

 genital

 muskuloskeletal  psychiatric  neurologic

Lecture 4: Skills in communicating with patients: Initiating the session and Gathering

the information

Lecture 5: Skills in Communicating with Patients: Building Relationship

 hematologic  endocrine

As you gain experience, the yes and no question at the end of the interview will take only several minutes.

Dr. Adiartha Griadi

Communication between doctor and patient is central to clinical practice. As a doctor, we will perform more than hundred thousand consultation in a professional lifetime. So we have to struglle to get it right. Communication is also a core clinical skill, an essential component of clinical competence. It is not an optional extra. Communication skills need to be thought and learned. By skills training there will be prize for us. It would be more effective consultation, improve health outcome, and a collaborative partnership.

There would be three broad types of skills in communication, content skills, process skills and perceptual skill. Those skills are inextricably linked and considered in unity. A content skill is the skill in determining the substance of questioning and responding to the patient. Process skill is the way we communicate and a perceptual skill is our internal decision making, clinical reasoning and problem solving.

We will emphasize the learning process in process and perceptual skill. Process skills will address two main issues, the structure of medical interview and individual skills needed.

There are teaching tools to provide structure and individual skills needed. There are numerous guides and check-list has been available, one of them is Calgary Cambridge Observation Guide (CCOG). As guidance, it has already made significant advances. It has structure which is more patient centered; provide us with the list of skills, and it also emphasis explanation and planning.

This guide will give us a simple five-point plan within which the individual skills are structured. This plan by intuitive and logical sense attempted to accomplish in everyday clinical practice. This structure was first proposed by Riccardi and Kurtz in 1983 and similar to that adopted by Cohen-Cole in 1991. The tasks are initiating the session, gathering information, building relationship, explanation and planning and closing the session. Each step will be expanded into expanded framework in which individual skills are structured. Medical interview is indeed very complex and cannot be summed up in a view broad generalization. However, it doesn’t need suggested that we have to employ each skills on every occasion. We have to tailor to the circumstance of the interview – they will not be used in every consultation. However, familiarity with all of the skill will undoubtedly be of benefit.

Lecture 7: Breaking bad news to patient and family Lecture 6: Skills in communicating with patients:

Explanation and planning, Closing the session Prof. Dr. dr. Mangku Karmaya

Every patient is a unique individual, relationship building with these unique individuals enables the patient to tell their story and explain their own concerns. It promotes adherence and help prevent misunderstanding or conflict. As an essential means in achieving all three goals of medical communication: accuracy, efficiency and supportiveness, relationship building is central to the success of every consultation. In building the relationship with the patient there are at least 3 points must be concerned: non-verbal communication, developing rapport, and involving the patient.

Dr. Ratnayanti

At some point, perhaps in the same interview or perhaps in a subsequent one, there will be a need to explain and discuss with the patient what has been found and what investigations and treatment are planned. It is important to remember that most treatment involves the cooperation of the patient. The way by which the information is given has been shown in a number of studies to have a major effect on the patient care. Certain skills are involved in giving information which doctor may not be aware of. Firstly, more is needed than simply telling what is wrong and what should be done. Secondly, it is often wrong to assume that patients are not capable of understanding explanation of their medical problem because of lack of knowledge. Thirdly, it is wrong to assume that patient will become anxious if the details of their problem and its management are explained to them. There is considerable evidence now that the majority of patients want to know what is wrong with them even if the news is not good.

Before giving information, try to find out what the patient already knows about his/her problem and its possible treatment. Give important information first using short words or short sentences and the information must be specific. Finally at the end of interview, ask the patient to summarize what has been agreed.

Prof. Dr. dr. Tjakra W Manuaba

In the practice of medicine, breaking bad news is often inevitable. Good patient’s cure or successful surgery on a benign tumor does not pose any problem to tell the patient or family, but to tell a patient that he/she has cancer or incurable disease is not easy. The patient’s expectation and the doctor’s finding of the disease may not always agree with each other, and on many occasions they may be contradictive. It is in such a difficult situation that the doctor most needs to communicate effectively and sensitively with the patient to reach similar understanding of the disease the patient suffers, and that they have to work together to deal with the problem. The need to build good doctor-patient relationship on one hand and the evidence of the disease on the other hand shape the main outcome of the doctor-patient communication. It may not be sufficient to have the relationship based on equality or partnership alone. In the case of Post Traumatic Stress Disorder (PTSD), in which

Lecture 8: Communication with patient from different cultural backgrounds

Lecture 9: Specific communication approach in psychiatry

psychological disorder develops in the patient/ family or even the doctor, the communication outcome of both sides may be decreased significantly.

Most studies on communication concerning imparting “bad news” have been focused on how the patients or their families should cope with the particular bad news, but not on the “process” or “techniques” of doctors on how to break the bad news. To some doctors who are gifted with good personality and stable emotion, communication is natural, but to most other doctors effective communication has to be taught and practiced continuously. Communication skills, therefore, must be taught in all levels of medical training.

To break bad news properly needs several stages, starting with conditioning and building a good rapport with the patient and family. This communication must involve honesty, truth, empathy & sympathy, openness, collaboration to be effective and sensitive. To break bad news the doctor should plan and summarize the news to convey. Doctors have to set the un-interrupted agenda in a good physical atmosphere (privacy, comforting room) and tell the patient or family the truth in an easy language. How much the patient or the family should know is another thing to consider and plan. Who should be told first, the patient, the spouse, or the family? Although medicine is universal and crosses beyond cultural boundaries, different medical cultures do exist and the proper way of how doctors should impart the bad news is different from culture to culture. On observing the human rights, it is the patient who should know the news first before others. Telling bad news should be direct, but the doctor must be able to consider the verbal and non verbal reactions of the patient and family, and judge how much to tell at one session to avoid violation or medical law sue. Telling bad news indirectly or postponing it might create a bigger problem later on.

Dr. dr. Diah Pradnya Paramita Duarsa

It is important to allow the patient to explain their cultural backgrounds, values, beliefs and expectations when these may be relevant to the consultation. Heightened awareness of the cultural issues can help you make a more accurate assessment of the patient's behavior, improve your professional relationship with the patient, and decide proper treatment.

The doctor needs to accept other people's cultural and racial ideas as different, but equally important. Important issues can be overlooked if either the doctor or the patient fear misunderstanding and rejection of cultural values.

The patients may be part of a particular culture, but they will have adopted some aspects of it and rejected others. The doctor must carefully assess each patient's individual and cultural needs before deciding on an appropriate treatment.

Matching patient and doctor according to race or culture is not always helpful.

Dr. Lely Setyawati

To be an effective clinician in any field, a physician must understand both the science and the art of medicine. With all of the technological advances in medicine, successful care giving still relies on the very basic, and deceptively simple, relationship between doctor and patient. Such relationship cannot be achieved without good

Lecture 10: Specific communication approach to obstetric patient

communication between practitioner and patient and may not matter how sophisticated the available treatments are.

In one survey of 700 patients, patients substantially agreed that many physicians do not have the time or inclination to listen and consider their feelings, that physicians do not have enough knowledge of the emotional problems and socioeconomic background of their families, and that physicians increase their fear by giving explanations in technical language.

The quality of patient doctor or patient therapist relationship is crucial to the practice of medicine. The capacity to develop an effective relationship requires a solid appreciation of the complexities of human behavior and a rigorous education in the techniques of talking and listening to people. To diagnose, manage, and treat an ill person, doctors and therapists must learn to listen. They need the skills of active listening, which means listening both to what they and the patient are saying and to the undercurrents of the unspoken feelings between them.

An effective relationship is characterized by good rapport. Rapport is the spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic alliance. It implies an understanding and trust between the doctor and the patient. Frequently, the doctor is the only person to whom the patients can talk about things that they cannot tell anyone else. Most patients trust their doctors to keep secrets, and this confidence must not be betrayed. Patients who feel that someone knows them, understands them, and accepts them find that a source of strength. In his essay, Caring for the Patient, Francis Peabody, M.D. (1881-1927), a talented teacher and clinician, wrote: The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

Different patient types and special situations are discussed in this topic, for example how we communicate and show empathy to a sad or weeping patients, silent, quite, angry, aggression, and dispute each others.

dr. Hariyasa Sanjaya

Effective communication is the key to successful provision of health services to patients. Communication involved verbal communication, physical contact as well as emotion presentation and impression.Good communication will result in trust of the patients and this will make it easier for the doctors to explore the patients’ history, do physical examination etc to reach appropriate diagnosis. In many instances, patients go to the doctor to discuss sexual problem or suffered from a sexual-related disease. Discussing about sexual problem is not easy to some patient. Special skills are required for soliciting a sexual history from a patient. Basically and ethically, no discrimination should be made in health services provision, but in to some extent exception is given to female patients. Obstetric and gynecologic patients are women, and thus should be treated differently. Women are unique in the sense that they have special characteristics and behaviors needing special

Lecture 11: Communication with pediatric patient and parent

approaches when dealing with them. Commonly all patients will expect respect, courtesy and privacy assurance from the doctors.

The following are conditions in female patients that should be considered by doctors before taking history, doing physical examination and giving treatment. In the eastern culture, women are more shy, more closed and tend to have sensitive feeling

 There are common assumptions and misconceptions about sexuality.

 In the eastern culture women are more shy, more closed and tend to have sensitive feeling

 Most women do not tolerate harsh or rude approach, so these should be avoided in obstetrics and gynecology, in which examination is focused on the genital organ that is most sensitive for women

 Pelvic examination tends to often cause hurt or pain sensation

 In examining pregnant woman, it should be taken into account that there is also a fetus as the second patient

 In certain condition, the complaints of the female patients may be expressed by body language and therefore the doctor should be able to “catch” the signals.

 The examination room should be organized to fulfill the standard requirements for examining women (closed or semi-closed to maintain privacy).

Dr. Siadi Purniti

The therapeutic relationship is achieved in a large measure during the doctor-patient interview. Rapport building, engaging with the patient, eliciting psychosocial and personal aspects of the patient’s experiences, supporting the parents in their roles as the child’s guardians, and involving the child, grandparent(s) and other significant individuals are the most important parts of the approach in dealing with the child patient. All of these are essential to establish a therapeutic relationship.

There are some basic factors that virtually can always strengthen the therapeutic relationship: greeting, introducing one’s self and set the agenda jointly with the parent, listening, facilitating the interview, using common courtesy, talking with the child, dealing with acute illnesses appropriately, redirecting the interview, counseling and reassurance, and closure.

Even the most intentioned and highly skilled clinicians may experience communication barriers with children because of limitations in children’s abilities to understand information and the clinician’s difficulty in communicating information at the approach of developmental level. The primary goal of open communication in the pediatric visit is to establish therapeutic alliance both with children and parents. The benefits of such therapeutic alliance have been well documented.

Lecturer 12: Writing letters, notes, and CV

Lecturer 13 & 14: Basic concepts of scientific writing

Dr. Yuliana

Physicians almost often deal with writing notes and letters. There are two kinds of letters: formal/business and private letters. In the medical profession/practice there are several kinds of formal letters, for example: referral letter, accompanying or covering letter, letter of introduction, notes on one’s being fit for employment and notes on one’s being unfit for duty or requiring hospitalization. In letter writing there is basic rules/formats that should be considered although they are not very strict rules. There may be differences between British and American practice and traditional and modern practice of letter writing. Generally, the guidelines for letter writing relate to writing name of the sender and addressee, address on the envelope and letter; date, greeting, main content and letter ending. Although there are many styles, the main principle of writing business letter is to write clearly, simply, and briefly. The principle of writing Curriculum Vitae or “resume”, which is a summary or outline of educational and professional background and personal information, will also be taught to students. It should contain the essential details such as name, address (personal and work), telephone number, date of birth, professional interests, current position/employment, educational background, professional experience, publication in journals, bulletins etc and papers delivered at conferences. The layout of curriculum vitae is not strict but there may be certain personal information needed when applying for a post.

Prof. Dr. dr. Raka Widiana

Until recently, scientific writing especially aiming for publication has been a much– neglected subject in Indonesian medical education and studies have shown that such high-level intellectual skills cannot be achieved overnight or in a fixed time period and the instruction should go deeper than mere instruction in English as a foreign language. Our new curriculum has taken a new initiative to overcome at least the ‘cognitive burden’ of scientific writing, a common problem for novice.

The course of scientific writing is divided into 2 parts: foundational or general consolidation English and essentials of writing biomedical papers. The foundational English will deal with highlighting the problems of accumulating a working vocabulary, common errors in English and word choice in academic writing. The second part of the course will focus on problems related to plagiarism, expressions to avoid, constructing effective sentences, deductive paragraphs, the basic principles of writing a biomedical research papers aiming to achieve a clear and coherent biomedical communication and the general anatomy of biomedical research paper.

Learning activities designed to strengthen the acquisition of the general knowledge and skills of scientific writing include 2 lectures, independent learning and exercises, facilitated small group learning, plenary sessions and feedbacks, self assessments and student project report. Summative assessment based on the defined learning outcomes will be conducted at the end of the curriculum block on medical communication scheduled for November 8, 2010.

Lecture 16: Communication in health promotion and education

Lecture 15 : Presentation & discussion in scientific meeting

Prof. Dr. dr. Adiatmika

By the end of this course, the students are expected to be able to make a good paper presentation in a scientific meeting. They are expected to be able to collect necessary information and references to organize the paper. They should also be able to develop the appropriate audio visual aids to support the presentation and know the necessary steps of a good presentation. These steps include opening remarks, entering the main section, summarizing, closing and thanking the audience. They should also be familiar with statements or expressions commonly used in an informal conversation following the presentation.

Dr. Oka Negara

The topic deals with problems related to health communication in Health Promotion and Health Education covering some principles of imparting health related information to the community at large. The principles include cultural characteristics of the audience, such as level education, gender, beliefs, tradition, socio-economic status etc. This will be enforced by examples in the real-world settings. The examples include the importance of preparing the content of the talk in a languange easly understood by common people. It should not consist of seemingly scientific jargons that are not familiar by the community. The procedure of imparting the information should always be kept simple.

The whole activities will be preceeded by a general introductory lecture. The lecture consist of some aspects of Health Promotion and Health education such as it’s definition, factors affecting health status, health behavior, decision making process, theories of behavior changes. It also includes some communication media and method that are commonly used in delivering information to the community. At the end of the course the students are expected to be able to apply those principles and theories in their practice.

LEARNING TASKS

Prof. Dr. dr. Tjakra W Manuaba Case

:

Dr Made is a 54-year-old experienced orthopedic surgeon. He is regarded by his colleagues as having excellent technical skills. For most of his 20-year career, he has been rewarded for his successful surgical outcomes and high productivity. Surprisingly, his patients’ satisfaction score is not as highly as he has assumed so far. More recently, he has been told to improve his patient satisfaction scores and too many of his patients complained and said that he is too much in a rush, businesslike, and doesn’t listen to his patients.

Learning Task:

1. In your opinion, what has caused the low patients’ satisfaction regardless of dr. Made’s excellent expertise?

2. What are the purposes of communicating in general? How do you relate them with the context of doctor-patient interview?

3. In your opinion, is it necessary or not necessary to study communication skills in your medical education? Explain your answer clearly!

4. What is the most suitable seating arrangement for a doctor-patient interview? Explain why.

5. It is said that to have a good beginning of the interview with patient will give a profound effect on the good outcome of the interview. How do you make such a good beginning of the interview?

6. Why do you use open questions in most part, especially at the beginning, of the interview with the patient? Give examples of open questions!

7. Discuss about all the key elements of listening skills and give examples of various ways to prove that you are listening attentatively to your patient!

8. Explain about the most important things to do at the beginning, main part, and end of the interview with the patent!

9. How can family of the patient help in the diagnosis and care of the patient’s problem?

Day 1

Basic concepts of communication with patient and family

Dr Ratna Saraswati

1. When performing history taking of your patient, how would you determine the scope of your question?

2. What kind of relevant personal data that you need to identify your patient at the first time?

3. Give examples of chief complaint (try to have different one for each student) 4. Identify the information that you need to ask from your patient, regarding:

a. the present illness b. the patient past history c. the family history

d. the personal and social history

Dr Ratna Saraswati

1. List some problem that you need to ask while reviewing of each system below: a. general

b. skin

c. head, eyes, ears, nose, throat (HEENT) d. neck

e. breast f. respiratory g. cardiovascular h. gastrointestinal i. peripheral vascular j. urinary

k. genital

l. muskuloskeletal m. psychiatric n. neurologic o. hematologic p. endocrine

2. Formulate some question asking the listed above problem.

Udayana University Faculty of Medicine, DME 25

Day 2

Basic concepts of history taking

Day 3

Review of The Systems

Day 4

Skills in communicating with patients: Initiating the session

Dr. Adiartha Griadhi dr. Adiartha Griadhi Scenario

Wawan, a medical student, just returned home from a private doctor because he had a bad cold since yesterday. This was his first visit to that doctor, because he had just moved to Denpasar 1 week ago. Having been arrived at home, he wondered about few things happened during his consultation with the doctor. He had doubt about who really was the doctor. In the sign it said that it was dr. Bambang practice, but the name in the doctor id tag is dr. Krisna. At that time he felt hesitate to ask, because the doctor only smiled a little and looked rush. Once in a while, the doctor looked at his watch and checked his cell phone. The doctor also did not greet and seemed to be distracted while examining him. He expected he could get better medical service than he had got earlier.

Learnig Task :

1. Mention the steps in anamnesis! In the scenario, which step is not properly carried out by the doctor? Explain!

2. In the Initiating the Session there are several components should be done. Mention those components!

3. Give example of expression used in each of the components in question number 2! Scenario

Wawan then visited another doctor two days later because his complaint was not relieved. He went to dr. Sagita which practice about 2 blocks away from the first doctor. The doctor was friendly and appealing. The consultation also went well. But unfortunately she dominated the conversation. Several times Wawan wanted to explain his complaint in detail, but he hardly had chance to speak or cut the doctor’s words. He was sprayed with questions by the doctor such as what is the problem? Since when? Is he has stuffy nose? Did he take any medication? And other questions. Everything was asked so quickly and he felt just like filling out a questionnaire.

Learning Task

1. In above scenario which step is not properly carried outby the doctor?

2. In gathering information there are several components should be done. Mention those components!

3. Give example of expression of each component in gathering information!

4. In gathering information section, there are several key steps which differentiate patient centered interview with doctor centered interview consultation. Mention the key steps!

ROLE PLAY

General Instruction

1) Prepare the role play session; the role play is preferable in Bahasa. One student play as the doctor, the other as a patient and an observer. Use the scenario or case provided for this role play session. The tutor will observe the role play.

a. The doctor have to initiate the session

b. The observer and tutor observe and prepare the feedback based on Calgary Cambridge Observation Guide (CCOG).

2) After the role play :

b. The patient, observer, and facilitator then give their constructive feedback on the doctor performance.

c. The tutor will write down the feedback given on Worksheet.

3) Then switch the role for the next role play session. Each student should be experienced as the doctor in this role play session.

Role Play : Initiating The Session

In this opening we make our first impression, begin to establish rapport and attempt to identify the problems that the patient wishes to discuss. Doctors tend to underestimate the potential and opportunities of these brief first minutes. The objectives of this first step are to establish a good relationship and identify as far as possible the problems that the patient has come to discuss. But research evidence showed that almost half of the patient complaint was not elicit, and doctors frequently interrupt patient opening statement so soon, and in half of visits, patient and doctor did not agreed on the nature of the problems presented. There are three individual skills identified for this step, such as preparation, establishing initial rapport, and identifying the reason (s) for the consultation. Each skill will consist of a new phrases or such behaviour so we should be familiarized with those things. Scenario

You are a clerk in the internal medicine outpatient clinic of Sanglah Hospital. You are under dr. Bambang, Sp.PD supervision and your duty is to record the history taking and physical examination result in the outpatient clinic. Today, you are asked to help taking history because there are plenty of patients come to the clinic. The Patient is a man complaining fever since three days ago. The fever is high and has not been decreasing ever since. Based on the job description, you should do the history taking and then report to your supervisor

.

Role Play : Gathering Information

Clinical studies have shown that the history contributes 60 – 80 % of the data for diagnosis. The story alone was sufficient to make the diagnosis in 66 of 80 patients. Yet the way that many doctors have been taught to take a history in medical school can lead to inaccuracy and inefficiency. Traditional questioning methods do not encourage comprehensive history taking, it concentrated on pathological disease at the expense of understanding the highly individual needs of each patient.

Research have shown this approach discourage patient to tell their story or voicing their concern. Unfortunately, the traditional method of history taking is so firmly established in medical practice that it is easy to assume that it is the correct approach. This approach only concentrated on the individual parts of the body that are malfunctioning and is honed this process down to a cellular and now molecular level. The patient’s individual concerns are brushed aside to support the function of their organ. It doesn’t try to understand the meaning of the illness for the patient or place it in the context of his life or his family. Subjective matters such as beliefs, anxieties, and concern are not the remit of traditional approach. Recently, the students are taught to concentrate only on the underlying disease mechanism and thereby avoid the patient’s perception and feelings.

The disease illness model is a new approach in medical interview, developed by McWhinney in 1989. He also called this approach as transformed clinical methods, to replace traditional method of history taking. This model encourages doctors to consider both the doctor’s and the patient’s perspectives and agenda in each interview. It also provides a practical way of using patient centered interview in everyday clinical practice. Research has shown that this approach gives several advantages. It proved that discovering patient’s perspective can aid diagnosis and make more effective and efficient interviews, it might become groundwork for explanation and planning.

Scenario

This week you are assigned in Wangaya Hospital for one week and your task is to examine patients with persistent coughing and suspected to suffer tuberculosis (TBC). You are asked to examine one patient in the outpatient clinic. The patient is a 60 year-old man. He can not speak Bahasa very well, he is more fluent in speaking Balinese language. He complains about persistent coughing with pleghm and sometimes the pleghm is mixed with blood. His general appearance shows that he comes from lower social economic class.

Dr. Mangku Karmaya Cases:

1. “Good afternoon Doc”. “Good afternoon Mam”, answered a doctor to his patient. The patient was a little bit impressed by the neat, good looking doctor. More over, when the doctor smiled to her, it almost made her forgot about her illness, a lump on her right breast. Checked on his watch once in a while, the doctor asked the patient; “Please sit down. Is there anything i can do for you?. After she comfortly sat, the doctor continued; “Please mam, you can tell me all your complaint and i will write it all down!”. Then the patient began to talk, she told everything about her illness and it went quiet fluent. The doctor looked so punctilious, wrote down every single word said by his patient. Once in a while he looked at his watch and then looked back to her, but still, kept his smile on. “Are you finish? Is there anything else? If not, i’m going check on few things. Would you lay on the examination bed, please!

2. After the examination, the doctor and patient sat back to their sit. How is it doc? How is my condition? The doctor kept silent for a while. He frowned his forehead and laid his head back then took a deep breath. He took a very thick book and opened the page in a hurry...

3. At the end, the doctor wrote a prescription. He still checked his watch once in while. “Mam, don’t worry about it. Here is the prescription, you can get the drug at the pharmacy. Take it as instructed. If something happen regarding your illness, you can contact me at this phone number”. Said the doctor while giving his bussinesscard.... Questions:

1. What are your impressions in general to situation (1), (2) and(3)? 2. Try to criticize thoroughly about:

a. non-verbal communication and its meaning in those situations b. the accepting response of the doctor to his patient

c. the empathy of the doctor d. the doctor’s support

e. the involvement of the patient ROLE PLAY : BUILDING RELATIONSHIP

Building the relationship runs in parallel to the other task of the interview. This task is easily taken for granted or forgotten, but this task is an essential means of achieving all three

Day 5

Skills in communicating with patients: Building relationship

goals of medical communication: accuracy, efficiency and supportiveness. Relationship building enables the patients to tell their story and explain their own concerns, it also promote adherence and helps prevent misunderstanding and conflict. Forging a relationship with the patient is central to the success of every consultation whatever the context. Patients wish their doctor to be competent and knowledgeable but also they need to be able to relate to their doctor, to feel understood and to be supported through adversity.

There are reports of patient dissatisfaction with the doctor-patient relationship. Many articles in the media comment on doctor’s lack of understanding of the patient as a person with individual concern and wishes. Relationship problems have featured highly as predictors of poor outcome and identified as one of the most important variable related to poor level of patient satisfaction and compliance. Individual skills for building the relationship are skills in nonverbal communication; developing rapport, such as accepting response, empathy, sensitivity, support; and involving the patient, such as sharing of thought, and providing rationale.

Scenario

You are now working in a private foundation that serves the high risk population for HIV/AIDS, especially the injection drug users. Your job is to take history and give explanation about the disease. Today, a 27 year-old male patient comes. He had been tested for the HIV and now brings his laboratory result. Now you are given the test result and ought to explain the test result to the patient. Please do a role play to explain the laboratory result to the patient which stated that he is infected by the HIV.

Dr. Ratnayanti Learning Task

Case

A male patient, Gede, 58 yo complained of flank pain and nausea. After the clinical radiography and laboratory investigation he was found to suffer from hydronephrosis due to ureter stone. The doctor also suspected he had hepatoma (liver malignancy). At that moment the doctor only gave supportive therapy and suggest further investigation for hepatoma; The doctor also planned a surgical procedure to remove the stone if the condition of patient permitted. The patient complained mostly about the flank pain and wished to get the surgery to be done as soon as possible. But, after several weeks the surgery had not been scheduled, in the mean time, patient condition was getting worse. The patient’s family then complained to the doctor and hospital because they think the patient is neglected for not being scheduled for the surgery. They suspected the doctor/hospital treat them so because they were supported by government health insurance for poor people and unable to pay for the expensive procedure.

1. Please discuss about the reason of patient and family dissatisfaction to the doctor/hospital service regardless administration and facilities aspect!

2. Please discuss about the use of medical term during explanation and planning to the patient and family!

Day 6

Skills in communicating with patients: Explanation and planning,

3. Please discuss about the role of doctor and patient/family for in healthcare decision making!

4. Please discuss about the principles in giving informed consent!

Case

Kocong, 15 yo boy, had been referred to the central public hospital with Steven Johnson Syndrome. He developed painful, massive bulae all over his skin after injection of antibiotic by a doctor in the private practice. The parents of the boy planned to sue the doctor because they believed there was malpractice in his son case.

5. What did the doctor missed to do during the management of the patient on the case above?

6. Please discuss and give example of contracting in closing the session part of anamnesis.

ROLE PLAY : GIVING INFORMATION AND EXPLANATION; CLOSING THE SESSION Many of teaching programs tend to neglect or underplay this vital stage of consultation. They usually concentrate on the first half of the interview, gathering information stage. Yet explanation and planning are of utmost importance to a successful consultation. There is a little point in being able to discover what the patient wishes to discuss, in taking a good history and in being highly knowledgeable if you cannot make a joint management plan that the patient understands, feel comfortable with and is prepared to adhere to. If the first half of the consultation represents the foundations of medical communication, explanation and planning is the roof.

It demonstrated that internist devoted little more than one minutes on average to the task of information giving in interviews lasting than 20 minutes and over-estimated the amount of time that they spent on this task by factor of nine. Study in British general practice, showed that patient placed the highest value on information about diagnosis, prognosis and causation of their condition. Doctors, however, greatly underestimated their patient’s desire for information about prognosis and causation and overestimated their desire for information concerning treatment and drug therapy. Patient’s individual information needs were not elicited. Many studies show that doctors usually use language that patients do not understand. It is clear that patient do not recall all difficult information, they only recall 50 – 60 % of information given by the doctors.

In the beginning of communication skills program, student should focus on several aspects of explanation and planning. These aspects are giving explanation at appropriate time; organize explanation; appropriate language; checking patient’s understanding of information given.

After all we come to the end part, closing the session. Summarizing the session briefly and clarifying the plan can act as a highly valuable facilitative tool for the doctor and patient. Summarizing is an important aid to accuracy and hence to adherence. Remember always to leave space for the patient to make correction or addition. The doctors should give end summary, summarize session briefly and clarifies plan of care; and contracting, contract with patient the next steps for the patient and physician.

Scenario

Today, you are substituting dr. Romeo in a private clinic in Jalan Sudirman. A patient comes to the clinic in the afternoon. He is a 45 year-old man and he complains about head ache. He feels headache most of the time and it feels like he carries a heavy burden on his shoulder. And today he felt very weak and almost fainted, so then his wife forced him to go

12. EXPLORES CONCERNS (including worries, effects on lifestyle) regarding each problem

13. DETERMINE PATIENT’S EXPECTATIONS regarding each problem

14. ENCOURAGES EXPRESSION OF FEELING AND THOUGHT

15. SUMMARIZES AT THE END OF A SPECIFIC LINE OF INQUIRY to verify own interpretation of what patient has said, to ensure no important data were omitted

16. PROGRESSES, USING TRANSLATON STATEMENTS; includes rationale for next session

17. STRUCTURE interview in LOGICAL SEQUENCE

BUILDING RELATIONSHIP

18. USING APPROPRIATE NON-VERBAL BEHAVIOUR Demonstrates appropriate non–verbal behaviour:

If reads, writes notes or uses computer: Demonstrates appropriate confidence: 19. DEVELOPING RAPPORT

Accepts legitimacy of patient’s views and feelings; is not judgmental:

Uses empathy, acknowledges patient's views and feelings:

Provides support:

Deals sensitively:

20. INVOLVING THE PATIENT Shares thinking:

Explains rationale :

During physical examination, explains process, asks permission:

EXPLANATION AND PLANNING

21. PROVIDING THE CORRECT AMOUNT AND TYPE OF INFORMATION Chunks and checks:

Asks patients what other information would be helpful:

Gives explanation at appropriate times:

22. AIDING ACCURATE RECALL AND UNDERSTANDING Organises explanation:

Uses explicit categorisation or signposting:

Uses repetition and summarising:

Uses concise, easily understood language:

Uses visual methods of conveying information:

Checks patient’s understanding:

23. ACHIEVING A SHARED UNDERSTANDING: INCORPORATING THE PATIENT’S PERSPECTIVE Relates explanations to patient’s illness framework:

Provides opportunities and encourages patient to contribute:

Picks up verbal and non-verbal cues:

Elicits patient's beliefs, reactions and feelings:

24. PLANNING: SHARED DECISION MAKING Shares own thinking as appropriate:

Involves patient:

Encourages patient to contribute their thoughts:

Negotiates plan:

Offers choices:

Checks with patient if accepts plans, if concerns have been addressed:

CLOSING THE SESSION 25. FORWARD PLANNING Contracts with patient:

26. ENSURING APPROPRIATE POINT OF CLOSURE Summarises session:

Final check:

References:

Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford)

Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)

Smstr Program or curriculum blocks

10 Senior Clerkship

9 Senior Clerkship

8 Senior Clerkship

7

Health System-based Practice

(3 weeks) BCS (1 weeks)

Community-based practice (4 weeks) Evidence-based Medical Practice (2 weeks) Special topics : Health Ergonomic & Health Environment (2 weeks)

Elective Study IV (evaluation) (3 weeks) Comprehensi ve Clinic Orientation (Clerkship) + medical ethic (4 weeks) 19 weeks 6 The Cardiovascular System and Disorders (3 weeks) BCS (1 weeks)

Medical Emergency (3 weeks) BCS (1 weeks)

The Urinary System and Disorders (3 weeks) BCS (1 weeks)

The Reproductive System and Disorders (4 weeks)

BCS (1 weeks)

Elective Study III (3 weeks)

19 weeks

5 Neuroscience andneurological disorders (3 weeks) BCS (1 weeks)

The Respiratory System and Disorders (4 weeks) BCS (1 weeks)

The skin & hearing system

& disorders (3 weeks) BCS (1 weeks)

Special Topic : - Palliative med - Complemnt & Alternative Med. - Forensic (3 weeks) Elective Study II (2 weeks) 18 weeks 4 Musculoskeletal system & connective tissue disorders (3 weeks) BCS (1 weeks)

Alimentary

& hepatobiliary systems & disorders

(3 Weeks) BCS (1 weeks)

The Endocrine System, Metabolism and Disorders (4 weeks) BCS (1 weeks)

Clinical Nutrition and Disorders

(2 weeks) BCS (1 weeks)

The Visual system & disorders (2 weeks) BCS (1weeks) 19 weeks

3 Basic microbiology & parasitology (3 weeks)

Basic Infection & infectious diseases

(3 weeks) BCS (1 weeks)

Immune system & disorders (2 weeks) BCS (1 weeks)

Hematologic system & disorder & clinical oncology (3 weeks) BCS (1 weeks)

Special Topic - sexology & anti aging - Geriatri -Travel medicine (4 weeks) Basic Pharmaceutica l medicine & drug etics (1 weeks) 19 weeks 2 Medical communication (3 weeks)

Basic pharmacology (2 weeks)

BCS (1 weeks)

Medical Professionalism

(2 weeks) + medical ethic (1 weeks) Basic Anatomy Pathology & Clinical pathology (3 weeks) BCS (1 weeks)

Behavior Change and disorders

(3 weeks)

BCS (1 weeks)

Elective Study I

(2 weeks) 19 weeks

1 Studium Generale and Humaniora (2 weeks) Basic Anatomy

( 4 weeks)

The cell as bioche-mical machinery (2 weeks) Basic Histology

(2 weeks) &

Basic Physiology (3 weeks) BCS (1 weeks) Growth & developme nt (2 weeks) Basic Biochemist ry

(2 weeks) BCS (1 weeks)

19 weeks

Pendidikan Pancasila & Kewarganegaraan ( 3 weeks ) Inter Professional Education (smt 3-7)

~ REFERENCES ~

1. Desmond J, Copeland LR; Communicating with Today’s Patients; Jossey-Bass; 2000

2. Llyod M, Bor R; Communication Skills for Medicine; Churchill Livingstone; 1996 3. Maher JC; International Medical Communication in English; The University of

Michigan Press; 2004

4. Parkinson J; A Manual of English for the Overseas Doctor. 5th _{Edition, Churchill}

Livingstone; 1999

5. Bickley LS, Szilagyi PG, Bates’ Guide to Physical Examination and History Taking, 10th _{edition. Lippincot William and Wilkins, Philadelphia; 2009.}

6. Ganiovor L, Porter RE; Communication Between Cultures; Wadsworth Publishing Company; 1995

7. Eleftheriadou Z; Transcultural Counselling; London: Central Book Publishing; 1994 8. Kleinman A; Patients and Healers in the Context Of Culture; Berkeley: University of

California Press; 1980

9. Brislin RW, Yoshida T, eds; Improving Intrecultural Interactions: Modules for Cross Cultural Training Program; London: Sage; 1994

10. Silverman J, Kurtz S, Draper J; Skills in Communicating with Patients; The University of Michigan Press; 2000

11. Behrens L, Rosen LJ, Beedles B; A Sequence for Academic Writing. New York: Longman, 2002

12. Zeiger M; Essentials of Writing Biomedical Research Papers, 2nd _{ed. New York:}

McGraw-Hill, 2000

13. Goodmann N W, Edwards M B; Medical Writing: a Prescription for Clarity; 2nd _ed.

Cambridge University Press.

14. Korsch B; Talking with Parents (Resource Unknown)

15. Bernzweig J, Pantell R, Lewis CC; Talking with Children (Resource Unknown) 16. Soetjiningsih; Teknik Berkomunikasi dengan Orangtua Pasien (Unpublished) 17. Soetjiningsih; Teknik Berkomunikasi dengan Anak (Unpublished)

18. DeCherney AH, Nathan L; Current Obstetric and Gynecologic Diagnostic and Treatment, 9th _{ed. Boston: McGrawHill; 2003}

19. Berek J S; Novak’s Gynecology, 13th _{ed. Los Angeles: Lippincott Williams & Wilkins;}

2002

20. Sadock B J and Sadock V A; Kaplan and Sadocks’s Synopsis of Psychiatry 10th _ed.

Lippincott Williams & Wilkins, Philadelphia, 2007