Medicine: A Competency-Based Companion E-Book , livre ebook

MEDICINE: A Competency-Based Companion

Jessica L. Israel MD
Chief, Division of Geriatrics and Palliative Medicine Medical Director, Inpatient Hospice Unit Monmouth Medical Center Long Branch, New Jersey Clinical Associate Professor of Medicine Drexel University College of Medicine Philadelphia, Pennsylvania
Allan R. Tunkel MD, PhD, MACP
Chair, Department of Internal Medicine Monmouth Medical Center Long Branch, New Jersey Professor of Medicine Drexel University College of Medicine Philadelphia, Pennsylvania
Series Editor:
Barry D. Mann MD
Chief Academic Officer Main Line Health System Wynnewood, Pennsylvania
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
MEDICINE: A COMPETENCY-BASED COMPANION ISBN: 978-1-4160-5351-4
Copyright 2013 by Saunders, an imprint of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Permission is hereby granted to reproduce the Competency Self-Assessment Form in this publication in complete pages, with the copyright notice, for instructional use and not for resale.

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
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Library of Congress Cataloging-in-Publication Data
Medicine : a competency-based companion / [edited by] Jessica L. Israel, Allan R. Tunkel.-1st ed.
p. ; cm.-(Competency based companion)
Includes bibliographical references and index.
ISBN 978-1-4160-5351-4 (pbk. : alk. paper)
I. Israel, Jessica L. II. Tunkel, Allan R. III. Series: Competency-based companion.
[DNLM: 1. Internal Medicine-methods-Case Reports. 2. Clinical Competence-Case Reports. 3. Patient Care-Case Reports. WB 115]
LC classification not assigned
616-dc23
2012001434
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Foreword
What constitutes an effective clinician?
Medical schools recognize the importance of defining the qualities, knowledge, and skills their graduates must achieve by graduation. Educators realize that to become effective clinicians, students must achieve a variety of competencies; all the organizations that regulate medical education have adopted competency language. The Accreditation Council for Graduate Medical Education (ACGME) has articulated six general competencies that residency programs must teach and assess, and many medical schools have been influenced by this framework. These competencies are:
1. Patient Care. Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Medical Knowledge. Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care.
3. Practice-Based Learning and Improvement. Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
4. Interpersonal and Communication Skills. Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
5. Professionalism. Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
6. Systems-Based Practice. Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. *
There is a problem, though. Over the years, medical education has proved most successful in teaching knowledge and technical skills and less successful in teaching and assessing competencies, such as skills in medical interviewing, behavioral change counseling, advanced communication (such as giving bad news), and clinical reasoning. Medical curricula often put too little emphasis on practice-based learning and improvement and on systems-based practice. Critical aspects of professionalism, such as maintaining altruism, integrity, and respect for patients, may be undermined by the hidden curriculum imparted by negative role models and the lack of adequate mentorship. The stresses of ward routines and sick and dying patients challenge values and emotions. Often there is little time or no appropriate venue for fruitful reflection and discussion. Because you use yourself as an instrument of diagnosis and therapy, you must know how your own attitudes, values, and biases may influence your clinical decisions. You must have balance and equanimity in your life so that you can be emotionally available and truly present for your patients. To do all this, you must develop into a reflective practitioner, always assessing your actions and thoughts in the light of the ideals of care you want to achieve. If you are to become a physician who can cure disease while healing illness, you must pay attention to multiple dimensions of learning.
The editors and authors of this book have done us all a great service in directing us to think about clinical problem solving in the context of the six competencies, which is necessary to provide the best patient care. When you care for a patient, you work to take an excellent history that helps you understand the factors in the patient s personal history and social context that have contributed to the illness; you perform a skillful physical examination; you create a robust differential diagnosis and work it through in your mind with the help of appropriate testing; you communicate with the patient and family members; you talk with consultants; you work within a multidisciplinary team to ensure coordination and continuity of care; you treat your patient with compassion and respect; you think about your decisions and make mid-course corrections; and you advocate for your patient with insurance companies and others involved in care.
In this gem of a book, the authors guide you in thinking in multiple dimensions of learning that are available in caring for every one of your patients. If you can learn to think in this multidimensional way, and intentionally work on enhancing multiple competencies, you will grow as an individual and as a professional. You will become an effective clinician who will be an asset to your patients and a credit to our profession.
Dennis H. Novack MD
Professor of Medicine Associate Dean of Medical Education Drexel University College of Medicine
* From ACGME Competency definitions: Used with permission of Accreditation Counsel for Graduate Medical Education ACGME 2011. Please see the ACGME website: www.acgme.org for the most current version.
Series Preface
When the Accreditation Council for Graduate Medical Education (ACGME) initiated the six competency categories a decade ago, it was left to the discretion of individual program directors to define and develop competency content and then to evaluate the ability of each trainee to achieve the competency. Elsevier s Competency-Based Companion Series represents the publisher s goal of demonstrating that the ACGME competencies are indeed important components of what makes the art and science of doctoring a multidimensional profession. I congratulate Elsevier for fostering the concept of exploring the