Transcript Native Hawaiian Values

Native Hawaiian Standardized
Patient Use of JABSOM
Martina L. Kamaka, MD
University of Hawaii
John A Burns School of Medicine
Department of Native Hawaiian Health
Photos courtesy of DNHH and JABSOM
Standardized Patients
Development-US Overview
96% of LCME schools have at least one
SP/OSCE
75% have final comprehensive exam
63% require passage for graduation
USMLE (US Medical Licensing Exam) now has
required OSCE exams as part of USMLE 2 (1012 cases)
46% will require passage of USMLE Step 2 CS
(Clinical Skills) exam
Barzansky B, JAMA, 2004;292(9):1025-1031
JABSOM using Standardized patients for teaching and
assessment since 1989
No Native Hawaiian cases with cultural issues exist
Photos courtesy of Center for Clinical Skills, JABSOM
SP Clinical Skills Evaluations
MD 1 2  3 4
MD 5  6 7
Clerkships 
MD 4 Clinical
Skills Exam
MD 7 Clinical
Skills Exams
3rd YEAR Clinical Rotations
Family Medicine
Internal Medicine
Pediatrics
4th YEAR
Geriatric Medicine
Comprehensive
Clinical Skills
Exam
Department of Native Hawaiian Health
• Piloted two Native Hawaiian OSLE cases with the Family
Practice residency
• Family Practice residency
– 7 year history of using standardized patient cases (Micronesian
and Filipino)
• DNHH C3 members acted as patients
• Assessment:
–
–
–
–
Other C3 members were evaluators
Patients also assessed residents
Resident self assessment
Based on AGME core competencies
• Issues:
– Establishing trust, communication skills, greetings, etc.
– Openness to the use of traditional medicines instead of western
– Culturally based concepts around illness and healing including
role of family members
Circle descriptions that best reflect the residentÕs perfor
mance during your patient encounter, then give a
final ÔscoreÕ
for each category below
Below Expectations (1-2)
Meets Expectations (3-4)
Exceed Expectations (5)
Num rating
(1-5)
PATIENT CARE
 Interviews and exa mines patients poorly;
lacks technical proficiency
 Misses key cues to examine patient
problems more in-depth
 Has poor judgment
 Disregards patient preference
 Ignores sensitive areas of history-taking
or physical exa m
 DoesnÕtexplain/give much warning before
conducting PE
 Satisfactory ski lls in interviewing,
PE
 Attempts to examine at least one
patient problem in-depth
 Adequate judgment
 Usually respectful of patient
preferences
 Maintains patient modesty and
comfort
 Explains what s/he is going to do
before/during exa m
 Limited knowledge base
 Poor understanding of complex problems
 Solid fund of knowledge
 Adequately understands complex
problems
 Performs excellent patient interviews,
exa ms, procedures
 Able to exa mine at least two patient
problems in-depth, according to highest
priority
 Uses sound judgment
 Is highly respectful of patient
preference
 ASKS PERMISSION and explains
what s/he is going to do before/during
exa m
MEDICAL KNOW LEDGE
 Exceptional knowledge base
 Has comprehensive understanding of
complex problems
PRACTICE-BAS ED LEARNING AND IMPROVEMENT
 Minimizes or ignores self-assessment
 Avoids new technology
 Ignores feedback
 Intermittently uses new technology
(i.e. PDA or web searches)
 Intermittently seeks feedback
 Uses new technology consistently
(PDA at the bedside, web search
during the patient encounter)
 Eagerly accepts feedback
INTERPERSONAL AND COMMUNICATION SKILLS
 Has poor relationships with
patients/families
 Negates or puts down patient concerns
 Misses all patient cues
 ÒTalks down to patientsÓ
 Does not listen to patients, answer their
questions or ask for patient understanding
 Interrupts patient often
 Avoid educating or counseling patients
 Speaks in medical jargon most of the
time, with little attempt to ensure the
patient understands
 Does NOT discussoptions and plans for
further management
 Does NOT negotiate final plan with
patient/family
 Incomplete, illegible records
 Communicated in a way that did not instill
confidence or trustworthiness (LOTS of
ÒoopsÓ,ÒsorryÓor ÒI donÕ
t knowsÓ)
 Maintains satisfactory relationships
 Acknowledges patient concerns
sometimes, picks up a few ÒcuesÓ
 Sometimes listens to patient,
sometime interrupts
 Asks questions of the patient to help
clarify understanding of the
problem
 Intermittently educates, counsels
patients
 Discusses options and plans for
further management
 Uses non-medical jargon
sometimes
 Fairly complete, legible records
 Communicated in a way that would
instill some confidence and trust
 Establishes excellent relationships with
patients/families
 Acknowledges patientÕsconcerns,
picks up non-ve rbal or verbal cues
 Interacts with patients at the same
leve l, no Òtalking downÓto patient
 Listens carefully to patients and
answers their questions, asks for
confirmation of understanding
 Hardly interrupts unless the patient is
rambling
 Educates and counsels patients, using
language they understand
 Discusses options and plans for further
management
 Negotiates final plan with patient/family
 Comprehensive , timely, legible medical
records
 Communicated in such a way that the
patient opened up, trusted and was
confident in this physician
PROFESSIONALISM
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Not respectful
Not compassionate
Dishonest
Does not recognize limits of his/her
knowledge or skills
 Not considerate of others
 Usually respectful
 Usually compassionate
 Recognizes limits of his/her
knowledge or skills
 Tries to be considerate of others
 Consistently respectful
 Very compassionate
 Is honest and truthful in telling his/her
assessment of the problem(s)
 Recognizes limits of his/her knowledge
or skills and puts forth a plan to
improve the deficiencies
 Considers needs of others (patients,
colleagues)
SYSTEM-BAS ED PRACTICE
 No attempt to look for resources, drug
formularies
 No attempt to balance cost and resources
with quality patient care
 Makes no attempt to reduce errors
 No attempt to understand proper E/M
documentation and coding
 Realizes need to look for resources,
prescribe according to insurance
formularies (or lowest cost
medications)
 Tries to understand proper E/M
documentation and coding
 Balances cost, resource allocation and
quality patient care
 Identifies and proposes to give patient
resources at the end of the first visit
 Prescribes medications according to
insurance formularies
 Properly documents and codes the
patient visit
Form courtesy of G.
Maskarinec, PhD
• Mahalo to:
– Gregory
Maskarinec, PhD
(Dept of Family
Medicine)
– DNHH C3 Team
– Mike Nagoshi, MD
• UH CCS (Center
for Clinical Skills)
• http://www2.jabso
m.hawaii.edu/ccs/
Photo courtesy of R. Kekuni Blaisdell, MD