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TRANSCRIPT
Exploring students' Feelings Counts in Education:The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics
Borahmah A [1], AlRasheedi S [1], Al-Braheem A [1], Elamir H [3], Jacob S [1], Bouhaimed M [1,2]
[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine.[2] Department of Surgery, Kuwait University Faculty of Medicine.
[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH
Background:
Learning consists of cognitive, emotional and social dimensions. In medical education, the cognitive dimension (Fig 1) is usually measured through assessments of performance, while the social and emotional dimensions are more challenging to capture. One of the objectives of the ethics and professionalism elective course on “Patient Safety: Better Knowledge for Safer Care” is to apply different reflection tools to the students’ hospital experiences to enable their development as future doctors. The Gibbs Reflective Cycle (Fig 2) was applied to the students’ experience of one of the nine World Health Organization "Patient Safety Solutions" (Fig 3) adopted by the Ministry of Health in Kuwait. In this case presentation, the four steps of the Gibbs cycle: to describe, to express feelings, to evaluate and finally to make sense of experience were applied to the “Performance of Correct Procedure at Correct Body Site” protocol. The first step in the protocol is the verification of the intended patient, procedure, site laterality (right or left without abbreviation) and any implant or prosthesis.
Remembering
Understanding
Applying
Analyzing
Evaluating
Creating
1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy
Fig 1: Bloom’s Taxonomy (Revised)
Can the student distinguishbetween di�erent parts?
Appraise, compare, contrast, criticize, di�erentiate, discriminate, distinguish,
examine, experiment, question, test
De�ne, duplicate, list, memorize,recall, repeat, state
Can the student recall orremember the information?
Can the student explain ideas orconcepts?
Can the student use informationin a new way?
Classify, describe, discuss, explain,identify, locate, recognize, report,
select, translate, paraphrase
Choose, demonstrate, dramatize,employ, illustrate, interpret, operate,
schedule, sketch, solve, use, write
Can the student justify a standor decision?
Appraise, argue, defend, select,support, value, evaluate
Can the student create a newproduct or point of view?
Assemble, construct, create, design,develop, formulate, write
Look-alike,Sound-Alike(LASA) Medication Names
Patient Identification
Single Use of InjectionDevices
Performance of CorrectProcedure at CorrectBody Site
Improved Hand Hygiene to PreventHealthcare-Associated Infection
Assuring MedicationAccuracy at Transitionsin Care
Avoiding Catheter andTubing Misconnection
Control of concentratedelectrolyte solutions
Communication DuringPatient Handovers
Patient safetySolutions
Fig 3:
DescriptionWhat happened?
DescriptionWhat sense can you make
of the situation?
Fig 2: Gibbs Reflective Cycle
FeelingsWhat were you thinking
and feeling?
Action PlanIf it arose again, what
would you do?
ConclusionWhat else could you have
done?
EvaluationWhat was good & badabout the experience?
Reflection can be used as a tool to facilitate the teaching of hospital based clinical ethics and patient safety in medical education.
Conclusion: Contacts:
For further information, please contact Dr. Manal BouhaimedEmail: manal_q8 @hsc.edu.kw Tel(office): 24636532
Acknowledgement:We would like to acknowledge the assistance provided by Quality Nurses: Abeer G. Dossokey, Amal T. Mohamed, Asila A. Alrasheedi, Lea Martinez & Rinto Francis.
Case Summary:
The students were able to identify that in a recent retrospective audit of 33 medical records of surgical procedures involving a bodypart that needed to be specified in terms of side laterality, there were 6 records that included at least one wrong entry (Fig 4). Out of a total of 86 different opportunities to enter the specific site of the procedure in the 6 patients’ records the following sources wereidentified (Fig 5a, b):
The students’ feelings were initially those of “shock and frustration, fear and need to be precautious going into the world of medicine, motivation to learn, and finally excitement and ambition to attain new perspectives about clinical ethics and patient safety".
0 20 40 60 80 100
Correct & Not Abbreviated
Abbreviatted
Missed
Wrong &Abbreviated
38%
Medical Forms
31%
Anaesthesia Forms
23%
Nursing Forms
8%Investigation Forms
Patient (1) had
WRONG SIDE surgery
Procedure: Right Pyelo lithotomy # of opportunities = 33 Correct & not abbreviated= 4 Wrong & abbreviated= 7 Correct & abbreviated= 15 Missed= 6
Patient (2) Procedure: Mesh repair for Right Inguinal Hernia # of opportunities = 11 Correct & not abbreviated= 1 Wrong & abbreviated= 1 Correct & abbreviated= 7 Missed= 2
Patient (3) Procedure: Amputation for gangrenous Left big toe # of opportunities = 10 Correct & not abbreviated= 4 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 0
Patient (4) Procedure: Amputation for Left Lower Limb Ischemia # of opportunities= 6 Correct & not abbreviated= 1 Wrong & abbreviated= 2 Correct & abbreviated= 2 Missed= 1
Patient (5) Procedure: Mesh repair for Left Inguinal Hernia # of opportunities= 16 Correct & not abbreviated= 9 Wrong & abbreviated= 1 Correct & abbreviated= 4 Missed= 2
Patient (6) Procedure: Mesh repair for Right Inguinal Hernia # Of opportunities = 10 Correct & not abbreviated= 2 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 1
Fig 4: Findings of laterality opportunities in 6/33 patients
LEFT
RIGHT
(Fig 5a)
(Fig 5b)