Professional Development V

Scholar Year: 2022/2023

Courses

Head Teacher Responsability Carmen Sofia Frade Caeiro Head Diogo Ramos dos Santos Colaborador Inês Charrua Pires dos Santos Colaborador Nuno Miguel Ramos Pinheiro Colaborador Andreia dos Santos Pombares Colaborador Diogo André da Fonseca Pires Gestor de Ano

Weekly workload Hours/week T TP P PL TC S E EL OT TPL O OT/PL Type of classes 8 Lectures Type Teacher Classes Hours Orientação Tutorial Totals 4 32,00 Carmen Caeiro   0,13 Diogo Santos   1,86 Inês Santos   3,73 Nuno Pinheiro   1,06

Teaching language

Portuguese

Intended learning outcomes (Knowledges, skills and competencies to be developed by the students)

At the end of the curricular unit, the student must demonstrate clinical reasoning to:
Recognise human dimensions of health and disease;
Analyse and interpret illness narratives;
Formulate a diagnosis based not only in the disease and dysfunction and their impact on disability but also in the individual context of each patient;
Integrate illness experiences in the approach to patients, using a patient-centred approach;
Define interventions considering patients` views about health, disease, disability as well as their perspectives about the ideal health care.

Syllabus

The narrative reasoning is the major theme of this unit. It includes tutorial sessions that explore the following topics:
Introduction to illness narratives (definition; characteristics and attributes; the role of illness narratives on health professionals education);
Narrative reasoning and meaning making;
Narrative reasoning on the development of illness narratives;
Patients` illness narratives;
Illness as a metaphor: experiencing illness;
Exile and disability;
Paternalism and human dignity.

Demonstration of the syllabus coherence with the UC intended learning outcomes

This unit is focused on the development of narrative reasoning, as a clinical reasoning strategy that helps health professional to understand patient`s illness experience. This involves the apprehension of patients` stories, beliefs and cultural background as well as the impact of the dysfunction/ disease in their life. In this context, the role of illness narratives on understanding patients and their illness experiences is explored throughout this unit. Additionally, some themes are discussed (such as “exile and disability) with the purpose of promoting the development of narrative capabilities, which include textual capabilities (example: recognise metaphors), creative capabilities (example: imagine multiple interpretations) and affective capabilities (example: create empathy with the story).

Teaching methodologies

The methodology is based on reflection using the principles of transformative learning as a framework of reference. It takes place in tutorial sessions guided by a tutor. Illness narratives developed by students constitute the central element of the discussions. Reflective writing is used in order to deconstruct and construct meaning, as well as apprehend details, interpret and respond to patients. Arts and literature are used to promote the development of competences of observation, analysis, empathy and reflection that are associated to patient-centered care. Simulations of interviews with a professional actor are also included in order to replicate clinical practice. This strategy aims to support students` self-examination of their competences to understand and implement narrative reasoning as well as contribute for the development of observation, empathy and reflection.

Demonstration of the teaching methodologies coherence with the curricular unit's intended learning outcomes

Aiming to promote the combination between evidence-informed practice and a more humanize practice, the contents of this unit are based on representations of clinical practice developed by the students – illness narratives. Through this strategy, students have the opportunity to develop skills to observe, absorb and interpret patients` stories, which facilitate a deeper understanding not only about the patients` clinical experiences but also about their own experiences in professional practice. Each student develops an illness narrative about one of the patients he/she had accompanied in previous clinical placements. Students have the opportunity to present and discuss a preliminary version of the narrative in a tutorial session and integrate the results of this discussion in a final version, which will be submitted for assessment.
Additionally, arts and literature are used with the purpose of facilitating the development of narrative reasoning capabilities and patient centred practice. Through reading, observing and interpreting artefacts students experience particular events, learn to attribute meaning, explore and understand the patient`s perspective about health/ disease and disability. The artefacts include literature, movies, poetry or painting and are used to promote the students` sensitivity to the biographical contexts of patients and families, the individual experiences of illness and the process of making sense.
Through simulated patients, students have the opportunity to implement and test the competences promoted by the curricular unit in a context that replicates clinical practice. The simulations are based on illness narratives from real patients. The behavior of the professional actor is instructed according to the learning outcomes. This creates the opportunity to analyze and reflect on the evolution of the students` performances.

Assessment methodologies and evidences

For the successful completion of this unit, the student must attend 80% of the tutorial sessions and must have at least 9,5/20 in the following activity: illness narrative. This narrative is focused on the clinical and experiential story of a patient, who had been accompanied by the student in one of the previous placements. It assesses the students` capacity to understand the personal dimension of health and disease, the singularity of each patient as well as the capacity to attribute meaning to patient`s story.


The final classification is based on the following formula:

FC= IN
Where:
FC= Final Classification
IN= Illness narrative

If the student does not have success, a new illness narrative (new patient) is required at exam. In this scenario, the classification of this unit is calculated based on the classification obtained in the illness narrative (100%).

Attendance system

In situations where it is not required the presence of the student in tutorials (students with student-worker status; students who are performing other academic activities, e.g. clinical education; students enrolled in another year of the course) the system defaults is not applied.

Bibliografia

Atkins, S., Ersser, S. (2008). Clinical Reasoning and Patient-Centred Care. In: Higgs, J., Jones, M. A., Loftus, S.,Christensen, N. (Eds.) Clinical Reasoning in the Health Professions. Butterworth- Heinemann New York.
Bandman, C. E. (2008). A medical humanist says good-bye. The Journal of the American Medical Association, 300(2), 149-50.
Bolton, G. (2007). Narrative and poetry writing for professional development. Australian Family Physician, 36(12), 1055-1056.
Caeiro, C., Cruz, E., Pereira, C. (2014) Arts, literature and reflective writing as educational strategies to promote narrative reasoning capabilities among physiotherapy students, Physiotherapy Theory and Practice, In press: 1 - 9.
Charon, R. (2000) Literature and Medicine: Origins and Destinies. Academic Medicine, 75(1), 23-27.
Charon, R. (2001). The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. The Journal of the American Medical Association, 286(15), 1897-1902.
Charon, R. (2004). Narrative and Medicine. The New England Journal of Medicine. 350(9), 862-864. Charon, R. (2005). Narrative medicine: attention, representation, affiliation. Narrative, 13(3), 261-270. Charon, R., Wyer, P. (2008) Narrative evidence based medicine. Lancet 371(9609), 396-397.
Charon, R. DasGupta, S., Herman, N. et al (2017) The principles and practices of narrative medicine. Oxford University Press.
Cruz, E., Caeiro, C., Pereira, C. (2014) A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students., Physiotherapy Theory and Practice 30, 4: 254 - 260, 2014
Dasgupta, S., Charon, R. (2004). Personal illness narratives: using reflective writing to teach empathy. Academic Medicine, 79(4), 351-356.
Edwards, I., Jones, M., Carr, J., Braunack-Mayer, A., Jensen, G. (2004a). Clinical Reasoning Strategies in Physical Therapy. Physical Therapy, 84, 312-330.
Edwards., I, Jones., M, Higgs., J, Trede., F, Jensen., G. (2004b). What is Collaborative Reasoning? Advances in Physiotherapy, 6, 70 -83.
Edwards, I., Jones, M., Hillier, S. (2006). The interpretation of experience and its relationship to body movement: A clinical reasoning perspective. Manual Therapy, 11, 2–10.
Frank, A. (2013) The wounded storyteller. Body, Illness & Ethics. 2nd Edition. Chicago, The University of Chicago Press.
Fernandes, I., Cabral, M. J., Casal, T., et al (2018) Contar (com) a medicina. 3ª Edição. Lisboa, Caleidoscópio.
Hatem, D., Rider, E. (2004). Sharing stories: narrative medicine in an evidence based world. Patient Education and Counseling, 54(3), 251-253.
Kalitzkus, V., Matthiessen, P. (2009) Narrative-Based Medicine: Potential, Pitfalls, and Practice. Narrative Medicine. The Permanente Journal, 13(1), 80-86.
Sakalys, J. A. (2003). Restoring the patient’s voice. The therapeutics of illness narratives. Journal of Holistic Nursing, 21(3), 228-241

Observations

During the unit other learning resources will be suggested.