Attitude and Communication (AETCOM)

Competencies for the

Indian Medical Graduate
Medical Council of India

July 2015
Medical Council of India
 AETCOM
• Attitude: Refers to a set of emotions, beliefs
and behavior towards a particular object,
person or event.
• Influenced by experience,
upbringing. A bad attitude is
like a flat tyre...
You cant go too far
Until you change it.
 AETCOM
• Attitudes can be changed specially over a long period
of time (longitudinally).
• Strategies used are:
– Reasoned arguments.
– Social pressure: social sanctions, social acceptance.
– Behaviour led attitude change – where people are
required to behave in a particular way whether they agree
with it or not. Over time attitude changes due to
habituation.
– Fear or threats
Nothing changes until you change, everything changes once you change.
 AETCOM
• Ethics: A system of moral principles that applies value
to the practice of clinical medicine & scientific
research.
Six principles of Medical Ethics
Beneficence To act in the best interest of the patient
Legal: What the Society
Non-Malfeasance Do noaccepts
harm as Good or Bad.
Autonomy Patient
Ethical: What a body has right to refuse
of Professionals acceptoraschose (consent)
Desirable Acts.
Justice Who gets what treatment on the merit f illness
Moral: What an Individual decides for oneself based on
Dignity Patient and doctor both have right to dignity
personal value system
Truthfulness / Patient deserves to know the whole truth about
Honesty the illness and treatment
 AETCOM
• Communication:
– the imparting or exchanging of information by
speaking, writing, or using some other medium.
Communication impacts
Diagnosis
Adherence
Patient satisfaction
Physician satisfaction
Malpractice litigation
 Curriculum Gap
INTENDED CURRICULUM ACHIEVED CURRICULUM Formal curriculum:
What we want students to Competencies students actually What we say
acquire pick up after the course Hidden curriculum:
What we do
TAUGHT CURRICULUM ASSESSED CURRICULUM
Engage students with intended Assessing what we want them IMG
curriculum to learn
Communicator
EXPERIENCED CURRICULUM Professional
Differs from student to student
Leader

Clinician
Harmonious development of the head, hand and the heart is the
Which of the IMG attribute is related to AETCOM? Lifelong learner
mark of a professional - Swami Vivekananda
 AETCOM
•Structured •27 modules.
•Longitudinal •Explicit TL methods
•Modular program •140 instructional
•CBME. hours incl SDL.
•54 competencies. •Assessment.
•39 core. 15 NC. •Logbook.
Prof-1 – M-3 The doctor patient relationship (p.21)
1- Angiography advice- (Trust in the doctor patient
relationship, Rights of a patient, Duties of a doctor)

2- Property- (Boundaries in the doctor patient relationship,

Trust and vulnerability in doctor patient relationships

1. Enumerate and describe professional qualities KH

and roles of a physician

2. Demonstrate empathy in patient encounters SH

A young doctor has been taking care of an 86 year old
woman who had a fall and has been mostly bed ridden. She
lives alone with just a care taker and her children are
abroad. She requires preventive care mostly and the doctor
visits her once a week and spends time talking to her and
makes her feel comfortable. On one visit, the patient
expresses that her children have been ungrateful and that
she intends to ask her lawyer to divide her assets between
the doctor and the caretaker after her death.
What should the doctor do?
Module 4 for professional year 4 (Page- 60-62)
Case studies in ethics empathy and the doctor-
patient relationship

Background- Continuation of a previous module

40. Demonstrate Addressed-

Competencies empathy in patient encounters
are following SH

35. Communicate care options to patient and family SH

with a terminal illness in a simulated environment
 Case- A letter from the grave
Respected doctor: Cancer pt. Alka - empathy but later Apathy

Points For Discussion

The role of a doctor as a healer
Failure of treatment and its implications for the Doctor Patient
Relationship
Empathy and patient care
Can the doctor patient relationship be terminated
Hospice care

Assessment-
Formative (by observation & reflective writing)
AETCOM - T-L methods
• Hours: 5
• Intro of case 1
• SDL 2
• Anchoring lecture: 1
• Discussion and
closure of case 1
• Reflective writing
& Portfolio
Stages in SDL
 AETCOM - T-L methods
• Interactive lecture/Tutorial-
Cognitive base for Sensitization (S)

• Experiential learning
or Immersion (I)

• Reflective Writing (R)

• By Arts (Cinemeducation, Role-play, Poetry etc.)

• Hybrid Problem based learning (PBL)

↓

→
 Reflection: Any experience Affect Analyse Action
Inbuilt
Feelings & Emotions
Physiology of Emotion Rolfe’s cycle

Hippocampus
Amygdala
M body

Cerebral cortex
Thalamus
Wernicke’s
Temporal lobe
area

Basal fore Reflection WWW

brain All domains : Knowledge, skill, affective
And beyond: psychological, personal,
emotional. HOLISTIC
REFLECTION
- What happened-
What happened?
Who was involved?

- So what-
-What key points did I take away from the sessions? What
interested me / motivated me about these session?

- What new skills, information, or understanding have I taken

away from this session?
What next-
-How will I use what I learned in my own teaching? How will
my students/ faculty be affected by these changes?

-What ideas can I use immediately and which are more useful
for future application?

- Will what I learned in the sessions change my teaching

practices
 WWW Hai-

What you learned (holistic & specific-5),

Why you learned,

Why you can’t learn and

How you learned

 Checklist for reflective writing
-What you learned (all domains)

- Emotional and psychological learning

- How you learned (learning style)

-Describes something that motivated him/her to learn

- Good or bad points and why Confidence,

fitness, focus
- Relate with professionally & personally and preparation
- Relate with broader picture (relevance- society) for big matches
What Happened?
I recently attended a talk on substance abuse. The speaker, a former addict turned counselor,
shared their personal journey with substance abuse, highlighting the challenges they faced
and the steps they took to overcome their addiction. The talk was both informative and
moving, as the speaker's raw honesty and vulnerability made it easy to relate to their
experiences. The speaker discussed the various factors that can contribute to substance abuse,
such as peer pressure, mental health issues, and genetic predisposition. They also emphasized
the importance of seeking help and support from professionals and loved ones.
What Next?
After attending the talk, I felt a renewed sense of awareness and empathy for individuals
struggling with substance abuse. I realized that addiction is a complex issue with no easy
solutions. The speaker's story inspired me to learn more about substance abuse and the
resources available to those in need. I plan to do some research on local organizations that
offer support and treatment for substance abuse. Additionally, I will be more mindful of my
own and others' behaviors and will not hesitate to reach out to someone if I suspect they
may be struggling with addiction.
So What?
Attending the talk on substance abuse has significantly impacted my understanding of
addiction and its consequences. I am now more aware of the signs and symptoms of
substance abuse and the importance of seeking help early on. The talk has also reinforced the
value of empathy and compassion for individuals struggling with addiction. I believe that by
raising awareness and reducing stigma, we can create a more supportive environment for
those in recovery.

Language no bar. Any format – Prose or poetry or pictorial. Should focus

on learners experience. Write in first person. What you learnt, not what
the class learnt. For e.g you can write “I attended this class on….” Don’t
write “We attended this class on….”
 Learning
communication by arts

(Role plays, Videos, Simulations,

Cinemeducation, Photographs, poems)
Feedback is
the heart of
formative
assessment
 Total 54 competencies. 39 core. 15 NC.
A- Related to Group Dynamics-
Demonstrate respect & ability to work with-

1. Superiors (C)

2. Colleagues in the profession (C)

3. Good mentoring relationship to junior colleagues (C)

4. And other health care workers (C)

5. Balance personal professional priorities (NC)

6. Manage time appropriately (NC)

B- Current issues- Identify discuss medico-legal
socioeconomic and ethical issues as it pertain to-

1. Organ donation (C)

2. Research in human subjects (C)

3. Physician patient relationship (C)

4. Physician industry relationships (C)

5. Health care in children (including parental right to

refuse treatment) (C)
C- Burning issues- Identify discuss medico-legal
socioeconomic and ethical issues as it pertains to

1. In vitro fertilization donor insemination and

surrogate motherhood (NC)

2. Medical negligence (NC)

3. Malpractice (NC)
4. Do not resuscitate and withdrawal of life support
(NC)

5. Medical errors
D- The AT-COM competencies- Guiding principle in
patient care

1. Autonomy (C)
2. Beneficence (C)
3. Confidentiality (C)
4. Justice (C)
5. Empathy (C)
6. Non malfeasance (C)
E- Related to consent- Demonstrate ability to obtain
consent-

1. For surgical procedures (C)

2. For procedures in a simulated environment (C)

3. Decision making in emergency where patients cant

give consent (C)

4. Research in human subjects(C)

F- Interesting competencies- Demonstrate ability

1. Pursue and seek career advancement (NC)

2. Form and function in appropriate professional

networks (NC)

3. Adequate and appropriate personal grooming (C)

4. Use of information technology (C)

5. Seeks help and consultations appropriately (C)

 Would you like to reflect on this
on going revised basic course
Communicate Courage Moral
CBME Behave Professional
Autonomy Empathy Immersion
Confidentiality Sensitive
DNR
Longitudinal Respect Thank You