SOCIAL FOUNDATIONS OF MEDICINE

MEDI 3001 & 3002

L E A R N I N G G U I D E

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SFM in Year 3

In Year 3, SFM is mainly integrated into clinical experience. This year focuses on using your skills in complex clinical situations where nuanced judgement is needed. It is not always easy to see what is the right course of action, and we will see that events in the distant past can continue to reverberate in the present-day health and clinical experiences of our patients.

The portfolio item on gender and medicine enables you to develop fresh insights into the ways gender and sex impact on medical practice, knowledge and the distribution of disease. The Medical Women’s Society Gender and Medicine prize will be awarded to the best piece of work produced for this portfolio.

Structure

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Year 3 Learning outcomes • Be able to critically analyse a complex clinical situation with regard to the impact of

past events on the present day experience of the patient • Exercise judgement to determine a range of reasons for a gendered or sex-based

phenomenon • Demonstrate skills in high-level communication, including using interpreters

Teaching format Formal SFM teaching occurs through three fixed resource sessions, addressing key areas in the development of professional lives:

• The influence of institutions on medical practice

• New media and professional practice

• Career planning in medicine

SFM is integrated into the three seminars which form the Violence Curriculum in the Integrated Child and Community Health term

• Violence and the family

• Refugee health

• Prison health

Students must complete a portfolio item on gender by the end of third year, and a practical portfolio item on working with interpreters by the end of fourth year.

Students in the ICCH term have the opportunity to have clinical attachments where they can work with socially disadvantaged patients. This is an unusual feature of the ANU Medical School, a product of our small size and the fact that many of the senior clinicians in these services are also ANUMS academics. These services demonstrate advanced primary health care delivery. Many have them have developed innovative models of care, so they are worth visiting simply for the opportunity to study health care delivery solutions.

Attachments are available at the Alexander Maconachie Centre, Winnunga Nimmityjah Aboriginal Medical Service, and Companion House Medical Service.

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FIXED RESOURCE SESSIONS

Developing as a professional

LECTURE 1: Cultures of Medicine

AIM: Explore cultures of institutions as they apply to medicine, and how they impact on medical practice.

OVERVIEW: This lecture is part of the introductory set of lectures for third year. It was introduced at the request of students, and provides a kind of social lens on the structures and determinants of institutional practices in hospitals.

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Describe the characteristics of a total institution, and demonstrate to what degree they apply to hospitals

• Describe the acculturation process for hospitals as you go through it

• Critically analyse the cultural milieu in which you will now be living

• Identify and respond to contestable comments that are part of the hidden curriculum.

READING MATERIAL:

Gutkind, E (ed). Becoming a doctor: from student to specialist, doctor-writers share their experience W.W. Norton and Company, New York, 2010.

Konner, M. Becoming a doctor: A journey of initiation in medical school Viking, New York, 1987

Klass, P. Baby doctor: a pediatrician’s training. Random House, 1992.

Rothman, EL. White coat: Becoming a doctor at Harvard Medical School Harper Collins, New York, 1999. JUST IN CASE: Ready Responses to Sexist Comments, a compendium of evidence-based responses for you to use

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LECTURE 2: Dr Google and the Heroic Healer: Medicare care in the age of media

AIMS: 1. To describe the impact of new and social media on medical diagnosis and treatment 2. To explore the ways in which new and social media can be used to extend patient engagement in care 3. To revise a framework to minimise ethical risks for emerging professionals with new and social media.

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Know how to access, assess and use patient experience-of-illness sites

• Identify key misconceptions about health care practice that arise from narrative media (usually television)

• Respect Dr Google

• Be aware of risks to your professional self associated with new media, and especially social media. And then be prepared to use them.

READINGS There are many doctor and medical student blogs and you may have your own favourites. Unfortunately they come and go and this one http://other-things-amanzi.blogspot.com.au by “Bongi”, a provincial surgeon in rural South Africa has now been in dormant for a couple of years. It’s still worth clicking on a few posts and there goes the evening.

A remarkable blog that’s still going is the one kept by Dr Agnes Binagwaho, the Minister of Health for Rwanda: http://dr-agnes.blogspot.com.au/

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LECTURE 3: Your Medical Career: Living and thriving in a time of change

AIMS:

1. To understand the social processes that determine career choice and opportunities

2. Understand the principles of career planning and applications for medicine

3. Describe methods of advocating for your own career paths.

OVERVIEW: This lecture explicitly addresses career planning, recognising that many doctors do not have standard careers but rather can follow “portfolio” careers. We will explores the systems that currently determine entry into particular career paths and alternatives, where they exist. We’ll conclude by arguing that the increase of medical students isn’t a tsunami but rather an important corrective in a very long downturn in numbers. We’ll also explore the medical careers that, according to the Productivity Commission, are likely to be undersubscribed and oversubscribed in ten years’ time.

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Articulate the changes that are likely to impact on your medical life

• Be conversant with the major determinants of career entry in medicine

• Identify medical subpaths that are projected to be in demand in ten years time, and those that will be oversubscribed.

• Recognise responses to change and deal with mischievous myth-making

• Describe principles of advocating for your own career

REFERENCE

Health Workforce Australia 2012. Health Workforce 2025. Doctors, Nurses and Midwives. Volume 3. Specialists https://www.hwa.gov.au/sites/uploads/HW2025_V3_FinalReport20121109.pdf

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INTEGRATED CHILD AND COMMUNITY HEALTH

Violence Stream

ICCH SEMINAR 1: Violence in the family

AIMS:

1. Describe the impact of trauma on the developing brain, and over the life-course 2. Explore the epidemiology of violence in the family 3. Outline legal requirements and provisions in relation to violence against children,

partners and elders for ACT Health employees and under ACT legislation 4. Identify interventions for violence in the family (fostering, enhanced support for

families, guardianship for elders, refuges for partners, emergency safety bags)

STAFF: Dr Sue Packer, Dr Kirsty Douglas

OVERVIEW

Families are the cells around which functional societies are organised; but families can also be very dangerous places. This seminar explores violence in the family across the continuum of the life course. Dr Packer presents the neuroscience of trauma on the developing brain, discussing the impact of trauma on attachment, through case histories and a lifetime in the field. Dr Douglas describes the epidemiology and clinical experiences of working with survivors of intimate partner violence, and elder violence, and the interventions that are available for each.

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Describe the impact of trauma on children’s brains, their development, and their health as adults

• Be able to explain your own responsibilities under mandatory notification legislation

• Describe options for supporting people in relationships marked by intimate partner violence, including basic safety provisions.

• Assess risk factors for elder violence, and community approaches to strengthen their safety

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ICCH SEMINAR 2: Refugee Health

AIMS:

1. Describe the national and international political environments which frames the health of refugees

2. Introduce the changing spectrum of health problems relevant to refugee health

OVERVIEW: This is the second of three seminars exploring violence in the community. The first explored the neurobiology of violence on the developing brain and violence in the family. This explores violence against the person as part of a group of people (violence as political act), and forced migration. The third explores violence against the person and the criminal justice system.

There are around 47 million refugees or displaced persons in the world today. Australia’s immigration program now takes up to 20,000 refugees and humanitarian entrants annually. This seminar addresses the changing policy framework which impacts upon refugee health in Australia, and outlines key health issues for current refugees. Principles of good refugee health care are outlined, including management of post traumatic stress disorder, and identification and management of nutritious, infectious and chronic diseases most common among refugees.

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Define refugee and immigrant under the 1951 convention.

• Define post traumatic stress disorder.

• Outline the current screening system for refugees on entry to Australia.

• Describe the key changes in the policy environment which has led to community detention and the widespread use of bridging visas

• Outline key health care principles in providing refugee health.

• Describe the impact of prolonged immigration detention and asylum

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ICCH SEMINAR 2: Prison Health

AIMS:

1. Explore the social determinants of the health of prisoners and detainees, including the disparities in imprisonment rates between indigenous and non-indigenous Australians

2. Outline key epidemiological features of prison health 3. Compare primary health and population health interventions in prison

OVERVIEW There are over 10 million people in penal institutions, almost half of whom are imprisoned in three countries (the USA, China and Russia). Prisoners have poorer health than the general population for a variety of reasons: they already have higher rates of mental illness and substance use, and they are exposed to an experience which can have direct effects upon their health. However, prison also represents an opportunity for primary health care and public health interventions for a group of people with poor health

STAFF: Professor Michael Levy, Director Justice Health (ACT)

WHAT SHOULD I BE ABLE TO DO AT THE END?

• Describe the purposes of imprisonment.

• Identify major health issues among Australian prisoners.

• Describe impacts of imprisonment on health

• Describe key elements of improving health among prisoner populations.

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PORTFOLIO ITEMS

Gender and Medicine & Working with Interpreters

1. GENDER AND MEDICINE PORTFOLIO ITEM

TASK

Write a case study OR reflection of the differential distributions of ill-health, provision of health care, or the gendered knowledge base of medicine (at least 500 words). Additionally, describe how a gender perspective may elucidate differential distribution or treatment, or point to hidden gender bias in medical epistemology. Make sure that you reference properly, and be careful in citing that you interpret the evidence without prejudice. Students who wish to be considered for the Medical Women’s Society Gender and Medicine prize (see below) should write a piece of at least 1000 words.

Further background information: http://www.med.monash.edu.au/gendermed

MAJOR ISSUES TO CONSIDER

A gender perspective on medicine enables us to trace the ways in which gender impacts upon the distribution of ill-health among patients (for example, men and women have different rates of survival after treatment for colorectal cancer); on the provision of care by providers (for example, gender concordance between doctor and patient may affect the decisions of men and women to access particular types of health services); and on the knowledge base of medicine (for example, the standard medical body in many anatomy texts is male; some of the personality disorders are defined in terms of traits which are stereotypically “feminine”).

Post your item on the discussion board. I will read and respond to every post. Please include a subject line so that other students can see what you wrote about. (I'll award a couple of prizes for the best titles at the end of the year). After some time a moratorium may be called on certain topics which are written about frequently, such as gender concordance between patient and doctor or women in surgery, so if you want to write on these topics don’t leave it too late.

Don't know what you need to do? Check the marking rubric. Not sure what to write about? There are very few topics that are not susceptible to an analysis using a gender or sex or both as a lens. Send me an email if you're uncertain.

Finally, this is an ANU site and subject to ANU policy about respectful posting, so no cartoons, commentary or pictures that you think are funny but actually are just sexist or racist.

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GENDER AND MEDICINE PORTFOLIO ITEM MARKING RUBRIC

Didn’t get there Pass Well done!

1. Demonstrates an understanding of the concepts of gender and sex

Doesn't understand the concepts (0 points)

Demonstrates understanding (1 point)

Demonstrates advanced level of understanding . (2 points)

2. Applies this understanding to the topic of the reflection

Applies concepts incorrectly to the topic (0 points)

Correct application of concepts to the topic(minimum for an acceptable answer) (1 point)

Demonstrates rigour and insight in applying concepts to the topic (2 points)

3. Writing is clear, cogent and persuasive

Writing incomprehensible, doesn't reference if relevant (0 points)

Clear and logical argument, may resemble an op-ed piece. (minimum for an acceptable answer) (1 point)

Writes a persuasive, competent piece of prose as a more extended essay (2 points)

4. Where relevant, recent good quality evidence is used to support the argument

Uses wikipedia, an Internet survey with 37 respondents, and someone's opinio (0 points)

Uses relevant evidence, ensures that this is recent. (1 point)

Uses relevant high-quality evidence, and explores controversy (if relevant) in that evidence (2 points)

5. If a case study is used, the writer clearly demonstrates the implications of this for medical knowledge, or medical practice

Case study is presented as a curiosity with no or little analysis of its implications (0 points)

Implications of the case study for wider medical knowledge are presented. (1 point)

Clearly demonstrates the wider implications of this for medical knowledge or practice, makes some suggestions for change OR describes underlying reasons for the situation described in the case study (2 points)

TO PASS: You must get a total of 4 points. This MUST include a pass (1 point) for either criterion 4 or 5.

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GENDER AND MEDICINE PRIZE:

The Medical Women’s Society has decided to award its annual gender and medicine prize to the entry in the Year 3 Gender and Medicine portfolio that addresses, in any way needed to meet the requirements of the task, a topic that is of relevance to women and/or children. A topic that addressed men’s health would also be acceptable provided it also considered the implications for women and/or children.

What is the award? The award will consist of $500 and a gift certificate. It’s an official ANU prize, so you can write this on your applications for subsequent jobs.

What do I need to do? All students who receive 8-10 points, using the scoring rubric, and have written a piece over 1000 words, will be automatically entered into the prize. A committee set up by the Medical Womens Association will choose the winner at the end of the year.

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2. WORKING WITH INTERPRETERS PORTFOLIO ITEM

TASK

Students will participate in a professional interpreted consultation, using either a telephone or onsite interpreter. Although you need not complete an entire consultation, you must have engaged in communication as part of the substance of the consultation with both the interpreter and the patient. At the end of the consultation please ask the observer (a health care professional) and the interpreter to provide some feedback on your consultation skills. You may work with a spoken language or sign interpreter, onsite, by phone or Skype (see resources). You cannot use a family member or friend as an interpreter for this task, even if they are bilingual. Students who have not been able to complete this task by the end of fourth year, will need to contact Dr Phillips to arrange a catch-up interpreter consultation.

RESOURCES

ACT Health and Calvary Hospital both hold contracts with the Translating and Interpreting Service (TIS) for interpreter services. You can access an interpreter by phone, or can book one to come in person. TIS is FREE for all medical services in private practice. The National Auslan Booking Service (NABS) provides FREE interpreters for all medical and health services in private, and for Aboriginal and TSI patients in public hospitals as well. If you complete this task in another state, be aware that there are a number of private language support services used by the public hospital systems in other states (eg ONCALL Interpreting services or Victorian Interpreting and Translating Services [VITS]).

SPOKEN LANGUAGE INTERPRETERS

To book an interpreter in advance (essential for on-site interpreting), the following online form can be used: http://www.tisnational.gov.au/Agencies/Forms-for-agencies/New-Job-booking-form The person doing the booking will need to know the code number of the ward, team, or (for Calvary Hospital) the whole hospital. Once you have found out this code number please display it prominently in the ward. NB: You do not have to provide the patient’s name when booking. Say it’s confidential.

To access a telephone interpreter rapidly (3 minutes) please call the TIS Doctors Priority Line on 1300 131450 OR 1300 . Try to find a speaker phone, or the consultation will be longer than necessary. You will need to give them the hospital code number. Once you have found out this code number please display it prominently in the ward.

In private practice, the doctor should have a code number. If they don’t have a code number, TIS can give them one over the phone, or you can encourage the practitioner to sign up online here: http://www.tisnational.gov.au/Agencies/Forms-for-agencies/Register-for-a-TIS-National-client-code

SIGN INTERPRETERS

TO BOOK AN AUSLAN INTERPRETER (DEAF PATIENTS), CONTACT NABS (THE NATIONAL AUSLAN INTERPRETER BOOKING SERVICE). PHONE: 1800 246 945. ONLINE BOOKING

SERVICE: HTTP://WWW.NABS.ORG.AU/BOOK-AN-INTERPRETER.HTML

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NABS will assist you in facilitating a consultation over skype for people on rural placements. NABS can book interpreters for deaf-blind patients. Make sure that you find out the sign language the person uses. Auslan is closely related to British Sign Language (BSL) and NZ Sign Language (NZSL). American Sign Language (ASL) is a different language. NABS will be able to find an ASL interpreter upon request.

HEALTH SUPPORT MATERIAL IN OTHER LANGUAGES

Have a look at the material indexed on the Victorian Health Translations Directory (most extensive in the world) http://www.healthtranslations.vic.gov.au/ and the NSW Multicultural Health Communications Service http://www.mhcs.health.nsw.gov.au/ (not as fancy but the website is functional and the material is all developed in Australia). Always check the English translation before using these materials. This seems self-evident but all of us have given patients the wrong health information material in a hurry.

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FEEDBACK FORM: WORKING WITH INTERPRETERS Student Name: _____________________________________________________________________ Student Number: ___________________________________________________________________ Observer Name: ____________________________________________________________________ Observer Signature: _________________________________________________________________ Details of Interpreted Consultation

Date of Consultation: ________________________________________________________________

Location of Consultation: _____________________________________________________________ Type of interpreter (Please Circle):

Telephone / Onsite Language: _________________________________________________________________________ Purpose of consultation: ____________________________________________________________________________________________________________________________________________________________ Observer Feedback The student introduced himself/herself to the patient (Please Circle):

Yes / No The student made eye contact with the patient, rather than the interpreter (Please Circle): Yes / No The student spoke in the first person when talking to the patient (“I would like to ask you some questions about…”) (Please Circle):

Yes / No The student’s speaking style was clear and included pauses for interpreting (Please Circle):

Yes / No

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The student’s questions demonstrated that they had listened to the patient’s interpreted responses (Please Circle):

Yes / No [On site]: The student’s body language was appropriate (Please Circle):

Yes / No Interpreter Feedback: The student’s consulting style was easy to interpret (Please Circle):

Yes / No Any areas for improvement? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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