21

Derek Bok(2006)
8
1.(The Ability to Communicate)
2.(Critical Thinking)
3.(Moral Reasoning)
4.(Preparing Citizens)
5.(Living with Diversity)
6.(Living in a More Global Society)
7.(A Breadth of Interests)
8.(Preparing for Work)

Key questions
1. ?
2.

3.

Outcome based Education

Structure and process Competency

?
UNESCO, 1996
4The Four Pillars of Education
1.Learning to know

2.Learning to do

3.

Learning to live together

4.[]

Learning to be

THE DEFINITION AND

SELECTION OF KEY
COMPETENCIES
De Se Co
Key Competencies for a Successful Life and a
Well-Functioning Society
Dominique Simone Rychen and Laura Hersh Salganik (eds.)
Hogrefe & Huber, Gttingen
Final report in 2003

PISA
In 1997, OECD member countries launched
the Program for International Student
Assessment (PISA), with the aim of
monitoring the extent to which students near
the end of compulsory schooling have acquired
the knowledge and skills essential for full
participation in society.

Key Competencies in Three

Broad Categories
1. Use tools interactively (e.g. language,
technology) (,)
2. Interact in heterogeneous groups

3. Act autonomouslyto take responsibility for

managing their own lives, situate their lives
in the broader social context and act
autonomously.


Civil Society
:
VS

Patient Care
Medical Knowledge
Practice-Based
Learning and Improvement
Interpersonal and
Communication Skills
Professionalism
System-Based Practice


System-Based Practice
1.

2.
3.

4.

V.S

Knowledge, skill communication skills

innate factors
Lowe M, Kerridge I, Bore M, Munro D and Powis D. J Medical Ethics 2001

Knowledge

Skill

Attitude

?
1. Skill training in communication and ethical
reasoning
2. Ethical reasoning is considered as logic game.
And according to Kohlbergs theory, reasoning is
independent of action.
Cultivate morality?
?
daily practice?

()

(
)

(

Caring

99

()

988 1 99731

Let the world change you... and you can change the world.----Che Guevara
----

Nussbaum MarthaA
classical defense of reform in liberal education

(:)

--

()
()
()

36

37

~1980s

1980s~

/
38

-
A
B
-
A
B
C

40

&

41

160
140
120
100
80

148

60

40

20

38

1
34

148

46
31.1A
25.7%B5.4
3523.6
A
23%B0.7

42

-
A

7
6

5
4

4
3

3
2

2
1

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44

TA

3-5

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48

100-101
47%
52%

38%
28%
29%

23%

40%
57%

41%
40%

100-1

22%
48%
39%

30%
22%
0%

10%

20%

30%

40%

101-1

100-2

32%

101-2

50%

60%

100-101
1201

03
11 6 9 3

020
48

10

11

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41

35

29

8 7 71

37

28

20

50
24
40

52
36

60
100-1

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80

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41

100
101-1

120
101-2

140

160

180

 -
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54

56


96

9672102109

95 546
962224
60

61

100-102

62

100-102

100

101

102

144

116

109

71

59

59

49.3%

50.8%

54.1%

63

100-102

64

100-102
102 n=59()
101 n=59()
100 n=71()

45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
e

102

24%

32%

36%

8%

101

27%

37%

27%

8%

100

25%

39%

24%

12%

65

97102
120
97-102365

33%

66

100-102
102 n=59()
101 n=59()
100 n=71()

60%
50%
40%
30%
20%
10%
0%

102

32%

34%

12%

3%

19%

101

48%

38%

5%

3%

7%

100

40%

47%

3%

4%

7%
67

100-102
102 n=59()
101 n=59()
100 n=71()

35
30
25
20
15
10
5
0

102

14

29

101

16

26

100

23

27

12

68

69

103

70

1.

ee

2.

3.

71

a.

b.
c.
d.

72

1.

2.

Health Care MatrixTRM

Simulation

3.

systems-based practice

4.

OSCE

5.

73

a.

b.

c.

74

1.

2.

3.

learning by doing

4.

75

a.

b.

76

1.

2.

3.

4.

77

a.

b.

c.

78

(1)

IRB
()
/

/
/

79

(2)

80

(3)
HREC
IRB103

82 REC
(Research Ethics Committee)

81

82

(1)
1.

(2)
2.


(clerkship)

(OSCE)(mini-CEX, p-MEX,
Kalamazoo )

(formative assessment):
Kalamazoo
Consensus Scale


Kalamazoo Consensus Scale


Jefferson Scale of Physician Empathy
JSPE-s
IRS

JSPE-s:
1.
2.
3.
4.
5.
6.


51

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5.53

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JSPE-s
JSPE-s

()

(Kalamazoo)(p-MEX)

(JSPE-s)

Kalamazoo
Consensus
Statement

(SPOSCE)

(Mini-CEX)

Jefferson Scale of Physician Empathy

Mini-CEX


McGill
University Prof. Cruess
Professionalism mini
Evaluation ExerciseP-MEX

Prof. Cruess

!
!

The human dimension of learning

Gaining Technical

Developing

competence

professional identity

Biological kowledge

Intern / Residents

Communication,

Learning from

less on pyschosocial
issue
undergraduate

practice

Learning to heal
Humble
Wisdom toward
practice
At least 5-10 year
not every physician
achieve this level


Stretching and pulling out
the rice shoot so that they
can grow faster.

1>
2>3>4>
5>

Practice points
Professionalism reflects societal values. An institutional definition must be
agreed.
Situated learning in the early years is not enough. Learning must be supported
in the workplace.
Role models are powerful. Both positive and negative behaviour will be seen.
Reflection on action and mentoring are important to ensure appropriate
learning is achieved.
Assessment must be integrated across the course using multiple tools.

MedEdPORTAL AAMC

ACGME Core Competency

Chapter 1-Competency 1: Interpersonal and

Communication Skills
Chapter 2-Competency 2: Medical Knowledge
Chapter 3-Competency 3: Patient Care
Chapter 4-Competency 4: Practice-Based
Learning and Improvement
Chapter 5-Competency 5: Systems-Based
Practice
Chapter 6-Competency 6: Professionalism

Set of professional responsibilities defined in the Physicians charter

on professionalism (Project Medical Professionalism 2002).
Commitment

Actions including, amongst others

Professional competence

Life long learning to maintain medical

knowledge and skills

Honesty with patients

Complete and honest information, including

reporting of medical error

Patients confidentiality

Disclosure of patients information

Maintaining appropriate
relationships with patients

Avoid sexual advances, financial gain

Improving quality of care

Reducing medical error and increase patient

safety, optimize outcome

Just distribution of finite

resources

Wise and cost-effective management of limited

clinical resources

Scientific knowledge

Promote research, create new knowledge

Maintain trust by managing

conflicts of interest

Recognise, disclose and deal with conflicts of

interest

Professional responsibilities

Collaborate respectfully, participate in process

of self-regulation, and standard setting

As the U.S. medical education community increases efforts to enhance

behavioral and social science understanding, physician educators
abroad also are recognizing the importance of these disciplines in
medical education. During the first week of the reports release, the
Taiwanese Ministry of Education requested permission to translate the
report into Mandarin Chinese

treatment optionshealth
strategies

CanMEDS

Practice points
Professionalism reflects societal values. An institutional definition must be
agreed.
Situated learning in the early years is not enough. Learning must be supported
in the workplace.
Role models are powerful. Both positive and negative behaviour will be seen.
Reflection on action and mentoring are important to ensure appropriate
learning is achieved.
Assessment must be integrated across the course using multiple tools.

Teaching and learning professional issues

Van Mook 2009e).

1. Setting expectations/creating awareness and mindset

Providing clear definitions
Defining goals and objectives
Developing clear policies and procedures
White coat ceremonies
Undergraduate introductory lectures
Recital Hippocratic oath
Pre-clerkship and clerkship orientation sessions
Workshop on altruism

Teaching and learning professional issues

2 Providing experiences: formal curriculum

Literary discussions, including books, narratives, poetry,

history of medicine etc

Hard case discussions
Cine medication
Grand rounds
Resident as teacher programmes
Medical ethics courses
Humanism sessions
Writing of short narratives about important incidents
Chart stimulated recall
Economic/political dimensions
Discussion of legal issues

Teaching and learning professional issues

2 Providing experiences: formal curriculum

Teaching leadership/management skills

Teaching of feedback skills
Teaching of communication skills
Teaching of reflection skills
Sociological consciousness development, including
community service programmes
Anatomy sessions, including issues as death and dying
Annual retreat or symposium on professionalism
Journal club articles on professionalism
Incorporation of professionalism concepts into morbidity
and mortality conferences
Simulated or standardized patients

Teaching and learning professional issues

3. Providing experiences: informal/hidden
curriculum
Role modelling
Educational climate and leadership
Learning by experience

4. Evaluating outcomes: assessment before entry

Selection

Hidden curriculum
Learned by watching what teachers and clinicians do

rather than by merely listening to what they say,

continues to undermine compassion, collaboration,
and communication.

hidden curriculum

formal
curriculum

Hidden curriculum:
the set of influences that function at the level of

organizational structure and culture including, for

example, implicit rules to survive the institution such
as customs, rituals, and taken for granted aspects

 While most of medical education and training is about

the nuts and bolts of clinical care how to treat

hypertension, how to manage a ventilator, how to take
out a gallbladder the process also involves learning
how to be a doctor.
As opposed to lessons covered in textbooks and
classrooms, this kind of learning is done through
modeling, or what medical sociologist F. W. Hafferty has
called the informal or hidden curriculum

First, Purified your heart

Put othes benefit at the upper most.
Master YinSune

()
Ethics

Dr Pt
communication

Medical
humanities

Integrating professionalism into the

curriculum: AMEE Guide No. 61
Medical teacher 2012; 34: e64e77

MOE Medical Education Reform

Project - Vertical integration
humanities , commuication and
Ethics in Tzuchi University 2008

Professionalism and medical humanities in

Tzuchu University
Vertical integration
Basic medical knowledge < - - > Clinical








//

Three kinds of curriculum

Formal curriculum
Informal curriculum
Hidden curriculum

Six core competencies

Communication
Ethics / law
Culture competency
Medical history, literature, philosophy
Medical sociology
Professionalism

Future development of professionalism curriculum

Med 1

Med 2

1
2
1
2
Humanities , caring
and practice 1,2,3,4
(2 credits / semester)
(Integrate
humanities,
commumication,
social service, gender
issue)

Med 3
1

Med 4

Med 5

Med 6

Population Health
1,2,3,4 (Integrate
public health,
epidemiolog, family
medicine)
Physicianship 1-8 (2 credits hour /
semester )
(Integrate ethics, communication, law,
humantities, medical history
)

Teaching communication across 7 years

Med 1

Med 7

Interact
with
society

Interact
with
science

Interact
with
patient

Interact
with
difficult
situation

Med year 1-2

Diary/ twice a week Intrapersonal communication
Training for self reflection
()
2

2,

Med Year 5 - 6
Standardize patient / video record
general examination, angry paient
truth telling
()

Medical ethics in Med Year 4 (past)

Role model

Illness literature

Film :
1/ The right to die
2 ()
3 The wit
4Doctor

Video used in medical ethics lecture

Integrating into basic and clinical

learning in the future
PBL + culture, psychocial issue, ethical / law issue
Clinical disease topic taught by clinical physician

+ disease historical backgound, culture, psychocial

issue, ethical / law issue (Prepare /assist from the
team of medical humanities).

Content of the program

Communication
Standardized patient , video record, discussion
M5 1 : general medical problem
M5 2: Angry patient / family
M6 telling the beds
M6/7 communication medical error
Ethics:
Small group individual case-based discussion CBD
Reflective report
Humanities:
Patient center, cultue sensitive CBD and narriative writing
Role modeling : Appreciating inquiry through facebook

Clinical ethics
Patient center decision - 3 E
Evidence based
medicine

Ethical
based

Experienced
based

Decision
making

Approach of clinical ethics 4 Boxes

Medical indications
Principles of Beneficence and Nonmaleficence

Patient preferences
Principle of Respect for Autonomy

Quality of life
Principles of Beneficence and Nonmaleficence and Respect

for Autonomy

Contextual features
Principle of Loyalty and Fairness
Clinical Ethics 5th Jonsen AR

Patient center care

- six domains
(disease and the illness experience)

(feelings . Ideas , effects on function

and expectations FIFE )

Understanding the whole person

(Personal history , life histroy , development

)
The proximal context (family, work, social relation)
The distil context (culture, heath ecology..)

 - : 2

Health enhancement
Risk avoidance
Risk reduction
Early identification
Complication reduction

Enhancing the patient-doctor

relationship

Compassion
power
Healing
Self-awareness

The Patients Perspective

Disease
Illness

Disease
Illness

Reflection practice
Reflection In Action
Reflection On Action
Reflection For Action

Reporting

?
Reconstructing

Reflective cycle
5 R

Responding

Relating

Reasoning

Experience and explanation cycles

Teaching strategies for developing

the reflective physician
Role modeling and reflection
Reflective feedback: a strategy for teaching and

enhancing reflection
Learning mindfulness
Narrative medicine and storytelling
Learning in reflection groups

Models of learning
Situated learning
Students observe and learn from expert role
models, students will develop professionalism more
effectively when involved in clinically related tasks
rather than guided classroom-based activities.
Three key learning principles : attenuated authentic
participation Freedman and Adam (1996):
Learning and knowing are context specific
Learning is accomplished through a process of

coparticipation
Cognition is socially shared.

Lave and Wengers (1991) theory of Legitimate Peripheral Participation and

Wengers (1999) subsequent work on Communities of Practice


(Appreciating Inquiry AI)
In Tzuchi Foundation
Always say the good word,
Lotus coming from your mouth

Bad things spread immediately to the whole world

Good things never know out of the doors


Attributes of the physician

Healer
1
2 /

8
9
10

3
4 11
12
5

Professional

16
17

13
18
14
15
19
R. Cruess & S. Cruess

God grant me the serenity

To accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
Reinhold Niebuhr

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