Whether you’re working with a partner, conducting a site visit, doing research, or getting to k now folks in a community, it helps to think through the before, during, and after to create a comfortable, safe, and reciprocal experience
GOAL: Appreciate the idea of aftermath of medical error and idea of provider as second victim..
Context and Instructions: Read article to begin to appreciate medical errors can have on providers and get introduced to a way of thinking of how to support ourselves and colleagues who experience the aftermath of a medical error.
GOAL: Understand how to access different sources of information depending on your question.
Instructions: Actively watch video to help understand differences between types of questions and available resources to answer them.
3) Write some PICO questions of your own
Develop 2-3 PICO question of your own to share in class tomorrow. It may help to think about a patient you have seen or a case discussed during Foundations or EHM so far. You can use the PICO diagramming tool to record your questions. Be prepared to share and discuss.
Goal: Apply the concepts of toxic stress and adverse childhood events to the cycle of interpersonal violence, and identify opportunities for clinician intervention.
Context and Instructions: In this JAMA article, Sumner et al explore the epidemiology of interpersonal violence, the effect of childhood exposure to violence on lifetime risk of violence and adverse health, and opportunities for community and clinician intervention.
Goal: Describe the proposed pathophysiologic mechanisms of toxic stress’ effect on health across the lifespan and the mediating effect of known resilience factors.
Context and Instructions: In this Pediatrics article, Shonkoff et al, delve into the science of toxic stress on the developing brain and the moderating effect of resilience factors. Based on this science, they propose an “ecobiodevelopmental framework” from which the clinicians of the future should approach primary care.
Goal: For students who want to read the Kaiser study that introduced the idea of ACES and the impact on health. A caveat that some language in this original paper (“family dysfunction”) would not be used in the trauma informed care environment that this work ultimately produced.
This article presents an overview of the mechanisms by which community-based organizations can contribute to community well-being. Consider the implications for local communities you have worked in, and think about questions you’d like to ask panel members about their work.
GOAL: Develop a preliminary grasp of using ethical frameworks that focus on social relations (see Ethics Worksheet Explained) and compare them to other ethical approaches covered thus far in the course.
Review these key ethics terms before turning to the video and reading:
2) Watch video of Carol Gilligan on Moral Development and Care Ethics.
GOAL: Understand the basics of care ethics and how it might apply to the clinical setting.
Consider what is different about the approach that Gilligan is suggesting (i.e. a relational or Care Ethics based approach) from what you typically think of in terms of your ethical obligations as physicians.
GOAL: Consider what you learned from Gilligan’s video and the above ethics key terms in this complex case of refusal of life sustaining treatment (LST).
Consider this is just one instance among a myriad of different clinical-community interactions. It will help us to begin to see the importance and sometimes the difficulty of respecting and valuing different community-based and relationship-based values and beliefs.
Have you ever found your own personal and community-based beliefs to be in tension with the norms of the institution of medicine?
IHI online open school. Optional assignment: Students complete the online curriculum and assessment for certificate program. To provide greater detail and context for the material covered in class. Recommended for students pursing a certificate in quality and safety.