Experience and Growth Make’th the Man

Over the past 4 years I have experienced so much growth; however it came with many failures and great results as well. The aim of my written piece is to reflect back over the past year as a physiotherapy student.  To reflect on the professional, personal and ethical development that took place within myself, my skill and knowledge.  Many scenarios and events over the past few years have shaped me into becoming a better professional by improving not only my skill but my thinking as well by allowing me to reach outside of my comfort zone and expand my thinking beyond the class, into real world scenarios.. The easiest way for me to reflect on the changes I noted within myself was to establish the definitions of the respective words and evaluate whether I have met those expectations of the words. Definitions such as continuing professional development, personal development and ethics are a few words that helped me along my journey.

Continuing professional development (CPD) is defined as a range of learning activities through which health and care professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely and effectively within their evolving scope of practice. Put simply, CPD is the way registrants continue to learn and develop throughout their careers to keep their knowledge and skills up-to-date and can work safely and effectively (“HCPC – Health and Care Professions Council – Continuing professional development (CPD)”, 2016). Similarly According to (“Business Directory Definitions”, 2016) Personal growth and development is defined as  the process of improving oneself through such activities as enhancing employment skills, increasing consciousness and building wealth through the development of skills and acquiring knowledge leading to a successful occupation and competence in the working environment. And lastly the health professions council of south Africa (hpcsa) defines ethics as “moral principles”. Within the health care field there are standards which must be met and maintained with regard to ethics (Health Professional Council of South Africa, 2008).

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“Knowledge comes from learning. Experience comes from living. A life without problems is like a school without lessons. Keep doing your thing…”- Frankie John. This quote leads me to an event that recently occurred during one of my clinical block rotations. As a fourth year student, I should have known that I needed to be prepared for whatever situation I was placed in, however we are always looking to take the easy way out. During one of my clinical block rotations I was placed within the Intensive Care Unit (ICU). This specific ICU was designed for patients who had cardiothoracic complications. Upon arrival I was extremely excited at the prospect of helping people whose lives depended on medical and physiotherapy intervention. Being that I was in my second block rotation as a fourth year student, I knew that at the end of the year there was a possibility that I could be sent back for my unseen exam where I could be examined on the ICU patients. I was assured by my clinical supervisor who is also the clinical co-ordinator of the clinical practice module that we would not be examined in an ICU we had not been exposure to during the year. This set me at ease and allowed me to fully understand the knowledge and skills the physiotherapist within the ICU was teaching me.

The warm, humbling feeling I felt when a patient who relied on ventilatory support and excessive chest physio suddenly makes a remarkable recovery and can be moved to the wards was an overwhelming and heart-warming experience. I soon became comfortable and confident within my assessment and treatment of cardiothoracic patients in the ICU. I was prepared that this was where I could have my unseen examination and if I was sent to that specific unit I felt that I would be confident enough to examine and treat the patient.

As fate would have it, I was sent to Cardio thoracic ICU for my final unseen exam to the cardiothoracic unit at Grootes schuur ICU. For weeks on end I had been hoping and praying that I would get to do my unseen exam at the ICU I attended as it was one of the best experiences I ever had on a clinical rotation. For an unseen assessment exam, the student receives the  patients file an hour prior to the examination, where you get to extract valuable information pertaining to the patient that will help in the optimal management of the patient. Going through my patients’ folder I realised that the patient I received was not a normal, classified cardiothoracic patient. This patient belonged within the Acute spinal cord injury icu.

The patient was a  17 year old male with multiple gunshot wounds which left him paralysed from C7, accompanied with various internal injuries and surgical intervention had not yet been implemented. The amount of confidence I had on entering the exam slowly began withering away as I realised that this patient required a type of management, with certain precautions and contraindications I was not accustomed to.  I decided to call my supervisor who blatantly told me I had to continue with my examination as there was nothing she could do. According to her she understood the concern at hand and would inform the marker about the situation however her hands were tied. The risk of me failing was high, but not as high as the lack of confidence I had in the examination. I stared at the wall clock and realised I had wasted 15 minutes of my time and decided to use the next 45  minutes to thoroughly prepare myself for a good outcome. I began researching the precautions and contraindications associated with spinal cord injuries (SCI) to refresh my mind. I looked up previous notes and literature for confidence on appropriate assessment techniques, principles of management and to familiarize myself with different types of Spinal cord injury levels and their classifications.

Finally the exam began and I had to assess the patient to the best of my ability. The examiner who was an external from another university seemed impressed and said that she thought my approach to the situation was very professional. She understood that I was not exposed to any SCI patients but she felt I showed growth as a student knowing that I could not go into an examination unprepared. She emphasised that she was happy I did some research beforehand as I did not make the situation about myself but made it about the patient as I could not manage him with lack of knowledge and skill. I managed to answer questions to the best of my ability, even though I was not 100% knowledgeable on all things SCI, I was  happy with the quality of information I produced within the set of time given.

According to Nortjé & Esterhuyse, (2015) an assumption that higher moral reasoning is a desirable quality for healthcare providers is supported by research that shows a correlation between moral reasoning ability and good clinical performance. However, moral reasoning (ability to distinguish between right and wrong and good and bad) can only begin, as a cognitive process, once a problem has been identified. This is disconcerting, as a considerable body of evidence indicates that people have little, if any, insight into what constitutes a moral problem and the processes underlying their judgements (mainly evaluations or estimates) and decisions (an intention to pursue a particular course of action), causing their moral behaviour to be based essentially on rationalisation. According to Kohlberg’s cognitive moral development theory, an individual must first become aware of an ethical issue before ethical judgement processes are likely to be triggered (Kohlberg & Hersh, 1977).

Sheehan, Robbins, Porter, & Manley (2015) discuss the failure in development in moral reasoning at medical school addresses an issue of great concern. It is of paramount importance for doctors to be capable of sophisticated ethical and moral reasoning, as this promotes a consideration of patients on an individual level and the adoption of a holistic approach to their care. The resultant concordance of doctor and patient may increase the likelihood of mutually satisfactory decisions, patient compliance and beneficial clinical outcomes. The finding that medical students do not seem to progress their moral reasoning is concerning.

Nortjé & De Jongh (2015) states that Ethics in healthcare is an important determinant of the professional outcomes for  therapists’ daily professional practice. The Health Professions Council of South Africa (HPCSA) places great emphasis on ethical behaviour towards clients and expects registered professionals to act accordingly. Occupational therapy (OT) students are expected to work in a variety of contexts and they experience many sources of conflict in their fieldwork practice on a daily basis, while at the same time upholding professional values, responsibilities and duties. This conflict results in ethical dilemmas, such as when an individual faces two or more equally stressful alternatives that are mutually exclusive. According to Pauly et al 2012. moral conflict is closely associated with the ethical dimensions of practice. In accordance with the Occupational Therapy Professional Board’s Minimum Standards for the Training of Occupational Therapists, the curricula should include ethics as part of the undergraduate training programme. Research indicates that OT students are mostly aware of the correct course of action, but often feel constrained to act in another way as a result of institutional and/or societal rules.  Ethics training strives to facilitate critical thinking, objective analysis and clinical reasoning skills to equip students with the ability to make an impartial and unbiased decision in different contexts and diverse client populations, which enhances students’ learning experiences.  Ethical training is guided by a consequential framework, where the outcome should guide the behaviour of clinicians, or a rule-based (deontological) approach, where rules (i.e. codes of ethics) should guide the conduct of a professional.

below is a video on the do’s and dont’s to ensure great personal development and ethics..

“proper preparation prevents poor performance”- unknown.

References 

Business Directory Definitions. (2016). BusinessDictionary.com. Retrieved 6 November 2016, from http://www.businessdictionary.com/definition/professional-development.html

HCPC – Health and Care Professions Council – Continuing professional development (CPD). (2016). Hpc-uk.org. Retrieved 7 November 2016, from http://www.hpc-uk.org/registrants/cpd/

Health Professions Council of South Africa. (2008). Guidelines for Good Practice in The Health Care Professions. Seeking Patients’ Informed Consent: The Ethical Considerations. Booklet 9 (Pp. 2-16). Pretoria.

Kohlberg, L. & Hersh, R. (1977). Moral development: A review of the theory. Theory Into Practice, 16(2), 53-59. http://dx.doi.org/10.1080/00405847709542675

Nortjé, N. & Esterhuyse, K. (2015). Changing students’ moral reasoning ability – is it at all possible?. AJHPE, 7(2), 180. http://dx.doi.org/10.7196/ajhpe.385

Nortjé, N. & De Jongh, J. (2015). Ethical dilemmas experienced by occupational therapy students – the reality. AJHPE, 7(2), 187. http://dx.doi.org/10.7196/ajhpe.396

Pauly BM, Varcoe C, Storch J. Framing the issues: Moral distress in health care. HEC Forum 2012;24:1-11.

Sheehan, S., Robbins, A., Porter, T., & Manley, J. (2015). Why does moral reasoning not improve in medical students?. International Journal Of Medical Education, 6, 101-102. http://dx.doi.org/10.5116/ijme.55d4.c8e4

 

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