Imparting education to inculcate ethical values, professional attitude and effective inter-personal communication is much stressed in current curricula for Medical and other Health-professions. This talk stresses the need for the teachers to evolve themselves as positive role models if they wish to be effective in their mission to empower their students with values and professional identity.

1. Attitude, Ethics and
Communication skills for the
Teacher and the Taught
Prof KR Sethuraman. MD, PGDHE.
Sri Balaji Vidyapeeth, Puducherry.
www.sbvu.ac.in

2. •Bad Attitude is like a flat
tire. One can’t go far with
that
•Attitude refers to a set of
emotions, beliefs, and
behaviors toward a
particular object, person,
or event.
•Attitudes are often the
result of experience or
upbringing.
11-06-2018 2MEDUCON June, 2018

3. This Talk is about –
• Gaps (Lacunae) in Higher Education
• Differentiate these: Legal – Ethical – Moral
• Desirable attributes of an Educator & a Doctor
• Attitude, Ethics and Communication skills of
the Medical Educators
– Some issues ; Some solutions
• Attitude, Ethics and Communication skills of
the Medical Students/Professionals
– Some issues ; Some solutions
11-06-2018 3MEDUCON June, 2018

4. Findings of Early 70’s, ( >45 Years ago)
Should We Rectify the Situation or Not?
11-06-2018 4MEDUCON June, 2018

5. Disharmony Results in Lopsided Education
11-06-2018 5MEDUCON June, 2018

6. Harmony in Education
(one of Gandhiji’s favourites Paraphrased…)
Professional
11-06-2018 6MEDUCON June, 2018

7. Legal – Ethical – Moral
• Legal: What the Society
accepts as Good or Bad
• Moral: What an Individual
decides for oneself based on
personal value system
• Ethical: What a body of
Professionals accept as
Desirable Acts
11-06-2018 7MEDUCON June, 2018

8. Ethical Principles are Aspirational Goals
• Universal principles :
– Nonmaleficence – do not cause harm
– Beneficence – do good
– Justice – fairness & equality
– Student Autonomy – freedom of choice
Principles can overlap as well as compete with
each other for priority
11-06-2018 8MEDUCON June, 2018

9. Traditional Ethical Theory
Rule of reciprocity:
“do unto others,
as you would have them
do unto you”
– “concern for others”
11-06-2018 9MEDUCON June, 2018

10. Educator Ethics: case-1
• Prof. B, a disciplinarian by nature, was an
external examiner. A pretty girl candidate
made an error in physical finding.
• Prof. B said, "Pretty girls are petted and
pampered; they don’t study. She should realise
that pretty face is not enough to pass” and
failed her.
• However, to the dismay of internal examiner,
plain looking girls were condoned by him for
greater errors.
11-06-2018 10MEDUCON June, 2018

11. Personal Bias is unethical
Four Common Biases
• Students the teacher likes get better
grade
• Pretty girls do not focus on studies
• Boys are out of control in the classroom
• Introverted students are stupid
https://education.cu-portland.edu/blog/classroom-
resources/unconscious-discrimination-avoiding-teacher-biases/
11-06-2018 11MEDUCON June, 2018

12. Educator Ethics: case-2
• Prof. X, published a guide for students,
which he called, “a gist of the best
textbooks”
• He expected all his students to learn it by-
heart and reproduce it in the exams.
• Those who did not fall in line got lower
grades.
11-06-2018 12MEDUCON June, 2018

13. Manipulating or Motivating Learners?
• Conflict of interest: any
situation in which an
individual is in a position
to exploit a professional
capacity in some way for
their personal benefit.
• Student autonomy gets
vitiated
11-06-2018 13MEDUCON June, 2018

14. Educator Ethics: case-3
• Prof. C, a conscientious examiner assessed a
'low-achiever' who chose dangerous options
(e.g., use of harmful drugs during early
pregnancy), and felt that the candidate
needed to learn much more to qualify.
• The internal examiner pleaded, "This
candidate is appearing for the 3rd time.
Please pass him."
11-06-2018 14MEDUCON June, 2018

15. Teacher Focus = Student welfare
Examiner Focus = Patient safety
• Dual obligation of
teacher versus
examiner
• Introspect on our
obligation to the
Society as examiner
License to Harm
11-06-2018 15MEDUCON June, 2018

16. Educator Ethics: case-4
• Prof. D was taking a class on `Rational Use of
Drugs'. He made a passionate plea for
prudent prescribing which impressed most of
the students.
• One of the students waved a prescription slip
and asked, "Sir, how do you then justify your
recipe containing 4 anti-convulsants, 3 brain
tonics and 3 vitamins for a patient with fits?"
11-06-2018 16MEDUCON June, 2018

17. Teachers, as Role-Models,
mould the students
• “What we do
conveys much more
than what we say.”
• Can we evolve to be
‘role models’ for our
students?
11-06-2018 17MEDUCON June, 2018
When you point a finger
at someone, the other 3
are pointing at yourself!

18. 11-06-2018 18MEDUCON June, 2018

19. Educators’ Code of Ethics
11-06-2018 19MEDUCON June, 2018

20. I: Ethical Conduct toward Students
• deals considerately and justly with each
student,
• seeks to resolve problems, including discipline,
according to law and school policy
• does not intentionally expose the student to
disparagement or humiliation
• does not reveal confidential information
concerning students, unless required by law
• presents facts without distortion, bias, or
personal prejudice
https://www.aaeteachers.org/index.php/about-us/aae-code-of-ethics11-06-2018 20MEDUCON June, 2018

21. II: Ethical Conduct toward
Practices and Performance
• maintains sound mental health, physical
stamina, and social prudence necessary to
perform well
• does not misrepresent official policies and
clearly distinguishes those from personal
opinions.
• honestly accounts for all funds committed to
his or her charge.
• does not use professional privileges for
personal advantage.
11-06-2018 21MEDUCON June, 2018

22. III: Ethical Conduct toward
Professional Colleagues
• does not reveal confidential information
concerning colleagues unless required by law
• does not wilfully make false statements
about a colleague or the institution
• does not interfere with a colleague's freedom
of choice, and
• works to eliminate coercion that forces
educators to support actions that violate
individual professional integrity
https://www.aaeteachers.org/index.php/about-us/aae-code-of-ethics11-06-2018 22MEDUCON June, 2018

23. IV: Ethical Conduct toward
Parents and Community
• communicate to parents all information that
should be revealed in the interest of the
student
• respect the values and traditions of the
diverse cultures represented in the institution
• exhibits a positive and active role in school-
community relations
https://www.aaeteachers.org/index.php/about-us/aae-code-of-ethics11-06-2018 23MEDUCON June, 2018

24. Teacher Effectiveness -
EQ not IQ !
11-06-2018 24MEDUCON June, 2018
Teachers
attitude is the
most important
factor
influencing their
effectiveness

25. AETCOM for Medicos*
11-06-2018 25MEDUCON June, 2018
*Attitude – Ethics – Communication skills for Indian
Medical Graduates
(Formulated by the Medical Council of India)

26. AETCOM is Not Exam-oriented
but is Life-oriented,
1901-’82. Coined the popular maxim "Think Globally, Act Locally"
EASILY
11-06-2018 26MEDUCON June, 2018

27. AETCOM Curricular Thread
YEAR MODULES HOURS
I 5 34 (34)*
II 8 37 (35)
III 5 25 (25)
IV 9 44 (45)
Total 27 140 (139)
*(figs) are of ATCOM-2015
11-06-2018 27MEDUCON June, 2018

28. “Indian Medical Graduate” (IMG)
• knowledge, skills, attitudes, values and
responsiveness, to function appropriately and
effectively as a doctor of first contact in the
community, while being globally relevant
• Five Major Roles & Responsibilities
1. Clinician
2. Communicator
3. Lifelong learner
4. Professional
5. Leader / member of the health care team
11-06-2018 28MEDUCON June, 2018

29. Attitude, Ethics and Communication
Competencies of IMG
• 3.1. Clinician, who - provides -- holistic care
with compassion
• 3.3. Communicator with patients, families,
colleagues and community
• 3.5. Professional who is committed to
excellence, is ethical, responsive and
accountable ---
• Shouldn’t we try to achieve these in all our
graduates?
11-06-2018 29MEDUCON June, 2018

30. List of competencies in Attitudes,
Ethics and Communication (n=68)
• Competencies 1 - 39 are core competencies
– MUST Value and Practice – for All IMGs
• Competencies 40 -54 are non-core
competencies to be assessed formatively
– Desirable Traits to value and practice for above-
average IMGs
• An additional 14 are listed as desirable traits
– Nice traits to value and practice for outstanding
IMGs
11-06-2018 30MEDUCON June, 2018

31. Inculcating Professional Attitudes
• Recognise the importance of training in professional
attitudes
• Secure necessary resources and skills, using examples from
elsewhere
• Ensure that professional development objectives are set
throughout the curriculum
• Use learning methods that match the objectives
• Tutors must be good role models
• Create a learning culture that examines own shortcomings
openly
• Use peer influence systematically to support the learner
• Reward good performance by students and staff
12- tips for developing professional attitudes in training. Medical Teacher, 2003, 25:485–711-06-2018 31MEDUCON June, 2018

32. http://slideplayer.com/slide/9825019/
11-06-2018 32MEDUCON June, 2018

33. COMMUNICATION SKILLS TRAINING
11-06-2018 33MEDUCON June, 2018

34. EXCELLENCE IN
COMMUNICATION:
TOP 5 ATTRIBUTES
11-06-2018 34MEDUCON June, 2018
Extracted from the Book: Communication Skills in Clinical Practice
www.jaypeebrothers.com/pgDetails.aspx?book_id=9789351524113

35. 1 – Accuracy
Two examples of near fatal communication
errors:
• Milk drip:
– Given iv (instead of through naso-gastric tube)
• Inj plain insulin 10 ml iv (instead of 10 units)
11-06-2018 35MEDUCON June, 2018

36. 2 – Availability & Timeliness ..
• A case of Scabies infestation who is prescribed
benzyl benzoate emulsion
• Two scenarios:
• Apathy – unavailable advice
– Patient drinks it, thinking that it is a ‘tonic’
versus
• Proactive – available and timely advice at the
time of prescribing and dispensing
11-06-2018 36MEDUCON June, 2018

37. 3-Understandability
“You had a syncopal episode last night without
any evidence of arrhythmia. I don’t think it
was vagal but I ordered a 2D echo and holter
to rule out CVS problems. I still can’t rule out a
vertebrobasilar event.”
?
11-06-2018 37MEDUCON June, 2018

38. 4 – Balance: cost – Benefit – risk
11-06-2018 38MEDUCON June, 2018

39. 5 – Repetition...
This is to ensure understanding. But do not repeat
the same words (like a parrot) .
Statement – Repetition – Explanation is effective
Example:
“It is important to act now before it is too late.”
Statement: “We think it’s important to act now”
-- pause --
Repetition: “It’s important to act now, -”
Explanation:“ because tomorrow may be too late.”
Making the patient repeat it is even more effective
11-06-2018 39MEDUCON June, 2018

40. Communication Skills:
Assessment for Learning
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941375/11-06-2018 40MEDUCON June, 2018

41. Summing up: “We looked at -
• Lacunae in Higher Education (UNESCO)
• Differentiating Legal – Ethical – Moral
• Desirable attributes of an Educator & a Doctor
• Attitude, Ethics and Communication skills of
the Medical Educators
– Some issues ; Some solutions
• Attitude, Ethics and Communication skills of
the Medical Students/Professionals
– Some issues ; Some solutions
11-06-2018 41MEDUCON June, 2018

42. Can we all work together to try
and produce the ideal “IMGs” we
all can be proud of?
How many of you say,
‘AETCOM – Here We Come’?
11-06-2018 42MEDUCON June, 2018

43. 11-06-2018 43MEDUCON June, 2018