A medicolegal curriculum for internal medicine residents

On legal guardianship: An exploratory assessment of knowledge, attitudes and practices of resident physicians

BACKGROUND

Clinicians encounter patients under legal guardianship. We aimed to assess the knowledge, attitudes and practices (KAP) on legal guardianship in residents.

METHODS

A KAP pilot survey about legal guardianship was developed by an interdisciplinary medicine-law-public health team and was distributed via institutional email to internal medicine, psychiatry, and neurology residents in a single academic institution.

RESULTS

Of the 172 invited residents, 105 (61%) responded and 102 surveys were included in the final analysis. Most respondents (58% women; internal medicine 73%, neurology 15%, psychiatry 12%) had attended 42 medical schools from 16 countries and had heard about guardianship (88%), but only 23% reported having received training on guardianship during medical school or residency. The vast majority (97%) understood the intended benefit of guardianship, but only 22.5% reported knowing that guardianship removed an individual's decision-making rights. Nearly half (47%) of respondents reported never having asked for documentation to prove that an individual was a patient's guardian, and only 15% expected to see a court order as proof of guardianship status.

CONCLUSIONS

Although most residents intuitively understood the intended benefit of guardianship, they did not understand its full implications for clinical practice. Training interventions are warranted.

Knowledge and Perceptions of Health Workers' Training on Ethics, Confidentiality and Medico-Legal Issues

Introduction

Health care delivery in recent times has become more complicated, as patients expect health personnel to not only provide professional services but be accountable as well. It is thus imperative that health personnel are aware of their responsibility to the patient and also sensitive to medico legal issues if quality health care is to be assured.

Objective

The aim of the study was to assess the knowledge and perception of health care workers on their training in ethics, confidentiality and medico-legal issues. It was expected that the results would inform policy on the training of the health workers.

Method

A cross-sectional survey was conducted among some categories of health workers (Doctors, Nurses and Health care assistants) at the Accident and Emergency directorate of Komfo Anokye Teaching Hospital, Ghana. A self-administered questionnaire was used to elicit information on ethics, confidentiality and medico- legal issues. Data collected was analyzed using SPSS version 16.

Results

A total of 103 health care workers were enrolled on the study representing 96% response rate. The study revealed that 74% had knowledge on ethics, confidentiality and medico- legal concepts; and 35.4% of the respondents indicated that health workers attitudes to ethics, confidentiality and medico- legal concepts was inadequate. About 28.3% indicated that their attitudes were good while 26.3% indicated attitudes were adequate with only 2% indicating that attitudes were very good. Nearly, 49% of the respondents also indicated that training on medico-legal issues should be taught during formal training and also on-the-job.

Conclusion

Knowledge of health workers on ethics confidentiality and medico-legal issues is high and their perceptions are positive. However, regular training to update their knowledge will be necessary in order to ensure continuous improvement of the quality of health care delivery.

Learning the law: practical proposals for UK medical education

Ongoing serious breaches in medical professionalism might be avoided if UK doctors rethink their approach to law. UK medical education has a role in creating a climate of change by re-examining how law is taught to medical students. Adopting a more insightful approach in the UK to the impact of The Human Rights Act and learning to manipulate legal concepts, such as conflict of interest, need to be taught to medical students now if UK doctors are to manage complex decision-making in the NHS of the future. The literature is reviewed from a unique personal perspective of a doctor and lawyer, and practical proposals for developing medical education in law in the UK are suggested.

Evaluation of a sequential structured educational curriculum for emergency medical technicians in airway management

Background and Aims:

Emergency medical technician (EMT) training programs for certification vary greatly from course to course, but it is necessary that each course at least meets local and national requirements. It is reasonable to expect that EMTs’ performance should improve after a structured educational curriculum. We hypothesized that EMTs’ performance in airway management would improve after a sequential structured educational curriculum involving airway, followed by cardiopulmonary resuscitation (CPR) modules, beyond what is achieved after only the airway module.

Materials and Methods:

To evaluate this, 76 EMTs were assigned to a 2-week airway module with a structured curriculum. This was followed by the 2-week CPR module, and the EMTs were tested before (preCPR test) and after (postCPR test) the CPR modules for improvement in their airway skills. EMTs also completed a questionnaire to evaluate the curriculum.

Results:

PostCPR test mean scores were higher than those of the preCPR test (P < 0.05) except for the bag valve mask domain. EMTs evaluated the curriculum and gave a score of 3.7/5 for perceived achievement of goals of the syllabus for improving their airway skills.

Conclusion:

Thus, a sequential, structured curriculum in airway management followed by CPR, improves EMTs’ performance levels above what they achieved after only the airway module, except for bag valve mask ventilation.

Medico-legal education: a pilot curriculum to fill the identified knowledge gap

PURPOSE

We sought to determine if a medico-legal educational curriculum designed to increase physicians' familiarity with the legal system in a nonthreatening environment-a didactic and interactive educational seminar-would positively influence learners' knowledge base and self-awareness.

METHODS

Because neither the Accreditation Council for Graduate Medical Education nor its Residency Review Committees specifically addresses medico-legal liability education, we designed a 2-day intensive medico-legal educational curriculum and piloted it in 2007 and 2008 at a large academic tertiary-referral medical center. Postcurriculum evaluations and precurriculum and postcurriculum testing were used to identify areas of common and/or persisting knowledge deficit.

RESULTS

A total of 50 graduating residents, fellows, and community practitioners participated in the course. Common areas of knowledge deficit were "privilege," "discovery," statutes of limitations, and basic legal procedure. Discordance in physician interpretation of patient perspective and misunderstanding among physicians of the impact of the legal suit were evident.

CONCLUSIONS

Concentrated legal education at selected times during medical training may support physicians' motivations to improve the assurance of quality and continuity of care. We continue to revise the curriculum to address issues of lecturer style, lecture content, and overall attitudinal values related to clinical practice, legal education, long-term impact on practice patterns, job satisfaction and its effect on attention to quality and continuity-of-care issues, and health care provider attitudes about the provider's role within the legal system and the community. We plan to conduct follow-up of participants to assess retention and subsequent use of this knowledge.

Current Status of Obstetrics and Gynecology Resident Medical–Legal Education

OBJECTIVE

To assess the level and type of medical-legal education offered to obstetrics and gynecology residents and medical students.

METHODS

All obstetrics and gynecology program directors (n = 252) were asked to complete a survey questioning the availability of, type of, and desire for medical-legal education within their programs.

RESULTS

Seventy-eight percent of the program directors answered the survey with 86% reporting some degree of formal medical-legal education. The most common formats were didactic lectures (38%), grand rounds (30%), case conferences (19%), mock trials (9%), and other (4%). These sessions most commonly contained information on proper documentation (48%), testifying (25%), and giving a deposition (24%). The average number of sessions per year was 4.1 with a median of 3 sessions per year. Despite this high percentage of some formal education, 88% expressed an interest in pursuing other educational options on these topics.

CONCLUSION

Most obstetrics and gynecology residency programs provide some form of medical-legal instruction to residents, but the small number of sessions suggests that this is inadequate. Residency programs may benefit from a larger and more formal resident education program on medical-legal issues.

Teaching systems-based practice to residents by using independent study projects

The changing health care marketplace requires new graduates to be familiar with complex health systems. Since 1999 the Oregon Health & Science University internal medicine residency program has offered a seminar-based health systems curriculum, but residents lacked an opportunity to actively apply learned concepts. To achieve this goal, the authors developed a second curricular component, the Health Systems Independent Study Project (HSISP). The HSISP is a self-directed assessment of a health care system or delivery issue residents complete in their third year. The curriculum was implemented in 2001 with goals of gaining a focused understanding of a health systems concept and building related skills. Residents present their study projects to all curriculum participants. Topics addressed so far include adherence to coronary artery disease guidelines in a defined population, screening strategies for lung cancer, resident burnout, and many others. Residents have found that these projects enhance their systems knowledge, help them link systems-based-practice concepts to clinical practice, and foster opportunities for networking and early career development.