RAB 2022-2023

Themes:

a) Person-centred care

b) Welcoming others and being ourselves: belonging, dignity and justice

Colours of Unity - Ayushma Gurung

  • Using a variety of colours and brush strokes, this painting aims to illustrate the importance of embracing our unique identities and values while recognising the diversity in others. Each colour and pattern represents a particular aspect of an individual's identity, such as culture, ethnicity, religion, and personality. By combining these colours and strokes, the painting represents the unity and sense of belonging that is created when we embrace diversity within the wider community. This artwork reflects the interconnectedness of all individuals, highlighting that we are all part of a collective whole.

    Creating a safe and inclusive environment that cultivates a sense of belonging for all patients is crucial in healthcare. To achieve this, it starts with primary care education by teaching students to learn, recognize, and appreciate the diversity that exists. This can be achieved by taking the time to understand the unique backgrounds and experiences of the patients that students are exposed to early on. It also requires reflection on one's own biases and assumptions. Patients must feel heard without judgment to be able to develop a deeper understanding of their needs and concerns, which ultimately leads to better outcomes in their care. Ensuring dignity in care also involves guaranteeing a safe space and privacy during examinations, providing care that maintains an individual's self-respect, and avoiding actions that may undermine them. For instance, treating patients with respect and autonomy, while taking into consideration their cultural beliefs and values in the care provided, acknowledges their individuality and promotes patient-centred care, thereby upholding their dignity.

    Another interpretation of this painting is that it can also represent the different communities that exist in our society, which share commonalities while highlighting their unique differences. In relation to justice, it is essential to recognize that discrimination still exists in clinical practice, as some minorities still experience prejudice based on the colour of their skin (1). It is crucial to recognize the impact of cultural competence and awareness of healthcare disparities and actively work towards enhancing it through education to overcome these barriers. A lack of awareness can result in unconscious bias and perpetuate inequities in access and quality of care, as seen in racial disparities in pain management (2). Cultural competence can be developed through exposure to understanding of the various cultural, social determinants, economic factors, and addressing healthcare disparities that affect the health of patients from different racial and ethnic backgrounds. Being taught on ethics and professionalism can help guide medical practice on the principles of justice, fairness, and respect for patient autonomy. Ultimately, to overcome these barriers, students should learn how to advocate for their patients and work towards creating a more just healthcare system. The colours of unity serve as a reminder of the interconnectedness of all individuals and the importance of embracing diversity and recognising the different communities of our society.

    REFERENCES

    1. Hoffman K.M., Trawalter S, Axt J.R., Oliver M.N. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301.

    2. Badreldin N, Grobman W.A., Yee L.M. Racial disparities in postpartum pain management. Obstet Gynecol. 2019;134(6):1147–53

Through the highs and the lows - Jit Yih

  • In today’s current healthcare scene, general practitioners (GP) are flooded with patients on a daily basis. They serve as their community’s first port of call, being there for the residents through sickness and health, and seeing a wide range of patients that vary in age, gender, ethnicity and more. As such, they are required to know how to diagnose and treat a wide range of conditions across the board, as well as when to know that their patient requires referral to specialist care or social services. They provide a continuity of care in the community, often seeing patients from birth to old age, and are able to foster that ever-present and important patient-doctor relationship and human connection.

    When I was on my GP placement, I noticed that each consultation is meant to be limited to 10 minutes per patient, however it often overruns and causes subsequent appointments to be delayed. I feel really frustrated on the patient’s behalf because 10 minutes is often quite short a timeframe to really relay your medical problems, especially if there’s more than one issue bothering you, and you also require the GP’s help for referral to social services or more. Yet, I also understand the need to maintain a time limit, for there are so many other patients who require the attention and services of the GP, and there is only so much time in a day. Thus, I have seen many GPs rushing through their consultations, paying more attention to typing down and clearing the patient’s worries and concerns than actually listening to the patient.

    Especially in today’s hectic society where burnout is becoming a major issue for many, a lot of patients come in with mental health issues accompanied by different socio-economic circumstances, which is vastly different from those in hospital who generally came in with physical illnesses. Oftentimes, I think we overlook the fact that mental health issues can coexist with physical illnesses, and that it is vital to acknowledge it and address it immediately. Though invisible, mental health is a crucial part of our daily life and it is important that we always ask our patients about their mental well-being and how they are coping. Furthermore, we often associate mental illnesses with old age or youths with troubled backgrounds, but this patient reminded me that mental health issues can affect anyone of any age, and that its effects are just as devastating. The GPs have to be highly sensitive and empathetic to their wide range of patients, having to be very careful and on their toes, ensuring not to miss out on the whole history taking, compared to hospitals where the consultants tend to focus on a specific area. Also, they have to be aware of the different non-pharmacological ways to help their patients, be it through lifestyle changes or referrals to the appropriate social services. Seeing a wide variety of patients presenting with multi-morbidities across different bodily systems within such a short timeframe is definitely insufficient to really give the patient the thorough care I feel they should be afforded.

    If possible, should we be able to give patients in GP a longer consultation time, more of us, doctors and students, would be able to again take a more proactive effort on remembering how we need to see our patients as humans and not their illnesses. GPs would be able to really listen to their patients and their worries beyond their physical or mental ailments, providing a shoulder to cry on, and also begin to act as a partner in patient empowerment. As a past social prescribing champion at school, I have learnt the importance of thinking of a solution with the patient that empowers them to take action to better their lives. It’s about enabling them to really think about their own health and do the activities because they want to, to give them autonomy over their own lives and well-being. I really believe in the power of social prescribing, such as encouraging community gardening, volunteering and more, because these activities provide long-term benefits to the health of our patients without them relying on artificial medicines to cure them. Oftentimes, the solution is simpler than we expect – social prescribing gives us the opportunity not only to treat the issue (e.g obesity) at its core, but to provide additional social benefits as well. By involving the patient with their community, I see how much better and more motivated they are to take steps to make a healthy change. With social prescribing, we are giving our patients greater autonomy and responsibility over their own health, by guiding them on the necessary steps to help improve their condition or even prevent further illnesses. Currently, we already face shortages of medications to patients - as well as the issue of antibiotic resistance - hence with this alternative method we are able to help improve the social wellbeing and health of the population without over-reliance on medications. By empowering our patients, we are encouraging them to not only be more aware of their own health and wellbeing, but to also improve their communal ties as they learn to look out for others as well.

    Furthermore, besides having a longer consultation time, I believe that promoting an after-work group reflection among the practice could encourage better patient care. By taking the time to introspect on their actions and responses of the day, as well as hearing the reflections of their fellow colleagues, GPs and students alike can gain insights on what they can improve on and better do to facilitate a more welcoming and patient-centred care. In addition, having an after-work group session can also provide the space for GPs to confide in one another any problems or issues they faced during the day - it could be a difficult patient hurling verbal abuses, or even a heartbreaking case in which they felt helpless. By being given the space and opportunity to process these emotions and thoughts, I strongly believe that GPs can improve the care tailored to their patients, as they learn from past mistakes and make the effort to provide more holistic care.

Through the highs and lows

To the GP we go

With our aches and moans,

Our fatigue and groans

They patiently listen,

Their attention to us given

They provide us a shoulder to lean on,

Building with us an everlasting bond

They are our first port of call,

When the world seems to stall

With great compassion and kindness,

Their sincerity we’ll not second-guess

They see us from young to old,

From spring to winter’s cold

Any time of day,

They keep our illnesses at bay

Be it medication or a kind word,

We are one of their herd

Thank you GPs for all you do,

You truly are the best, most cool

As I Walk Up the Stairs - Serena Jayshree Ramjee

  • Earlier this year, during my Near-Peer Student Selected Component (Medical Educator and Clinical Development in Primary Care), I was acquainted with psychological safety, a term defined as “a shared belief held by members of a team that the team is safe for interpersonal risk-taking” [1]. My role consisted of working with faculty and supporting third-year students, an experience resulting in the formation of a dual perspective on psychological safety as I was both a learner and educator.

    As a Learner

    Initially, I felt a sense of accomplishment assisting younger-year students in their GPCD (GP Community Diagnosis) module. Having a more senior role positively affected my professional identity, allowing me to view myself as an educator for the first time. However, my previous similar experiences occurred in more informal settings, so I was concerned about a gap in my knowledge and skills. I felt a steep learning curve lay ahead of me. This realisation led to a shift in my confidence, and my sense of seniority disappeared, leaving me unsure whether I could rise to the challenge.

    Now that I have completed the module, I believe my positive experience can be partly attributed to the treatment I received from the faculty I collaborated. I was given responsibilities (e.g. focus group interviewer) with confidence in my capabilities, evidenced by the lack of micro-management, alongside various avenues of support (e.g. Dr Mistry). I also felt that the staff respected my views and took my suggestions seriously. Imposter syndrome often afflicts medical students, including myself [2,3]. As a learner, working with faculty in this manner gave me an understanding of how psychological safety can ease imposter syndrome and the comfort that educators never really stop being learners. It was also valuable to watch how co-creation between staff and students can positively impact primary care education, an observation I will take forward to my vocation as a doctor in August.

    As an Educator

    In addition to supporting the GPCD, I independently taught General Practise 3 (GP3) students clinical skills. This role also resulted in me feeling a great sense of responsibility. However, I also felt this self-inflicted pressure to re-create the previously mentioned psychologically safe environment the faculty had given me as a learner. This pressure was eased by the knowledge that near-peer environments inherently create some safety due to reduced seniority [4,5]. But as an educator, I wondered how I could further this aspect and create a welcoming environment in a GP setting. To answer this question, I recalled teaching sessions and placements where I felt psychologically safe, considered how they achieved that and then supported these ideas by researching the topic. My mind first went to the role-play-based teaching I received throughout the university. The session lead and my peers typically provided feedback using the Pendleton model [6]. I found this process encouraged self-reflection, provided a chance for everyone to participates, and was much less intimidating than other feedback methods, leading me to utilise this model. Other aspects I used were ensuring that I learned, correctly pronounced and used my students' names, clearly stating that any response was acceptable, and affirming my student's emotions (e.g. empathising with their frustrations about remembering large volumes of content) [7]. I was proud to see a high level of participation from students and that they felt more confident in their skills at the end of the session. I hope that, like my experience, my session can one day inspire these learners when they become educators.

    Creative Enquiry Explanation

    As I Walk up the Stairs captures the previously mentioned dual perspectives, the learner and the educator, using symbolic imagery.

    The poem details a figure (the educator) leading another (the learner) up some stairs. Both figures are shrouded in darkness, guided only by a torch. Despite this, the first figure adeptly leads the second through the darkness, indicating to the second figure that they are safe. The first figure then passes the torch to the second, who takes it in their hand, knowing it is safe for them to do so.

    To capture the dual perspectives, I wrote the first two stanzas from the learner's point of view and the last two from the educator's. It was essential that they were similar to illustrate my experience of simultaneously being in the two roles. The stairs are the journey, with the darkness representing uncertainty. This darkness persists throughout the poem showing that, even as an educator, you never stop learning and growing. The educator holds a torch, symbolising the knowledge and skills vital for orientating new challenges and guiding learners. In this poem, I illustrate the educator's role as a guide by using the literal word "guide" alongside a ship metaphor in the first and third stanzas. Our learner is treated in such a way that even though there is uncertainty, they know the educator is there to support them. This treatment tells the learner that they are (psychologically) safe. In stanzas two and four, the educator passes on their knowledge and skills to the learner. Now confident they are in a safe environment, the learner stands alongside the educator, ready to go forth using the provided tools.

    References

    1. Re:work - guide: Understand team effectiveness [Internet]. Google. Google; [cited 2023Apr27]. Available from: https://rework.withgoogle.com/guides/understanding-team-effectiveness/steps/foster-psychological-safety/

    2. Khan M. Imposter syndrome—a particular problem for medical students. BMJ. 2021;

    3. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American Medical Students: A Pilot Study. International Journal of Medical Education. 2016;7:364–9.

    4. Henderson S, Needham J, van de Mortel T. Clinical facilitators' experience of near Peer Learning in australian undergraduate nursing students: A qualitative study. Nurse Education Today. 2020;95:104602.

    5. Alexander SMK, Dallaghan GL, Birch M, Smith KL, Howard N, Shenvi CL. What makes a near-peer learning and tutoring program effective in Undergraduate Medical Education: A qualitative analysis. Medical Science Educator. 2022;32(6):1495–502.

    6. Burgess A, van Diggele C, Roberts C, Mellis C. Feedback in the clinical setting. BMC Medical Education. 2020;20(S2).

    7. University College London. Creating safe spaces for students in the classroom [Internet]. Teaching & Learning. 2020 [cited 2023Apr25]. Available from: https://www.ucl.ac.uk/teaching-learning/publications/2020/apr/creating-safe-spaces-students-classroom

As I walk up the stairs,

a figure before me guides me,

our hands held tight,

their torch adorning each step

with a brilliant white.

Steering our bodies,

navigating the sea of darkness,

telling me I'm safe.

And then they stop.

The torch,

accompanied by a dim-lit smile,

rests on my palm

for a brief while.

Before I enclose my hand around it,

knowing that I'm safe.

As I walk up the stairs,

I usher the figure below me,

our hands held tight,

my torch adorning each step

with a brilliant white.

Steering our bodies,

navigating the sea of darkness,

telling them they're safe.

And then I stop.

My eyes,

gleaming with gentle pride,

watch my hands give the torch

to the figure, now at my side.

They enclose their hand around it,

knowing that they're safe.

Observing Privilege: A Medical Student’s Perspective on Inclusivity in Healthcare - Abigail Atie

  • For this creative enquiry I created a video filled with my first two years of memories from medical school. Initially my intention was to reflect upon the general theme of inclusivity in healthcare, however I found through making a scrapbook like curation of my own memories, I was really exploring how I fit into the practitioner pyramid as a student and as a future doctor. I also used GarageBand to create the music which mirrors the mood of the narration. Initially there is a solitary piano, but this expands to include an array of instruments reflective of diversity. The narration cites sources like Steven et al. [1] and Mukherji et al. [2], the presentation shows the importance of practitioners recognising their privilege and how this impacts patient care. Hopefully, more practitioners recognising this will foster awareness and improve rapport between patients and clinicians.