The Wrap Up (My professional and ethical development journey in 2016)

Dineo Mothogoane                                                                                                          3304805

“Education is not the learning of facts but the training of the mind to think”_ Albert Einstein

The start of any academic year can be stressful I think that this is more true when it is your final year. Earlier this year at my first block I was assigned two 3rd year students that were instructed to shadow me for a week in order to learn and adapt to being in the clinical setting, I found this ironic as I did not know what I was doing as behind my mask of confidence was a confused second year trying to puzzle things together. I pulled the students to the side and informed them that although I was in 4th year I did not have the answers to everything and I would be learning just as they are learning. In retrospect this would be the exact attitude I want to have in every setting as I press on to learn and not necessarily be the fount of all knowledge.

Our first ethics class was one that required self-reflection on which characteristics we thought the perfect clinician should embody but most importantly if we measure up to the image we have in our heads, this created conversation within the class but I instantly knew that I was nowhere near all of the 40 characteristics mentioned in class. The idea of holding people accountable to standards that we ourselves cannot uphold all the time felt hypocritical to me. I contemplated making this writing piece on how I do not compare to this ideal clinician at the moment and how I am willing to work towards getting closer to the 40 character traits but decided against it as I would rather write about what seems to be a movie blooper reel to my ethical and professional development journey in 2016. pov

Understanding the distinction between right and wrong may seem like an easy task but clinical practice has showed me that regardless of what I think is right the next person may not. In my previous post, The Bone Toss, I wrote about being challenged as I was assigned a traditional healer to treat, but they did not believe in ‘western’ medicine and felt that as a black person I should subscribe to the same belief even though I am Christian. That would be one of many situations that I found myself having a different stance to my patient’s beliefs but still having to acknowledge and respect the contrasting views. Traditional, cultural and religious norms form a big part of people’s lives, it impacts the view of which we have of the world (Groff& Smoker, 1996). I personally am not from a traditional or patriarchal household and so when I had a male traditional patient who demanded I change the tone of my voice, not make eye contact during sessions and not give instructions to him as he was a man definitely challenged me. Many times I wanted to skip him and say that he refused treatment, but that would have denied both of us the opportunity to learn from each other and adapt accordingly by accepting that due to the diversity of our backgrounds we probably would not see eye to eye on all issues but we both had the same goal of getting him to his previous level of functioning. There would be other presumably simple situations like choosing to treat frail and elderly patients first at a community healthcare center as policy states, but when a patient has been in the line from 6 o’clock in the morning there is no way to reason with them. Research shows that patient-participation in medical decision making has been associated with patient satisfaction (Davis, Jacklin, Sevdalis, & Vincent, 2007). Furthermore, research shows that waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming and incredibly expensive (Buffa, 1983). This affects the perception of quality of care negatively as patients are not made to feel as though they are priority which is contrary to the principles the healthcare system subscribes to in the Batho Pele initiative. This made me do research as waiting is often unavoidable and found that people responded well to being informed why they are waiting, how long it would take for them to be seen or simply giving them a task to complete whilst they wait like fetching their folder or filling out forms.

The term “profession”  means  “a  dedication,  promise  or  commitment publicly  made. To  be  a  good  health  care  practitioner,  requires  a  life-long  commitment  to  sound  professional  and  ethical  practices and an overriding dedication to the interests of one’s fellow human beings and society. _HPCSA

Watch: Video of Michael Sandel addressing Justice: What is the right thing to do

 

My quest to becoming a professional has been filled with various stumbling blocks as I had to almost develop an alter ego in dealing with the day to day requirements of being at clinical practice. I am usually the first to have an attitude towards things I do not agree with like an overwhelming patient load that impacts treatment times which impact treatment outcomes and is related to time management. All of this has a domino effect and add on clinicians that undermine and you as a student it is enough to make me scream, internally of course, as I have learned that most times complaining was associated with incompetence.

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According to Stern (2006) as a future physiotherapist I am expected to consistently demonstrate core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication and accountability, and by working together with other professionals to achieve optimal health and wellness in individuals and communities. This becomes a challenge when you find yourself in situations where  it is much easier to be unprofessional, in my post “Hands off physio” I addressed a scenario I found myself in when a patient had physically infringed on my rights which scared me as there was no one around and had I not been in this role of being a ‘professional’ I would have most likely retaliated.  Professionalism still feels like a mask and not part of who I am to be honest, the Health Professions Council of South Africa is a structure of which health care practitioners are required to subscribe to certain rules of conduct. To this end the Health  Professional  Council  of  South  Africa  has formulated  a set    of    rules    regarding    professional    conduct    against which complaints   of   professional   misconduct   will   be   evaluated (HPCSA, 2008). Having a formal structure is great in the grand scheme of things as this gives a guideline which is important when trying to avoid chaos, but this is challenging when in  situations when you are expected to provide everyone with the same quality of care. In my previous blog post ‘Warm Klaap’ I address abuse and how I laughed when my patient’s girlfriend slapped him whilst he was in hospital (infringing on his rights) as she was admitted multiple times after he had physically abused her. My conduct in that instance was not reflective of a professional as I did not emphasized with my patient as he was often the abuser but I also failed to see his girlfriend as an aggressor and how this potentially could have continued the cycle of abuse. Professionals are expected to emphasize  with patients and family members especially after death but this was a challenged as I had felt desensitized, I elaborate on this further in my blog post ‘ Live With Death’.

The strikes around universities in South Africa has had a big impact on me in various ways, specifically with  regard to clinical as I was placed at the campus clinic which I thought was perfect initially as I would have no traveling costs because I live on campus. This was short lived as strikes began which resulted in me being sent to a different block which required me to adapt and adjust faster than I would elsewhere as I had 2 weeks till my final seen exam. My colleague and I were greatly disappointment as our new placement did not have enough patients for the students that were there already let alone new students, this meant that we had to move yet again.

Watch video: Medical student confronting BBC reporter after attempting to report on effect of Fees Must Fall on medical campus without consent

At our new placement we fortunately had plenty of patients to see, but we still had to adapt  which was a tedious process even with the help of our peers, I cannot count the times I wanted to complain about how this situation disadvantaged us. In our final week on the way to the shuttle we were met with a group of protestors carrying sticks that threatened us to not go work and return to campus, we then returned to campus but had a colleague pick us up in order to get to work as getting to work was important and seeing our patients had become a priority. A few days later strikes escalated and I was unfortunately tear-gassed twice by the police and had to move off campus until my last clinical exam in the a few days. fees-must-fall

On the day of my final seen exam I was scheduled to go second but earlier that day my back up patients cancelled and my exam patient did not show up for my exam. Naturally I wanted the earth to open up and swallow me but as though I was not crumbling inside I made attempts to call my patient, I failed to get a hold of him so a contingency plan was made and I was given 20 minutes to assess a new patient and would have my exam immediately after my peer was done with her exam. I said a prayer under my breath and did as I was instructed and sure enough it was time to start my exam, I than took on a different persona and before I knew it the exam was done. It was at that point that I realized how much I had developed, a few years or months ago this situation would be enough to gather storm clouds in my eyes. I had in some way, learned to use stress as a fuel and not a hindrance. I also realized that this time I had an archive of challenges and situations that I had overcome and that it is with the overcoming of each small obstacle that brought me closer to the ultimate goal.

Watch video: Clinical health psychologist Kelly McGonigal on how to make stress your friend which is contrary to what research has been saying for years.

Critical thinking, readiness for self-reflection, and professional development have recently been emphasized as important goals of medical education (Sobral, 2000).  According to Smith& Irby (1997) refection is a multifaceted concept which stands for a number of ideas and activities. It comprises the act of thinking about what one has learned as well as how one learns, and seems to be an essential element in the ideal learning cycle. Reflection, both on the process and the content of learning can help students to control their learning even in   constraining   circumstances. The rationale   for encouraging reflection in the promotion of self-directed learning is extensive, reflection is conceived as one of the metacognitive skills or cognitive regulation strategies required for the development of self-regulated learning, from a theoretical viewpoint (Kuiper & Pesut, 2004).

It is essential for the development of professional identity that the student develops a realistic view of the challenges and opportunities of the profession (Wilson, Cowin, Johnson & Young, 2013). Identity formation consists of exploring the available alternatives   and   committing   to   some   choices   and   goals. Self-reflection has been a big part of this journey which started in 2nd year clinical practice when uploading reflections on Touch or in reflective pieces that are structured to ask what happened, what we learned and how do we plan on improving the next time. This has then revealed areas of strength and weakness in my clinical practice  and redirected the problem to me in order to find a solution. Solutions have , for me, often been found in seeking to better understand patients, managing my time better, planning in advance and beginning tasks with the goal in mind.

This journey has not been  about the destination but one of learning to maneuver and navigate through challenges and even as the environment changes your principles do not. I refer to professionalism as a mask or alter ego in this writing piece as it is still something I am learning to be and although it is a little big on me I hope to one day grow into it, embody it and have it be a part of who I am. Until that day I will continue to be challenged, be wrong, start over and ask why in order to better find a solution or clarity through this process of learning and unlearning.

The Lord bless you
    and keep you;
25 the Lord make his face shine on you
    and be gracious to you;
26 the Lord turn his face toward you
    and give you peace._ Numbers 6:24-26

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suck

 

References

Buffa, E.S. (1983), Modern Production/Operations Management. New York: John Wiley and Sons.

Davis, R. E., Jacklin, R., Sevdalis, N., & Vincent, C. A. (2007). Patient involvement in patient safety: what factors influence patient participation and engagement?.Health expectations, 10(3), 259-267.

Furlong, E. (2008). Right or wrong: legal and ethical issues and decision making. Decision-making in nursing: thoughtful approaches for practice. Sudbury, MA: Jones and Bartlett Publishers, 29-46.

 

Groff, L., & Smoker, P. (1996). Spirituality, religion, culture, and peace: exploring the foundations for inner–outer peace in the twenty-first century. The International Journal of Peace Studies, 1(1), 57-113.

Hendelman, W. & Byszewski, A. (2016). Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BioMed Central. Retrieved 6 November 2016, from http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-139

Health Professions Council of South Africa. (2008). General ethical guidlines for health professions . Pretoria: HPCSA.

Kuiper, R. A., & Pesut, D. J. (2004). Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self‐regulated learning theory. Journal of Advanced Nursing, 45(4), 381-391.

Smith CS, Irby DM.(1997). The roles of experience and reflection in ambulatory care education.Acad Med;72:32±41

Stern, D.T. (2006). Measuring Medical Professionalism. Oxford University Press. New York, NY.Vermont Ethics Network. (2011). Vtethicsnetwork.org. Retrieved  6 November 2016, from http://www.vtethicsnetwork.org/ethics.htm

Wilson, I., Cowin, L. S., Johnson, M., & Young, H. (2013). Professional identity in medical students: Pedagogical challenges to medical education. Teaching and learning in medicine, 25(4), 369-373.

 

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