Chapter 3 Patient Care
Introduction
Patient care is at the foundation of becoming an effective clinician and is truly at the center of all of the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Effective patient care encompasses excellent communication, professional behavior, a solid knowledge base, self-reflection skills, principles of lifelong learning, and an understanding of the health-care system. For most students and residents, caring for patients was the initial stimulus for entering medical school and the basis for pursuing a residency program; however, the all-encompassing nature of patient care is often not realized early in training. For educators, teaching and assessing this competency and providing effective feedback are thus critical to resident education and development.
Definitions of Patient Care
The ACGME expects “residents to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.”1 The American Board of Pediatrics (ABP) has developed general guidelines for the pediatric competencies and states that for patient care “residents must be able to provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for the treatment of health problems and the promotion of health.”2 The ABP pediatric-specific components of patient care competency include:
Gather essential and accurate information about the patient using medical interviewing, physical examination, diagnostic studies, and developmental assessment.
Make informed diagnostic and therapeutic decisions based on patient information, current scientific evidence, and clinical judgment: use effective and appropriate clinical problem-solving skills, understand the limits of one’s knowledge and expertise, use consultants and referrals appropriately.
Prescribe and perform competently all medical procedures considered essential for the scope of practice.
Counsel patients and families: to take measures needed to enhance or maintain health and function and prevent disease and injury; by encouraging them to participate actively in their care by providing information necessary to understand illness and treatment, share decisions, and obtain informed consent; by providing comfort and allaying fear.
Strategies for Learning Patient Care
The ACGME outlines the content that should be taught under the patient care competency. This includes specialty-specific skills that address key skill sets, specialty-specific procedural knowledge, and knowledge about information technology. Learning can take place in the following settings: clinical teaching, lectures/seminars/conferences, role modeling, workshops, simulations, and self-directed learning through case-based modules. Teaching methods should include didactic conferences, clinical teaching, case-based teaching, role modeling, journal club, mentoring, morbidity and mortality (M&M) conferences, simulation, self-directed learning modules, individual or group projects, research projects, and chart audit. Simulation is defined as recreating a medical situation that contains the visual, auditory, and tactile information that might be experienced in an actual clinical encounter. Importantly, simulation takes place in a safe environment that does not pose risk to a patient and can provide learners with experiences that they might not encounter during their clinical duties.
Passive methods of instruction, including case conferences, didactics, and M&M conference, are also important in educating residents on patient care. Through M&M and case conferences, trainees are able to critically appraise a patient’s case and subsequent care, to develop their own thoughts on how things may have been done differently or how the disease process works more thoroughly. This takes the trainee away from the bedside to review a case in detail from an outsider’s view and to learn from other specialties’ viewpoints. Didactic conferences enhance patient care by providing the fundamentals of medical knowledge and current guidelines for treatment strategies.
