‘… you kind of frantically go from one thing to the next and there isn’t any time for thinking any more’: a reflection on the impact of organisational change on relatedness in multidisciplinary teams

This paper reflects on the relational impact on Clinical Psychologists of NHS organisational change in the context of cuts and reorganisation. The reflections illustrate one theme drawn from a study of eight Clinical Psychologists working within adult Community Mental Health Multi-Disciplinary Teams. The paper considers the impact of competition and change in healthcare on the ability to engage in reflective practice potentially affecting client care due to reduced joint-working, consistency and creativity. The paper considers how acts of kindness (compassion) within organisational contexts at all levels can facilitate relatedness, reflection and more human care. It concludes by considering how shifting from short-term planning evaluating efficiencies based on perceived financial value, to thinking more widely and long-term about relational value may be of benefit to clinicians, clients and the system as a whole.     

恶性肿瘤多学科综合诊疗模式的探讨

恶性肿瘤的治疗方法和理念不断更新,依靠单一治疗方法很难取得理想效果,多学科综合诊疗(MDT)模式是以患者为中心和以多学科专家组为依托的多种诊疗模式的有机结合,保障了肿瘤患者最佳诊疗方案的实施,促进了学科间的交流和了解.资料显示,MDT是恶性肿瘤患者改善结局的最好模式.推广和完善MDT模式将有助于我国医疗资源共享,减少误诊误治,改善肿瘤患者预后,提高存活率.     

恶性肿瘤多学科综合诊疗模式的探讨

恶性肿瘤的治疗方法和理念不断更新,依靠单一治疗方法很难取得理想效果,多学科综合诊疗（MDT）模式是以患者为中心和以多学科专家组为依托的多种诊疗模式的有机结合,保障了肿瘤患者最佳诊疗方案的实施,促进了学科间的交流和了解.资料显示,MDT是恶性肿瘤患者改善结局的最好模式.推广和完善MDT模式将有助于我国医疗资源共享,减少误诊误治,改善肿瘤患者预后,提高存活率.     

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.     

Fuzzy Genes: Epistemic Tensions in Genomics

Genomics contributed to making modern biology a prolific multi-disciplinary field leading to new approaches such as systems biology. Reporting in the media reflects the high stakes involved in these changes, but such reporting often appears inconsistent as contradictory claims are made about new applications contrasting with uncertainties from new insights. Such inconsistent claims might relate to different disciplines involved in the field. New approaches from engineering disciplines such as computer science have changed research practices and approaches towards the object; the meaning of genes having become context-dependent. Since disciplines must cooperate, tensions arise over methods, evidence criteria and the significance of hypotheses. The concept of epistemic cultures, developed to highlight differences between distant fields such as high-energy physics and molecular biology, can render insights into the ‘cultures’ related to practices and approaches within genomics. Qualitative interviews with scientists shed light on how computer science and experimental molecular biology co-operate and which problems arise from epistemic differences as the criteria for relevant findings become subject to the disciplinary context. In addition, genomics-like approaches have entered other fields of biological research, whilst systems biology further challenges hypothesis-driven experimentation. This may lead to a new epistemic culture differing from the one previously described. These findings provide insights into how different accounts arise and shed light on general properties of prolific multi-disciplinary research fields. Inconsistencies in the way such fields appear from outside might be considered normal rather than the exception.     

Multi-disciplinary Competence Assessment: A Case Study in Consensus and Culture

Theoretical Medicine and Bioethics - The case of May Redwing, an American Indian woman assessed for competence is examined in detail. The case highlights the interconnections between the cultures...     

The Gap Between Clinical Trial and Application in Health Behavior Counseling: Can Behavioral Medicine Build a Bridge?

Patients desire to have information about health-related behaviors (e.g., exercise) provided to them by their health care provider. Outcomes of clinical trials in physical activity counseling are modest at best and therefore, the degree of effectiveness of physical activity counseling in the primary care setting remains unclear. We describe what may be considered a real-world example of behavior change counseling aimed at primary or secondary risk factor identification and modification for CHD in women. We examined rates of baseline and follow-up physical activity in our sample of midlife Caucasian and African American women (N = 227) participating in a hospital-based CHD-risk screening. Baseline physical activity levels and rates of return for follow-up appointments were quite low with only negligible achievement of behavior change recommendations. In light of these findings, the potential role of behavioral medicine in training and collaboration with health care providers in primary care behavior counseling is discussed.