Week 4:
Core Content: Dimensions of Quality
❏ Why is Quality important?
Quality is a highly important factor across all aspects of the healthcare delivery system. The standard of quality in one area has a ripple effect on the standard of quality in other areas. Whilst there are costs associated with quality, the costs incurred because of non-conformance to quality can be extensive. As a result, poor quality care can be expensive and have implications for patients, institutions and broader societal and economic conditions.
Health institutions may experience unnecessary laboratory tests, overburdened resources and low staff morale.
Due to poor quality and poor patient experiences, patients may choose not to adhere to treatment. Poor quality can lead to other factors such as an incorrect diagnosis, which can lead to prescribing ineffective treatment and result in repeated visits to health centres, or a prolonged illness, and even death. ❏ What are the dimensions of quality for health systems?
Maxwell's dimensions of quality are outlined as:
Access to services
Relevance to need
Effectiveness
Equity
Acceptability
Efficiency and economy
❏ How do we improve quality in our health system?
The quality improvement cycle begins with defining the standards of quality, measuring these standards against indicators, using the information to identify gaps or challenges, applying a root-cause analysis to identify the underlying reasons for an identified challenge, and putting measures in place to address problems. It is important to design interventions that can be implemented within resource constraints and to continuously monitor the process of implementation in order to improve the intervention as it unfolds. At the end of any improvement cycle, the problem needs to be (re)evaluated in order to determine if the issue has been adequately addressed. Very often, improving one aspect within the health system allows for opportunities to address other concerns.
Cross-cutting Content: Presentation Skills ❏ What are the characteristics of an engaging presentation?
An engaging presentation is one that you want to listen to, absorb and interact with. It has the information that you want to be delivered to you in a manner that is easy for you to digest, that is interesting, and that encourages you to engage with the content. There are three main skills that you need to bring together in delivering an engaging presentation: content creation, visual rhetoric, and delivery (voice production and body language). ❏ What skills do I need to develop to present better?
The time, sometimes it can be too long and presenting skill, speaking slower.
Complementary Content: History of Medicine ❏ What was the impact of hospital medicine on the teaching and practice of medicine today?
Medical schools were designed to train more practically rather than theoretically, and training was done inside the hospital. Importantly, the division between the physician and surgeon fell away as medical students were trained in both medicine and surgery. ❏ What impact did the psychiatric hospital have on our understanding of mental health today?
A final legacy of hospital medicine is the development of the asylum, where mental and psychiatric conditions were relegated to mental hospitals. Making mental and psychiatric conditions not accepted and stigmatised.
Week 5:
Core Content: Structure & Process in Health Care
❏ What does success in a health system look like to you?
when healthcare is people-centered and all the components that make up a health system are work together to focus on primary and preventative care compared to treatment only. ❏ What are the differences between structures and processes in a health system?
Structure includes all of the factors that affect the context in which care is delivered, such as facilities, equipment, and human resources.
Process refers to the sum of all actions that make up healthcare. It relates to the active part of providing healthcare to patients, such as diagnosis, treatment, preventive care, and patient education. It makes use of the facilities provided in healthcare organisations. ❏ How do structures and processes affect the outcomes of the health system?
Structure: It refers to the infrastructure and facilities in place to capacitate medical professionals to assist patients.
Process: According to Donabedian, the measurement of the process is nearly equivalent to the measurement of quality of care as the process contains all acts of healthcare delivery.
Cross-cutting Content: Communication & Presentation Skills
❏ What is a discussant and what is their main role?
A discussant is an important member of the audience who actively listens to presentations, and then poses questions and points of discussion to presenters. A discussant should stimulate and elevate a broad and meaningful discussion around the presentation, as well as highlight their strengths and areas of improvement. Additionally, a discussant can offer new insights around a key theme or topic being discussed. ❏ How do you prepare to be a discussant?
Read all the papers/presentations that will be presented, if they are made available to you. Beyond the papers, do further research. Spend time conceptualising your game plan. Draft presentation slides. ❏ What strategies do you use to answer questions?
I answer with the knowledge that i have, and if itis not sufficient then I say that I am unable to speak more about a topic. ❏ What advice can you provide to presenters to improve their presentations?
Interact with you audience and link what you are saying to what previous speakers have mentioned.
Complementary Content: History of Medicine
❏ What light does the history of public health shed on structures and processes in health systems?
Foundational concepts and basic principles of public health focus on maintaining health standards, containing diseases, promoting health and preventing disease. ❏ How did the events of the past necessitate the development of structures and processes?
It caused the development of isolation and quarantine and also emphasized the need for sanitary environments. ❏ What structures and processes were inherited from the past, that do not address contemporary challenges?
[I don't know how to answer this]
Week 6:
Core Domain: Structure & Process in Health Care
❏ What are the factors in an individual's environment that affect their development?
Individuals are situated within a set of nested social systems where the interactions between levels within a system can influence the individual’s development and behaviour.
❏ How does the individual's environment shape their experiences of the world?
Social constructs such as race, gender, and class shapes the way social systems position an individual. In their life course, individuals move through a series of transitions, which are facilitated or hampered by the micro, meso or macro systems in which they are embedded.
❏ How can the fluid nature of the dynamic relationships between systems promote patient-centred healthcare?
Patient-centered health services is an approach to care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways.
Competency: Communication & Presentation Skills
❏ How can your group prepare for an upcoming presentation?
Carefully reading the brief and reading the assigned pages of Bynum's 'A History of Medicine'.
Revising the history sessions that are relevant to your topic.
Revising the notes your team made on effective and engaging presentations.
Reflecting on the kinds of roles you naturally play in teams; and
Preparing, mentally, to play a constructive role in ensuring the whole team succeeds.
❏ What strategies do you use to pose/ answer questions?
Use them as rhetorical question to the audience then answer as the presentation happens.
❏ What tools, applications or resources will you need for your presentation?
Laptop, Bynum book and an app to make slides.
History of Medicine
❏ How did the events of the past lead to new inventions, discoveries and new areas of specialisation?
Robert Koch was of a younger generation than Pasteur. However, he was more thorough in his research techniques. He introduced the importance of sterilising equipment and made use of the Petri dish, as we know it today. In the early 19th century, numerous theories were developed that suggested that the whole organism (Plants and Animals) were composed of microscopic units termed cells. One drawback of the earlier microscopes was that the biologists often mistook particles of dust, pollen or other particles for cells. In 1830 a major improvement to the Microscope was made by Joseph Lister (building on the work of Charles Hall) which resolved this problem.
❏ What impact did the discovery of the microscope have on scientific research?
Since then the microscope has improved allowing scientists to study molecular and biological specimens in great detail. In the 19th century, the microscope became the symbol of identity for a scientist, much like the stethoscope for a doctor.
❏ How did the discovery of biomolecular cells revolutionise medical practices?
As cells are the building blocks of life, understanding how they work was instrumental in laying the foundation for Modern Scientific Medicine. Molecular biology (the study of the composition, and structure of cells as well as the interactions of cellular molecules) has since developed into the foundation for understanding the dynamics of the disease process.
Week 7:
Core Domain: Structure & Process in Health Care
❏ What are the differences between medical malpractice and professional negligence?
Professional negligence is when a health professional fails to exercise the degree of skill and care of a reasonably skilled practitioner in their field.
Medical malpractice refers to the negligent or intentional unlawful conduct by a health professional that causes injury or damage to a patient or the patient’s proprietary rights.
❏ What is the role of the HPCSA for the medical profession?
The Health Professions Council of South Africa's is mandated in terms of the Health Professions Act 56 of 1974 to guide the professions and protect the public. The HPCSA is responsible for setting standards of professional conduct for health professionals and ensuring that healthcare practitioners are fit to practice their profession free from any impairment which may prevent them from practicing their profession or which may cause harm to a patient.
The Health Professions Council of South Africa sets the legal and ethical guidelines for the practice of health professions in South Africa.
❏ How does the law regulate medical practices?
Health professionals are obliged by law to be registered with their professional council, to ensure that their personal details are updated and that their professional skills are kept up to date, for the benefit of their patients, their colleagues and the health institutions where they work.
❏ What are a doctors ethical obligations to patients and society?
The manner in which the profession is practiced is connected to diagnosis, treatment or prevention of physical or mental defects, illnesses or deficiencies.
❏ When does vicarious liability become applicable?
“Vicarious liability, sometimes referred to as “imputed liability,” is a legal concept that assigns liability to an individual who did not actually cause the harm, but who has a specific superior legal relationship to the person who did cause the harm. Vicarious liability most commonly comes into play when an employee has acted in a negligent manner for which the employer will be held responsible.”
Competency: Communication & Presentation Skills
❏ How do you identify signs of anxiety when you present?
When faced with a situation that makes you anxious, you will typically have thoughts that may allow you to perceive unreasonable challenges and hamper your ability to cope well. These thoughts may Illicit irrational behavioural responses that would not typically be the case when you are not anxious, such as avoiding the situation or being over-precautious. Your mood will be different to your normal self. You may experience a certain set of physical symptoms before and during an anxious situation including shortness of breath, increased heart rate, a dry mouth, sweating, shaking, dizziness, stomach problems including nausea, frequent urination, restlessness, muscle tension, and even difficulty swallowing. Having a fast heart rate, stuttering and forgetfulness.
❏ How can you overcome anxiety?
One way to counter performance anxiety is to reframe the presentation as an opportunity to communicate instead of simply presenting. View your presentation as your tool to communicate your ideas. There may be a correct way to act or perform, but there is no single correct way to communicate. Breathing exercises.
❏ How does the environment and audience impact your presentation?
With less and familiar people it is not as frightening.
❏ How can you contribute effectively as a discussant?
Spend time visualising your audience, the setup, and how you will be presenting. Ensure that before you present that you rest, exercise, eat well, drink enough, and limit caffeine intake. Taking the time to dress properly and smartly also helps deal with anxiety in the build-up to your presentation.
History of Medicine
❏ How did the events of history lead to the systematisation of health systems and medical practices today?
Medical research has evolved over centuries but has often been impacted by how much funding is made available for research. In the Western world, there is strong support and funding available for extensive research, which has rapidly increased the discovery of disease prevention and cure.
❏ What impact does the systematisation of health delivery have on the various levels of costs?
[I don't know]
❏ How can the epistemological disposition of modern medicine be described?
[I don't know]
Overall Module 2 Reflection:
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