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Zhu Y, Li S, Zhang R, Bao L, Zhang J, Xiao X, Jiang D, Chen W, Hu C, Zou C, Zhang J, Zhu Y, Wang J, Liang J, Yang Q. Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial-a stepped wedge cluster randomized trial protocol. BMC Psychiatry 2023; 23:476. [PMID: 37380993 DOI: 10.1186/s12888-023-04948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships. METHODS A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions. DISCUSSION Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate. TRIAL REGISTRATION AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW.
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Affiliation(s)
- Yunying Zhu
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Sisi Li
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Ruotong Zhang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Lei Bao
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Jin Zhang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Xiaohua Xiao
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Dongdong Jiang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Wenxiao Chen
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Chenying Hu
- Community Health Service Center in Jiangcun Street, Hangzhou, 310050, Zhejiang Province, China
| | - Changli Zou
- Community Health Service Center in Sandun Town, Hangzhou, 310030, Zhejiang Province, China
| | - Jingna Zhang
- Community Health Service Center in Liuxia Street, Hangzhou, Zhejiang Province, 310050, China
| | - Yong Zhu
- Xu Zhen Town Center Health Center, Wuhu, 241306, Anhui Province, China
| | - Jianqiu Wang
- Community Health Service Center in Jishan Town, Wuhu, 241307, Anhui Province, China
| | - Jinchun Liang
- Nanling County Traditional Chinese Medicine Hospital, Wuhu, 241307, Anhui Province, China
| | - Qian Yang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China.
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Chen WT, Fu CP, Chang YD, Shiao YC, Chen PY, Wang CC. Developing an innovative medical ethics and law curriculum-constructing a situation-based, interdisciplinary, court-based learning course: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:284. [PMID: 35428246 PMCID: PMC9011998 DOI: 10.1186/s12909-022-03349-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Traditional lecture-based medical ethics and law courses deliver knowledge but may not improve students' learning motivation. To bridge this theory-to-practice gap and facilitate students' learning effectiveness, we applied situated-learning theory to design an interdisciplinary court-based learning (CBL) component within the curriculum. Our study aimed to investigate students' learning feedbacks and propose a creative course design. METHODS A total of 135 fourth-year medical students participated in this course. The CBL component included 1 h of introduction, 1 h of court attendance, and 2 h of interdisciplinary discussion with senior physicians, judges, and prosecutors. After the class, we conducted a survey using a mixed-methods approach to gauge students' perceptions of engagement, performance, and satisfaction. RESULTS A total of 97 questionnaires were received (72% response rate). Over 70% of respondents were satisfied and felt that the class was useful except for role-playing activities (60%). More than 60% reported a better understanding of the practical applications of medical law. Approximately half (54%) reported less anxiety about medical disputes. 73% reported that the lecture provided awareness of potential medical disputes, and most respondents expressed an interest in medical law courses after the court visit (78%). 80% of the respondents were able to display empathy and apply mediation skills. Qualitative analyses showed that students demonstrated new knowledge, including recognizing the significance of the medical profession, distinguishing the importance of physician-patient communication, having confidence in the fairness of the justice system, and being willing to increase their legal knowledge. CONCLUSIONS CBL curriculum increases students' learning motivation in strengthening medical professionalism and medical law, develops students' empathy for patients and communication skills, as well as builds up students' trust in the justice system. This novel course design can be applied to teach medical ethics and law.
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Affiliation(s)
- Wan-Ting Chen
- Present Address: Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, 11490 Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 11490 Taipei City, Taiwan
| | - Chung-Pei Fu
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, Taiwan
| | - Yan-Di Chang
- Center of Medical Humanities Education, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 11490 Taipei City, Taiwan
| | - Yi-Chih Shiao
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 11490 Taipei City, Taiwan
- Present Address: Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, 11490 Taipei City, Taiwan
- College of Law, National Chengchi University, No. 64, Sec. 2, Jhihnan Rd., Wunshan Dist., Taipei City, 11605 Taiwan
| | - Po-Yi Chen
- Center of Medical Humanities Education, School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 11490 Taipei City, Taiwan
| | - Chih-Chia Wang
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 11490 Taipei City, Taiwan
- Present Address: Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, 11490 Taipei City, Taiwan
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Wu KJ, Chen YW, Chou CC, Tseng CF, Su FY, Kuo MYP. Court decisions in criminal proceedings for dental malpractice in Taiwan. J Formos Med Assoc 2021; 121:903-911. [PMID: 34663527 DOI: 10.1016/j.jfma.2021.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE Malpractice claims place heavy economic and emotional burdens on both dentists and patients. Recently, medical malpractice lawsuits are decreasing in prevalence but increasing in severity. The percentage of dental malpractice payments is also growing among the health profession. The present study aimed to explore criminal convictions in dental malpractice litigation and to analyze the factors affecting the judgment in dental disputes in Taiwan. METHODS The keywords "dentist," "professional negligence," "medical malpractice," and "professional liability" were used to search Taiwan's Law and Regulations Retrieving System for criminal dental malpractice cases in all district courts from January 1, 2000 to June 30, 2021. The eligible judgments were summarized and analyzed. RESULTS Overall, 425 cases were identified, with 28 dental disputes included in the final analysis. The dentists lost in 10 cases (35.7%). The average claim time was 36.75 ± 16.34 months. Taipei and Taichung dealt with more lawsuit cases (n = 8). Local clinics were the most common institution of the defendants (75%) and had the highest number of convictions (n = 9). Implant dentistry was the most common specialty involved. Expert testimony of the Medical Review Committee (MRC) had a high K coefficient of agreement with court judgments regarding professional negligence (p < 0.001). CONCLUSION The overall criminal conviction rate was 35.7%. Implant therapy and local clinics had the highest rate of lawsuits and a considerably higher conviction rate. All guilty dentists were fined or given probation. The court judgments were highly consistent with the expert testimony of the MRC.
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Affiliation(s)
- King-Jean Wu
- Department of Dentistry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan; College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Yi-Wen Chen
- Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan; School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chu-Chun Chou
- Department of Legal Affairs, Taiwan International Cooperation and Development Fund, Taipei, Taiwan
| | - Chien-Fu Tseng
- Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Fang-Ying Su
- Biotechnology R&D Center, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Mark Y P Kuo
- Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan; School of Dentistry, National Taiwan University, Taipei, Taiwan.
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