undergraduates is not particularly large, but there are foreign students, and at the end of six years of study they must pass a national examination for medical and dental practitioners. To deal with this, fifth year students begin practical training prior to graduation. Of course, a large portion of this training is devoted to arriving at appropriate diagnoses based on a broad scope of knowledge spanning a variety of specialties. At the same time, however, the skillful management of medicalcommunication with patients is a major point not to be forgotten, and of course, the nonverbal aspects that accompany such verbal interactions are also of great importance even in Japan (Ishikawa, Hashimoto, Kinoshita, Fujimori, Shimizu & Yano, 2006), especially for foreign medical students as part of their overall communicative competence
AbstractThis study is concerned with the practice of invoking third parties among doctors and patients in Vietnamese medical consultations. These third parties are relatives of the patient who are also medical professionals. We show that doctors invoke relatives-plus-medical professionals in order to elicit information from patients, while patients adopt this practice in order to circumvent a troublesome administrative requirement; obtain a preferred form of treatment; receive a health-related service from the hospital, while also diminishing accountability for making this request in case it turns out to be irregular; give reasons for selecting the current hospital; or challenge the doctor’s expertise. Another possible motive is to receive special attention from the treating doctor. We suggest that doctors and patients are particularly inclined to invoke relatives-plus-medical professionals as third parties because of two social forces within Vietnamese culture: collectivism and social status. We also adduce evidence that, as a determinant of the patient’s future treatment for their problem, their familial relationship with the third party overrides this person’s status as a medical professional in this cultural context. More broadly, our findings indicate that medicalcommunication is not invariant across cultures, but can be shaped by culture-specific forces.
However, the methods of medical education in Hungary lag behind other countries. Prior to the initiative documented in this paper, no medical training centers incorporated simulated patient programs in their curriculum of graduate or postgraduate training. Interestingly, Béla Buda, the famous Hungarian psychiatrist, psychotherapist and writer of several medicalcommunication books, urged the improvement of medicalcommunication skills in 1986. Buda emphasized the necessity of developing empathy during medical education training and argued that understanding and perceiving major channels of verbal and non-verbal communication were essential (Buda, 1986). Moreover, Szili’s work discusses the challenges of treating ‘difficult’ patients and the importance of employing the necessary politeness strategies in order to facilitate more accurate history taking and initiating closer cooperation between the participants of the interaction (Szili, 2007). Therefore, the program in Pécs has been designed to address these issues.
interactions with patients, accountants’ interpersonal skills can also impact their interactions with clients. While there are some obvious differences between a visit to a doctor and a visit to an accountant, both share common elements of professional communication. Accountants and their clients will benefit from accountants developing their interpersonal skills. Clients’ satisfaction is likely to improve when they interact with accountants who have not only excellent technical skills but also well developed interpersonal skills. The benefit to accountants is that clear communication reduces the time lost in correcting misunderstandings. In addition, satisfied clients are more likely to make referrals. Approaches taken in effectively developing the interpersonal skills of doctors can be adapted for use in accounting education. It is recognised that accounting graduates will never gain all the skills they require while at university, as it is inappropriate to regard universities as surrogate employment and training agencies. However, there are certain levels of skills, including interpersonal skills that employers require of graduates (Helliar, Monk, & Stevenson, 2009). Students need to develop communication skills while they are at university and these can then be enhanced when they are in the workplace (Krause, 2007). The appendices provide helpful information for accounting educators who would like to enhance their current curriculum by specifically addressing students’ interpersonal skills. Appendix 1 provides a medicalcommunication training model adapted for accountant- client interactions, while Appendix 2 provides a listing of factors that need to be addressed when implementing interpersonal skills training as well as some helpful resources.
This paper presents our experiences in evolving the Virtual Objective Structured Clinical Exam (VOSCE) system. This system allows medical students to experience the interac- tion between a patient and a medical doctor using natural methods of interaction with a high level of immersion. These features enable the system to provide training on medicalcommunication skills. We discuss the experiences of a group of medical and physician assistant students that pilot tested the system. Further, we examine the impact of evolving the system based on their feedback. The VOSCE system’s performance in subsequent studies has indicated that end-user feedback improvements have significantly impacted overall performance and efficacy.
Our study has several limitations. The analysis was re- stricted to only 14 companies who made data available in 2010. It is possible that the distribution of funds from industry to vari- ous groups is different among those companies not included in this report. Although 10 of the 14 companies that released data ranked among the top 20 drug companies for sales, we focused on the top 5% of MCCs who received the majority of Table 3. Top MedicalCommunication Company (MCC) Recipients of Company Grants
Faculty development received limited attention at participating schools. Students may learn the funda- mentals of effective doctor-patient communication in classroom settings, but if they fail to observe precep- tors and residents demonstrate these skills, they may conclude that they are not relevant to patient care. Be- cause of the variability in the skills, time, and interests of faculty preceptors, most of the methods developed by the UME-21 schools focused on the classroom set- ting. A challenge for the future is to train preceptors who are scattered over wide geographic areas to model effective communication skills, observe students’ in- teractions with patients, and provide specific, reliable feedback based on these observations, thus creating an environment that demonstrates and consistently rein- forces the importance of doctor-patient communication and helps students improve their skills.
Communication training or real life exercises are provided every year of the medical curriculum. The training starts with strait forward basic skills for human interaction, seen as the essential of every meeting. Gradually it slips into medicalcommunication and consultation training. This goes along with the end of the study of the normal human being and just before the students start studying diseases. Communication in different contexts or with specific patient groups (going along with the study of specific syndromes), is the last stage of the training. Poorly performing students get extra training.
After three rounds of ratings, the experts agreed to retain 22 behaviors which were distributed throughout the Model. Interestingly, 6 behaviors that the experts agreed to retain were among the 14 originally-proposed by the project team. The final list addresses key aspects of patient communication, such as sharing and prioritizing concerns, expressing feelings, and summarizing informa- tion and recommendations provided by the physician. While most behaviors can be assessed using existing cod- ing schemes, the list also includes a few behaviors that may require methods that examine the content of state- ments made by the patient. Examples of such behaviors include "describe how the illness affects (one's) daily life" and "share your story".
A study has been completed examining design issues concerning the interpretation of and dissemination of mul- timodal medical imaging data sets to diverse audiences. To create a model data set mouse fibrosarcoma tissue was visualised via magnetic resonance imaging (MRI), Matrix-Assisted Laser Desorption/Ionisation-Mass Spectrometry (MALDI-MSI) and histology. MRI images were acquired using the 0.25T Esaote GScan; MALDI images were acquired using a Q-Star Pulsar I mass spectrometer. Histological staining of the same tissue sections used for MALDI-MSI was then carried out. Areas assigned to hemosiderin deposits due to haemorrhaging could be visualised via MRI. In the MALDI-MSI data obtained the distribution sphingomyelin species could be used to identify regions of viable tumour. Mathematical ‘up sampling’ using hierarchical clustering-based segmentation provided a sophisticated image enhancement tool for both MRI and MALDI-MS and assisted in the correlation of images.
being cultural phenomenon, executes dif- ferent functions: instructional, develop- mental, and educative. That’s why in higher medical school special attention is paid to linguo-professional training helping to de- velop and improve communication skills, and is oriented to the development of the axiological potential of tomorrow’s doctor personality . The whole process of train- ing passes through the student’s personal- ity, his or her motives, aims, interests, life plans and perspectives, system of values. When using simulation technology from the point of view of communicatively-valuable aspects at the lessons of foreign language, students get the possibility to work off and try out the skills of work with patients un- der the conditions most closely resembling the real ones.
Fig. 1 outlines the technical system. The system is divided into three sections: On-site section, which is sub-dived into inside and outside of the ambulance, the TNAZ and the communication network. The TNA is linked via the communications network to the communication entities at the site of the emergency. Hence, several information and communication channels are available to access the distress situation, including audio communication, electrocardiogram (ECG), vital signs, auscultation streams, pictures taken by rescue personnel, video sequences from inside the ambulance vehicle as well as informal and tactical data, e.g. positioning and system diagnostic data. Thanks to such information the TNA is capable to create a diagnosis and assign further treatment to the rescue personnel. Moreover, securing the quality of patient-centered care will be facilitated with the application of standard operating procedures. Additionally, extensive contact possibilities to other structures of the health service and external information are established in the TNAZ, so that organizational and patient-related information can be extensively exchanged and processed. The TNA transmits all relevant information to the targeted hospital prior to arrival of the patient. An adequate therapy to the patient can be prepared at the best-suited location, well in advance. Due to the fact that emergency might happen everywhere, the system consists of two communication entities. One is installed inside the ambulance (incar) and is capable of radio transmission through antennas mounted on the roof. The portable device (portable) is fitted in the right side bag of the Monitor/Defibrillator device (MRx) and is limited by less transmission capacities as the incar-device, but offers a user-interface comprising display, light-emitting diodes (LED) and speaker. Besides an Ethernet connection between MRx and portable-peeqBOX, there are several other devices including headsets, electronic stethoscope (eScope), smartphone and the MRx connected to the portable- peeqBOX via Bluetooth technology. The interaction of both communication entities underlies a hub concept in such a manner that inside the ambulance a handover of voice and data streams is performed. In contrast being outside the ambulance with the MRx, both units operate independently.
In this chapter, I examine the impact of the Australian model of professionalisation of interpreting on the relationship between the patient, the interpreter and the clinician. This chapter begins with an exploration of the impact of the professionalisation of an occupation on the social status of its practitioners. The Australian professional model of interpreting encompasses a set of assumptions about best practice. This is enshrined in the AUSIT Code of Ethics, which emphasises the accuracy of language rendition, the impartiality of the interpreter and the speaker’s confidentiality. The Code explicitly prohibits patient-centred practices such as advocacy or prioritisation of communication needs. In other words, the interpreter is not supposed to prompt the patient even if they are aware that the patient does not know how to clearly state their needs in a culturally appropriate manner. Institutional practices such as surveillance and monitoring of interpreters determine and confine the relationship between interpreter, patient and doctor. I trace the
In Poland, medical waste posing an epidemiological threat may only be neutralized in processes leading to the reduction of the total organic carbon content to 5% in such waste. This signifies that the only legal method of process- ing infectious waste in this country is incineration. The Polish legislature has thus adopted a solution which, even though not contraventing European law, eliminates the pos- sibility of using alternative methods, hence grants a monop- oly for infectious waste incineration plants. At the same time, there is no data in the literature that would point to incineration as the only method of neutralizing infectious waste. It might be appropriate to recommend the inclusion of other effective and approved alternative methods to be included in the legislation, requiring the full control of the conditions of these processes and their effectiveness as with incineration. Development of waste management policies, careful waste segregation, and training programs are essen- tial to minimizing the environmental and health impacts of any technology. Unfortunately, the present legislation does not offer the possibility of choosing between neutralization methods, hence there is no incentive to seek solutions other than incineration that are likely to improve the overall qual- ity of the medical waste management system in Poland.
The establishment of the new Center of Advanced Simu- lation marked the beginning of the process of interpro- fessionalization of academic teaching. After analyzing the specific aims of the third year medical school cur- riculum, we identified seven topics for the laboratory sessions that would contribute to the development of communication and gestural skills: venipuncture, measu- ring central venous pressure, rectal examination, bladder catheterization, surgical wound care, physical examin- ation and taking a patient’s medical history.
Where 0 was no knowledge, 1=below average, 2=Average, 3=Good, 4=very good and 5 was excellent. After the completion of the proformas, they were collected by the coordinator of the workshop. Large group interactive sessions on importance of good communication skills, history of medical ethics, and examples of ethical dilemmas faced by physicians were discussed by a subject expert. Students were encouraged to discuss ethical issues faced by them during their ward rotations. Video clips provided by Center of Bioethics and Culture, Sindh Institute of Urology and Transplant (SIUT) were displayed. Permission to use the material was taken from SIUT beforehand. Next, small group activity was arranged where case scenarios related to informed consent, breaking bad news, palliative care and patient confidentiality were discussed with pre trained facilitators from multidiscipline. For homework, theme related literature was provided to the group members and they were asked to prepare case scenarios for role plays on day 2. On day 2, the case scenarios and role plays were discussed and amended under the guidance of facilitators. Individual students were given time to rehearse their communication skills while preparing role plays according to the theme allotted to their group. Individual group presentations were done in classroom. After each role play the group members concluded their case and how they resolved the ethical dilemma. House and faculty were invited for questions. Presentations were judged by two members of ethical committee and one clinician on Communication Skills Attitude Scale (CSAS) (10). The best presenting group was awarded a shield. Post workshop proformas were provided for the students. They were asked to write same code numbers which were present on their pre workshop proformas. Pre and post workshop pro formas were matched with the codes by the coordinator and handed to the workshop organizers.
Results: An exploratory factor analysis revealed three domains: communication openness, quality of information, and shift report. Medical Intensive Care Unit Shift Report Communica- tion Scale scores ranged from 12 to 27 (mean = 18.78; standard deviation = 3.28). Perception of communication did not vary between nurses based on years of nursing experience or age. Scale reliability was good (Cronbach’s alpha = 0.079). Nurses were likely to have had a positive perception of the openness of communication on the unit. However, they had a less favorable perception of peer ability to fully understand information shared during shift report and identified as a common problem the frequent need to review the chart to verify reported information. Conclusion: The MICU Shift Report Communication Scale may be used to provide useful information to support health care organizations and nurse leaders in the evaluation of nurse communication during shift report. Initial testing indicates that the MICU Shift Report Com- munication Scale is easy to use; however, additional testing with larger groups of nurses is needed.
A number of critical factors contribute to satisfactory performance. These include bandwidth, latency, and breadth of coverage, reliability and quality of service (QoS). Reliable operating range is difficult to predict due to the lack of knowledge of the special propagation characteristics in indoor scenario. Reflected signals by floors, ceilings, walls, various furniture and people are present near transmitters and receivers. That is the sig- nals are travelling over multi-paths. In most indoor cases, there is no direct line-of-site path, and all signals are the result of reflection, diffraction and scattering. Higher throughput improves immunity to interferences and ex- cess bandwidth can be traded for longer reach and better power efficiency. In this article we present turbo convo- lution coding technology for reliable communication. Its inbuilt interleaving technology exploits time diversity, which helps in combating multi-path effect. It is also useful in high throughput scenario.
This single-blind, randomized, controlled clinical trial was conducted in nurses working in Sayyad Shirazi and Panj-Azar educational hospitals and west healthcare centers (Aqqala Al Jalil Hospital, Bandar Torkaman Imam Khomeini Hospital, Kordkuy Amir-Al-Momenin Hospital, and Bandar-e Gaz Shohada Hospital) with two parallel arms in 2015. The protocol of the study was approved by the ethics Committee of Golestan University of Medical Sciences (code: R.GOUMS. REC. 1394.73) and registered in the Iranian Registry of Clinical Trials (IRCT201501277821N1). The inclusion criteria were a minimum of 6 months’ experience in the emergency units, holding B.Sc or M.Sc. Degrees in nursing, and a negative history of acute stressful events in the past six months (death of fist-degree relatives, use of drugs related to psychotic disorders).
our pathology laboratory. Study data was collected via paper and electronic medical record review. Five patients were excluded from the pre-intervention group because of difficulties with their paper chart review, such as difficulty establishing the existence of prior Papanicolaou (Pap) smears or cervical intraepithelial neoplasia treatment (Figure). One patient was excluded from the post-inter- vention group at her primary physician’s request. Thirteen patients were excluded from the post-intervention group because they were less than 21 years of age, and screening was no longer indicated in this age group. 15 Nine patients were excluded because they trans- ferred care out of our clinic system prior to the need for follow-up. In compliance with the requirements of our IRB, one patient was excluded due to the presence of adenocarcinoma.