Rethinking Professional Ethics in the Cost-Sharing Era

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.     

Patients’ intention to speak up for health care providers’ hand hygiene in inpatient diabetic foot wound treatment: a cross-sectional survey in diabetes outpatient centres in Lower Saxony,Germany*

Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs’ hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434)?=?41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292)?=?4.4, p = .013) and knowledge on HCPs’ hand hygiene (F(2, 294)?=?3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs’ hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge.     

Inviting perspective transformation: Sexual history awareness for professional formation

How do we deal with our own sexuality as teachers and as learners in the classroom? As a seminary professor in a mainline Christian context, I find that discussing sexuality increases student discomfort levels by threatening to raise questions about the connections between morality, behavior, and bodies of those in the room – questions we have been culturally trained to avoid. In order to decrease discomfort, many instructors approach sexuality only as content‐based subject matter. Particularly for ministry students, this approach can be a disservice to their discernment process and preparation for future ministry contexts, especially for those in turmoil regarding sexuality‐related issues. By explicitly engaging how personal experience and cultural contexts shape our sexuality, pedagogical models can promote critical self‐reflection and seek perspective transformation, not values change, as a resource for professional sexual ethics training in ministry.     

Practical work in physiotherapy students’ professional development

Learning practical work through cooperation between school and working life is part of physiotherapy higher education. Students learn practical work through the integration of theoretical, practical, tacit and situational knowledge in a socialization process. Workplace practices and habits direct students’ learning. This study answers the question: What kind of conceptions of learning practical work do physiotherapy students have? Longitudinal data written by 21 volunteer students (mean age 25 years) was collected over three and a half years. Thematic analysis was used to analyse the data. Learning practical work proceeds in five phases: (1) the basis of practical work, human movement and action and therapeutic tools is learned at school; (2) the meaning of the profession and practical work takes shape in an interaction with clients and observing how professionals work in real workplaces; (3) the wholeness of the practical work takes shape by gradually participating in the work processes; (4) critical reflection of the work processes – thinking, construction, evaluation and reasoning – develops; and (5) the conception of practical work widens. This study brings new information about learning practical work for developing healthcare education and its curricula. The role of workplaces is huge in learning tacit knowledge of the profession.     

Classroom engagement dynamics: examining the potency of reflective teaching approach among some selected universities in Ghana

The purpose of this research was to investigate the effectiveness of the use of reflective teaching approach by university lecturers in Ghana to achieve improved student learning outcomes. The research utilised a quantitative survey design involving 180 lecturers who were accidentally or haphazardly selected from four universities in Ghana to complete a reflective teaching survey (RTS) questionnaire. The results showed that participants frequently engaged in varied reflective teaching activities, and were successful in evaluating the effectiveness of their pedagogies. The research concluded that the approach should be an essential component of the teacher performance appraisal system.     

Mental health in retired professional football players: 12-month incidence,adverse life events and support

ObjectivesThe primary aim was to explore the incidence of symptoms of common mental disorders (CMD; distress, sleep disturbance, anxiety/depression, adverse alcohol use) in retired professional football players and to explore the association between adverse life events and the onset of symptoms of CMD. The secondary aim was to get an insight into the views and needs of retired professional football players on medical support related to symptoms of CMD.DesignAn observational prospective cohort study with three measurements over a follow-up period of twelve months was conducted among retired professional football players.MethodThe data for symptoms of CMD and adverse life events was collected by using validated questionnaires. The views and needs were explored by means of five questions.ResultsThe 12-month incidence of symptoms of CMD (self-reported and not clinically diagnosed) ranged from 11 to 29%. Retired professional football players with one or two life events were 1.7 times more likely to report distress than retired football players with no life events. The risk with three or more recent life events on sleep disturbance was more than 4.5 times higher than with no recent life events.ConclusionsThe 12-months incidence of symptoms of CMD in retired professional football players seems high compared to the general population. More life events showed a higher risk of experiencing distress and sleep disturbance in retired professional football players. The views and needs showed that there is a need for support for current and former professional football players.     

The alchemy of facilitation revealed through individual stories and collective narrative

Facilitation is a key ‘ingredient’ in the success and sustainability of communities of practice. Yet, little attention has been given to in situ experiences of facilitators of these communities. This paper takes up the challenge to explore these experiences using reflective stories written by seven TATAL (Talking about Teaching and Learning) facilitators (the authors) from different disciplines in five different Australian universities. The authors’ collaborative analysis of their experiences suggests reframing the role of facilitator to include the role of alchemist, a promoter of transformation. This reframing has the potential to change the way higher education community of practice facilitators think about and enact their role. The story-based reflective process used in this self-study could also be used by facilitators to investigate their own practice, as a component of facilitator education programmes or by academics and researchers in other contexts who seek a participatory, collaborative approach to evaluate their practice.     

Can voicing conflict within experiential learning groups facilitate connection? building and developing effective multi-disciplinary team-working skills

In the UK, Clinical Psychologists (CPs) work in a variety of settings within the National Health Service (NHS), often within Multi-Disciplinary Teams (MDTs). Problem-Based Learning (PBL) within CP training at the University of Hertfordshire (UH) offers unique opportunities to combine scientist-practitioner and reflective-practitioner models to learn about group dynamics from the personal experience of working within an experiential learning group.

Further, given Trainees work three days per week on placement within MDTs in the NHS, the learning gained within a ‘safer’ PBL context can be utilised within these clinical settings. For two years, Trainees at UH have to work in small PBL groups with five or six members learning to work together to achieve a goal (four assessed presentations) negotiating their own personal and professional journey, as well as a group journey. Consequently, PBL offers trainees opportunities to learn (1) how individuals work within a group; (2) how personal experiences influence this process; (3) how others influence them and are influenced by them; and (4) how a group of diverse individuals conceptualise, understand and convey case vignettes to an audience. Within these groups, many Trainees learn to speak out, reflect, listen attentively, empathise, validate and accept diverse experiences. Further, when differences dominate they often learn to negotiate these, finding a way to maintain effective team working in order to complete the presentation. Focusing on the conflict that can occur within (any) group, this paper explores themes from the reflective narratives of six trainees: parallels and differences between MDTs and PBL groups, striving for and achieving authenticity; and conflict as a ‘swear’ word. We conclude that exploring the role PBL can play in training individuals to work effectively in teams may be of benefit within the training of other professional groups.     

Depth of discussion of multicultural identities in supervision and supervisory outcomes

The present study empirically examined the relationship between perceived depth of discussion of multicultural identities in clinical supervision and supervision outcomes in 132 practicum trainees and interns from American Psychological Association-accredited doctoral programs in counseling, clinical, and combined psychology. Results indicated that ethnic minority trainees and gay, lesbian, and bisexual trainees perceived increased depth of discussion of their corresponding identities compared to White trainees and heterosexual trainees, respectively. However, women and men reported no difference in perceptions of depth of discussion regarding gender. Perceived depth of discussions of three multicultural identities (gender, race/ethnicity, and sexual orientation) was significantly and positively correlated with supervisory working alliance, multicultural intervention self-efficacy, and general counseling self-efficacy, and significantly and negatively correlated with role ambiguity and role conflict. These relationships between perceived depth of discussion and role ambiguity and working alliance-rapport remained significant for the three identities while controlling for past training experiences. The relationships between perceived depth of discussion of gender and role conflict, of race/ethnicity and working alliance client focus, and of sexual orientation and role conflict, multicultural intervention, and working alliance client focus also remained significant while controlling for past training experiences. Implications for supervisory practice, training, and research are discussed.     

师范生职业认同与自杀意念的关系:抑郁的中介作用及其性别差异

基于心理健康的社会学模型和社会-文化模型,本研究考察师范生职业认同与自杀意念之间的关系,以及性别的调节效应和抑郁的中介效应。被试为700名师范生,研究工具包括师范生职业认同感量表、自杀意念自评量表、流调中心用抑郁自评量表。结果表明：（1）职业认同得分、自杀意念检出率的性别差异显著;（2）职业认同与抑郁、自杀意念均呈显著的负相关,自杀意念和抑郁呈显著的正相关;（3）性别在职业认同负向预测自杀意念的关系中起到调节作用,该调节作用还部分通过抑郁这一中介变量来实现。