Prepared
and written on 01 September 2014 by Prof Dr Omar Hasan Kasule Sr MB ChB (MUK),
MPH (Harvard), DrPH (Harvard)
LEARNING OBJECTIVES
- To outline the learning opportunities presented by the PPD Theme
- To outline Program Content and Assessment requirements
OUTCOMES OF THE PPD THEME
- Commitment to compassionate, ethical and professional behavior.
- The ability to work cooperatively as a member of a team accepting and providing leadership as appropriate.
- Recognition of the inevitability of decision-making in circumstances of uncertainty and the capacity to make rational and sensitive decisions based on the best available evidence.
- The ability to recognize his/her personal physical and emotional needs and responses to stress and openness to assists in times of need.
- Ongoing commitment to the advancement of learning within the medical community.
- Commitment to maintaining professional standards and obligations.
- Commitment to improving the quality and safety of health care
SAFETY AND QUALITY OF HEALTH CARE:
- Promotion of humanistic values for students, teachers, patients and families to help prepare for your future roles in the health care system.
- Doctors carry heavy responsibilities and are at special risk for stress-related illnesses. By identifying some of the problems that can arise, it is possible to identify ways of coping while fulfilling your clinical and other responsibilities.
NATURE OF THE PPD THEME
- The PPD curriculum equips students with ethico-legal, research and personal skills necessary for successful medical practice.
- PPD is an integral part of the problem-based teaching methodology used by the institute of medicine.
- PPD teaching methodology is student-centered and student-driven.
- THE PPD learning and assessment strategies emphasize skills rather than accumulation of facts.
VISION OF PPSD
- PPSD and the total curriculum: PPSD is an integral and essential part of medical education and training. It complements knowledge and skills of biomedical technology with skills that the medical student needs to be an effective well-rounded physician able to function efficiently inside and outside the hospital.
- Components of PPSD: PPSD skills can be classified as ethico-legal, research, and personal skills. The vision of PPSD is a physician who is ethical in his professional and personal activities, who has the skills of life-long learning through research on the frontiers of knowledge, and who has leadership and management skills that he needs as a leader of a healthcare team.
- PPSD as skills: The PPSD curriculum is not about student acquisition of a large corpus of information either passively or actively. It aims at equipping them with specific ethico-legal, research, and personal skills that can be employed in various situations.
INTEGRATION OF PPSD THROUGHOUT THE 4-YEAR
PROGRAM:
- The curriculum covers the three components of the PPSD vision mentioned above.
- These components are covered all through the program being fully integrated vertically and horizontally with the three other themes of the program namely health sciences, patient care, and our community.
ETHICO-LEGAL-FIQHI ISSUES:
- Ethics: theory and principles,
- Informed consent,
- Balance of injury & benefit
- Privacy & confidentiality,
- Disclosure and truthfulness
- Fidelity & loyalty conflicts
RESEARCH SKILLS: COVERED UNDER EBM
- Mathematical foundations: (Probability)
- Descriptive statistics: (means and proportions)
- Disease measures: (Incidence and prevalence)
- Analytic statistics: (Hypotheses testing)
- Study design and analysis: (Clinical drug trials)
- Study interpretation: (Bias)
PERSONAL DEVELOPMENT SKILLS:
- Formation of the physician: (Team-work)
- Trans-cultural skills: (Culture, lifestyle, and civilization)
- Communication & negotiation skills: (Public speaking, win-win negotiation)
- Personal skills: (Psychosocial development)
- Leadership Skills: (Characteristics of effective leadership)
- Management skills: (Strategic planning & management)
METHODOLOGY OF PPSD
- Student-centered: teaching of PPSD will be largely student-centered learning (SCL) and student directed learning (SDL).
- Ethical, legal, and fiqhi issues will be taught using case scenarios with students being required to identify and solve ethical and legal problems that arise in the case.
- Research skills will be taught as very brief presentation with students learning by working on actual data sets or review of journal articles.
- Personal skills will be taught by discussion of case scenarios.
EUROPEAN ETHICAL THEORIES
- According to the utilitarian consequence-based theory, an act is judged as good or bad according to the balance of its good and bad consequences. Utilitarianism means attaining the greatest positive with the least negative.
- The obligation-based theory is based on Kantian philosophy. Morality was based on pure reasoning. A morally valid reason justifies action.
- The rights-based theory is based on respect for human rights of property, life, liberty, and expression.
- According to the community-based theory, ethical judgments are controlled by community values that include considerations of the common good, social goals, and tradition.
- The relation-based theory gives emphasis to family relations and the special physician-patient relation.
- The case-based theory is practical decision-making on each case as it arises. It does have fixed philosophical prior assumptions.
EUROPEAN ETHICAL PRINCIPLES
- The 4 basic European ethical principles autonomy, beneficence, non malefacence, and justice.
- The Principle of Autonomy is the power of the patient to decide on medical procedures.
- The Principle of Non-maleficence is avoiding causation of harm.
- The Principle of Beneficence is the providing benefits and balancing them against risks and costs.
- The principle of justice is distribution of benefits, costs, and risks fairly.
ISLAMIC ETHICAL THEORY
- Islam has one theory of ethics expressed as the purposes of medicine which are preservation, protection, and promotion of 5 essentials:
- morality (hifdh al diin),
- life and health (hifdh al nafs),
- progeny (hifdh al nasl),
- intellect (hifdh al ‘aql),
- and resources (hifdh al maal).
- Any medical intervention must fulfill or not violate these purposes to be considered ethical.
ISLAMIC ETHICAL PRINCIPLES
·
Five principles of the Law are considered
ethical principles: intention (qasd), certainty (yaqeen), injury
(dharar), difficulty (mashaqa), and precedent (urf).
·
The Principle of intention has three
implications: each action is judged by the intention behind it; what matters is
the intention and not the letter of the law; means are judged with the same
criteria as the intentions.
·
The principle of certainty has 2 implications:
established medical procedures and protocols are treated as customs or
precedents; and all medical procedures are considered permissible unless there
is evidence to prove their prohibition.
THE PRINCIPLE OF INJURY
- According to the principle of injury, medical intervention is justified on the basic principle is that injury, if it occurs, should be relieved.
- An injury should not be relieved by a medical procedure that leads to an injury of the same magnitude as a side effect.
- In a situation in which the proposed medical intervention has side effects, we follow the principle that prevention of a harm has priority over pursuit of a benefit of equal worth.
- If the benefit has far more importance and worth than the harm, then the pursuit of the benefit has priority.
- The prohibited has priority of recognition over the permitted if the two occur together and a choice has to be made.
- If confronted with 2 medical situations both of which are harmful and there is no way but to choose one of them, the lesser harm is committed.
- A lesser harm is committed in order to prevent a bigger harm. In the same way medical interventions that in the public interest have priority over consideration of the individual interest.
- The individual may have to sustain a harm in order to protect public interest. In the course of combating communicable diseases, the state cannot infringe the rights of the public unless there is a public benefit to be achieved. In many situations, the line between benefit and injury is so fine that a prayer of consultation, salat al istikharat, is needed to reach a solution since no empirical methods can be used.
PRINCIPLE OF HARDSHIP
- According to the principle of hardship, medical interventions that would otherwise be prohibited actions are permitted under the principle of hardship if there is a necessity.
PRINCIPLE OF CUSTOM
- According to the principle of custom or precedent, the standard of medical care is defined by custom.
- The basic principle is that custom or precedent has legal force.
- What is considered customary is what is uniform, widespread, and predominant and not rare.
- The customary must also be old and not a recent phenomenon to give chance for a medical consensus to be formed.
ASSESSMENT OF PPD
- A reflective paragraph of 75-100 words:
- What do you think of the PPD theme
- How will this theme help you in your future career?
