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141230L - TEAM APPROACH TO APPROACH TO ARTHRITIS



Session by Professor Omar Hasan Kasule Sr for Year 3 medical students Faculty of Medicine King Fahad Medical City Riyadh Saudi Arabian on Monday 30 December 2014.


Learning Objectives:
·        To introduce students to critical issues and current models for team management of Rheumatoid Arthritis
·        Keywords: Team management clinical models

Agenda
·        Background on team work
·        Presentation of the case
·        Role playing of consultants from various disciplines involved in caring for patients with Rheumatoid Arthritis. The aim is to develop a management strategy for the patient.
·        The panel will include Rheumatologists, Orthopedic Surgeons, Physiotherapists, Occupational Therapists, Social Workers, General Practitioners and patients.
·        The panel will be presented with the case of the PBL patient of Rheumatoid Arthritis for discussion.
·        The panel is eventually required to develop a management strategy.

References

Types of groups
·        A group is several interdependent and interacting persons.
·        A team is a group whose members work together for a long time on specific objectives.
·        A task force is temporary (adhoc) group set up to solve a specific problem.

Etiquette of teaching & learning in the health care team
·        The hospital health care team consists of senior doctors, junior doctors, allied health professionals, and students.
·        It is multi-disciplinary with complementary and inter-dependent roles.
·        Members have dual functions of teaching and delivering health care. Most teaching is passive learning of attitudes, skills, and facts by observation.

Etiquette of care delivery in the health care team
·        Each member of the team carries personal responsibility with leaders carrying more responsibility.
·        Leaders must be obeyed except in illegal acts, corruption, or oppression.

Principles of group work
·        Groups must be united, cooperative, open and trusting.
·        Group members must be similar, empathetic, supportive, and sharing.
·        Group norms must be respected.
·        Breaking norms, secretive behavior, concealment of information, and secret talks destroy groups.

Maturity of groups
·        Group identity,
·        Optimized feedback,
·        Decision-making procedures,
·        Cohesion,
·        Flexibility in organization,
·        Resource utilization,
·        Good communication,
·        Clear accepted goals,
·        Interdependence,
·        Participation by all
·        Acceptance of minority views.

Failure of groups
·        Constituted on the wrong basis,
·        When members cannot communicate,
·        There is no commonality (interests, attitudes, and goals),
·        Diseases of envy, hypocrisy, rumor mongering, backbiting, lying, pride and arrogance, love of leadership, and negative feelings.

Effectiveness of groups
·        Members feel secure and not suppressed,
·        Members understand and practice sincere group dynamics,
·        Members are competent and are committed to the group and the leadership.

Team positive behaviors:
·        Mutual love,
·        Empathy,
·        Caring for one another;
·        Leniency,
·        Generosity,
·        Patience,
·        Modesty,
·        A cheerful disposition,
·        Calling others by their favorite names,
·        Recognizing the rights of the older members,
·        And self control in anger.

Team negative behaviors
·        Harshness in speech,
·        rumor mongering,
·        Excessive praise,
·        Mutual jealousy,
·        Turning away from other for more than 3 days,
·        Spying on the privacy of others).


Case summary
Mrs Jean Norman is a forty-five-year-old house wife from Mildura where she helps her husband grow peaches. She’s had pain in her joints for the last eight months but put it down to “getting on a bit”. The symptoms started with occasional early morning stiffness and swelling in her right knee and ankle. Stiffness and swelling in her hands followed. She later experienced severe pain. She had difficulty walking. She failed to undertake activities of daily living (ADL) in her home. She always felt fatigue even when she did no work . Her muscled were weak. She became irritable quarrelling with her husband, her neighbors, and children for no reason. She would also go into spells of depression. She went to see her primary care physician who referred her to a rheumatologist. After confirming the diagnosis the rheumatologist assembled an RA team to take care of her.

Members of the RA team
·        Primary care doctor: initial diagnosis and referral to rheumatologist. Follow up after the rheumatologist
·        A rheumatologist: specialist evaluation. Regular follow up by rheumatologist gives better results because he can detect problems before they grow bigger. Rheumatologist refers to other specialists
·        An orthopedic surgeon
·        A podiatrist
·        A physical and/or occupational therapist
·        A massage therapist
·        A pharmacist
·        Alternative medicine: chiropractor, an acupuncturist
·        An ophthalmologist and/or optometrist
·        A psychiatrist or psychologist
·        A social worker


EVALUATION OF TEAM WORK DURING THE SESSION ON TEAM WORK IN ARTHRITIS

TABLE #1: SCORING GROUP MATURITY

Type of Activity or Behavior
High
(2)
Medium
(1)
Low (0)
Observations and Comments
1.            Giving and accepting feedback




2.            Democratic decision making     




3.            Group cohesion             




4.            Flexibility of members




5.            Use of all member resources     




6.            Members feel free to disagree




7.            Everyone is free to express an opinion




8.            Humor is the norm




9.            Communication is effective      




10.        Group sets clear strategies and goals   




11.        Interdependence Among members         




12.        Shared participation and not dictatorship




13.        Listening to and considering minority views           




                                                    TOTAL






TABLE 2: SCORING GROUP EFFECTIVENESS:

Type of Activity or Behavior
High
(2)
Medium
(1)
Low (0)
Observations and comments
1.            Productivity




2.            Positive handling of complaints
  




3.            Positive conflict resolution




4.            Commitment to goals




5.            Action-orientation




6.            Dealing with apathy of some members




7.            Encouraging creativity and innovation




8.            Competence of team managers/leaders




9.            Effectiveness of meetings and discussions




10.        Effective communication




11.        Trust among team members




12.        Making sure decisions are understood by all




13.        Feeling good as a team member




14.        Principled behavior




                                                    TOTAL






TABLE #3  JUDGE’S OBSERVATIONS ON INDIVIDUAL GROUP MEMBERS


ID
Comments and observations
























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Writings of Professor Omar Hasan Kasule, Sr








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