Syllabus Information

1.1. Introduction

As regards the part of the subject dedicated to the study of Medical Ethics and Assistance Communication, the subject has a content eminently applied. The theoretical content is structured into two thematic blocks integrated with each other: the first presents a basic model of communication with the patient and clinical interview, necessary for future professional development and acquisition of communication skills of the student. The second one, includes everything related to the ethical aspects that the physician will face in the interpersonal relationship with the individual, and their professional environment

1.2. Recommendations to take this course

The subject is composed of two subjects "Medical Communication, Medical Ethics I" and "Legislation I" which are complemented by the subject "Assistance Communication, Medical Ethics and Legislation II", characterized by having contents and language that differs nuclearly from the rest Of the subjects of the Degree of Medicine, of great importance because they are transversal to the rest of curricular subjects and contents of the degree. Every doctor or medical specialist should apply them in the future, regardless of the modality of their professional practice.

For these reasons, the student is recommended: the attendance to class and the accomplishment of the practical activities of each subject that composes the subject; The personal study supported in the bibliography, the active participation of the student that is fundamental and, all this, with the support and the orientation of the teaching staff.

The purpose of these recommendations is to reach the learning outcomes that define the subject and its competences, as well as equip students with the tools and elements for reflection that will be useful to them throughout their professional life .

1.3. Context and importance of this course in the degree

In accordance with:

    Order ECI / 332/2008, of February 13, which establishes the requirements for the verification of official university degrees that qualify for the practice of the profession of Physician, and

    The Resolution of October 20, 2009, of the University of Zaragoza, which published the curriculum of Graduate in Medicine that includes within the subjects / compulsory subjects of 3rd year (second semester) of the Degree.

The general objective of this course is that students, based on the knowledge of the different training activities that comprise it, have acquired the theoretical skills and practical skills necessary to assimilate the legal and deontological regulations, as well as the tools of communication assistance to the exercise and Practice of medicine.

The subject of "Medical Communication, Medical Ethics and Legislation I", is independent and different from the rest of subjects that includes the Medical Degree, although at the same time it is related to all of them. The exercise of any of the activities that the doctor / specialist (care, teaching, research, management, prevention, ...) needs to know, apply and have a proper attitude to their ethical and legal duties, as well as Essential content and skills of clinical communication and clinical interview

2.1. Learning goals

By surpassing this subject, the student will demonstrate that he is able to explain, apply and act in accordance with the theoretical-practical basic concepts of Health Legislation and Medical Ethics that affect any modality of the practice of Medicine.

And, to recognize all the elements that construct a clinical interview, to structure them, and to apply strategies for an excellent communication with the patient.

It is competent to apply the knowledge of legal norms and ethical and deontological standards in the professional practice, mainly in the area of ​​patients 'rights (doctors' duties)

 The student will also be able to develop and practice the communication skills learned.

He will know the consequences of breaching his ethical and legal duties and the bases of legal and deontological responsibility in his professional practice.

Will be able to recognize professional attitudes of good and bad medical praxis in relation to healthcare communication, reflect on them and assimilate for themselves everything necessary for a good communication of care.

3.1. Aims of the course

The subject and its expected results respond to the following approaches and objectives:

The general objective of this subject is that the student, from the knowledge of the different training activities that comprise it, has acquired the theoretical skills and practical skills necessary to assimilate the legal and deontological regulations, as well as the tools of communication assistance to the exercise And practice of medicine.

In Legislation I the student must:

- Introduce yourself in the law by acquiring the basic concepts that make you understand the subject, as well as knowing the structure of health law and fundamental regulations from the perspective of different areas of law.

- To know the requirements of the legal profession of the medical profession and the consequences of its non-compliance.

- The legal nature of the medical-sanitary act, its functions and competences, as well as the different ways of practicing the medical profession.

- The rights of patients and their professional duties

- The legal consequences of non-compliance with medical duties with respect to the patient: professional legal and deontological medical professional responsibility.

 In Medical Ethics and Care Communication, a progressive agenda is developed that will be developed according to the following teaching scheme for training in:

A) Attitudes: promotion of a provision of intellectual openness and activation of professional qualities based on respect for the patient and responsibility in sustaining the health system.

B) Knowledge: concepts and foundation in clinical ethics, care communication and clinical interview.

C) Skills:

- Training for a clinical relationship of excellence

- Training for deliberation and ethical argumentation

3.2. Competences

BASIC.

 

CB1 - That the students have demonstrated to possess and to understand knowledge in an area of ​​study that starts from the base of the general secondary education, and is usually found to a level that, although it relies on advanced textbooks, also includes some aspects Which involve knowledge from the vanguard of their field of study
CB2 - Students can apply their knowledge to their work or vocation in a professional way and possess the skills that are usually demonstrated through the elaboration and defense of arguments and problem solving within their area of ​​study
CB3 - That students have the ability to gather and interpret relevant data (usually within their area of ​​study) to make judgments that include a reflection on relevant social, scientific or ethical issues
CB4 - Students can transmit information, ideas, problems and solutions to a specialized and non-specialized audience
CB5 - Students have developed those learning skills necessary to undertake further studies with a high degree of autonomy

SPECIFIC.


CE10 - To know the legal bases of the exercise of the medical profession. Informed consent. Confidentiality
CE11 - Recognize, diagnose and guide the management of physical and mental damage. Social and Legal Implications of Death
CE12 - To know and to recognize the normal evolution of the corpse. Postmortem diagnosis. Fundamentals of Medical Criminology
CE13 - Being able to write medical-legal documents
CE14 - To know the fundamentals of medical ethics. Bioethics. Resolve ethical conflicts
CE15 - Apply the professional values ​​of excellence, altruism, sense of duty, responsibility, integrity and honesty to the exercise of the profession
CE16 - Recognize the need to maintain professional competence
CE17 - Know how to approach professional practice respecting the patient's autonomy, beliefs and culture
CE34 - To know the aspects of the communication with patients, relatives and their social surroundings: Models of clinical relation, interview, verbal, nonverbal communication and interferences. Give bad news. Write stories, reports, instructions and other records, in a way that is understandable to patients, families and other professionals
CE35 - To make an oral and written public presentation of scientific papers and / or professional reports

4.1. Assessment tasks (description of tasks, marking system and assessment criteria)

1.- CONTINUED EVALUATION For the teaching team is very important the continuous evaluation throughout the development of the subject, which we understand in a bidirectional sense. This ongoing evaluation consists of:

Class attendance, which will be valued, as well as the active participation of the student in it.

Attendance at the seminars (compulsory) and completion of the portfolio (compulsory) and voluntary programmed activities (demonstrating the interest and participation of the student and that will serve to improve the final grade).

- Elaboration of the Portfolio (mandatory completion): 40% of the overall evaluation.

It will include three cases (one of communication and two of ethics), that reflect situations that the student has lived in his practices carried out in other clinical subjects. The cases should deal with the situation experienced both from the point of view of medical ethics and that of the communication of care, and if possible, reflect both positive situations (good medical practice that they have been observers), and negative for the professional And / or the patient. In order to facilitate the realization and help the student in the elaboration of the cases, some templates have been developed with the sections to be completed and a rubric to guide their preparation, self-evaluation and independent evaluation by the teaching staff.

- Voluntary programmed activities (will allow to raise the final grade of the mandatory assessment up to 2 points, with the corresponding evaluation of the merits alleged: 0.1-0.2 per activity presented)

They can be of several types:

A) Elaboration of a memory of the subject (communication block
(Eg, 20 lines per hour of class or seminar, telling the most relevant information that the student has learned).

B) Assistance to activities related to Ethics and Communication (Seminars and Forums of the College of Physicians, conferences, activities of the Delegation of Students, etc.)

 

C) Commentary of books or films related to the syllabus of this block of the subject (a guiding list will be provided).

5.1. Methodological overview

The learning process that has been designed for this subject is based on the following:

In the combination of theoretical classes in a large group, theoretical-practical tutorials in small or individualized groups, practical work, seminars / discussion in small groups, and the special importance of personal study.
As well as the interaction in the forums, debates through moddle and in person in the different seminars and activities. The realization of the student's reflective work, which is reflected in the fibal portfolio, is essential for this.

5.2. Learning tasks

LEGISLATION I (3 ECTS)

A) .- Theoretical teaching (19h = 0,76 ECTS): Explanation and orientation for the personal study of the different contents of the subject, aimed at the acquisition of competences and learning outcomes. All the necessary resources will be used for interaction with students and supports in the various audiovisual supports, including video conferencing if possible.

In addition to encouraging the active participation of the student in the theoretical classes, tutorials will be done in a personalized way, with the request of the teacher or through Moodle.

B) .- Practical teaching: type 2 (6h = 0,24 ECTS) and type 6 (20h = 0,8 ECTS).
Practical teaching tutored in small subgroups, according to Plan of Bologna and completion of work. It aims to stimulate, guide and follow the students in the elaboration of a tutorial work following the methodology of learning based on problem solving, from the perspective of the medical-legal problem of the different contents of the subject.
 
Legislation I: 3 ETCS.
0.76 ECTS: lectures (19 h)
0,8 ECTS: tutored practices type 6 (20 h)
0,24 ECTS: practical type 2 (6 h)
0,04 ECTS: performance of the exam (1 h).
1,16 ECTS: student's personal study (29 h)
COMMUNICATION ASSISTANCE, MEDICAL ETHICS I (3 ECTS)
 
This subject is compulsory and semester. Its elective load is 6 ECTS, of which:
0.5 theoretical ECTS, (master class I),
0.2 practical ECTS (problem solving and cases, Type I),
0.5 ECTS tutored practices, type 6, and
1,8 ECTS of personal work destined to carry out the work on practical cases, and study to acquire the competences of the subject.

5.3. Syllabus

The program that the student is offered to help you achieve the expected results includes the following activities ...

COMMUNICATION PROGRAM WELFARE, MEDICAL ETHICS I: 3 ECTS
 Class topics with large groups (Tuesday, Wednesday and Thursday from 9 to 10 h) *
* The order of delivery will adapt to the logic of the subject
Concepts and History of Bioethics. Ethics and Medical Ethics. Ethics logic against the logic of law. The challenge of defensive medicine. The principles of autonomy, beneficence, non-maleficence and justice.
ethical references in the practice of the different types of medicine: curative, palliative, preventive and satisfactiva. models of clinical ethics and doctor-patient relationship: patronizing, contractualist, cooperative. The therapeutic distance.
Types of ethical issues in professional practice: attitudes, dilemmas and operational on a day to day issues of the medical profession. Procedures in decision-making. Care Ethics Committees.
Confidentiality in clinical practice: ethical, limits and exceptions. The concept confident required. Practical issues in the development of clinical history and clinical documentation management.
Ethics prescription. Scientific evidence, patient information and efficiency. deontological rules. Ethical issues in the relationship with the pharmaceutical industry medical providers and health care institutions.
Ethics relations between professionals. Work in multidisciplinary teams. Respect for colleagues. Loyalty to the patient, colleague and to the institution. Professional ethics of dealing with the sick colleague (PAIME) or professional difficulties. The responsibility for continuing education and professional development.
Ethics of Biomedical Research. The responsibility to investigate and communicate knowledge. Scientific authorship. national and international standards governing research. Ethics committees of clinical research.
Ethics and palliative care in the patient in a terminal situation. Diagnostic and therapeutic obstinacy. The adequacy of the therapeutic effort. The right of refusal and choice of treatments. Palliative sedation. The euthanasia debate.
Introduction to communication and the clinical interview. The doctor-patient relationship. The objectives and phases of the clinical interview. The patient-centered communication. The style of consultation and participation of the patient. Reference models and models of doctor-patient relationship.
Non-verbal communication. Noise, interference. The image formation side in the clinical interview. Listening skills. Proxemics. Kinésica. Paralanguage.
The clinical interview. exploratory phase of communication with the patient. First interview skills. Interview techniques. Types of interview. Common errors in the exploratory phase.
The clinical interview. Information phase. Information technology. Common mistakes. Difficulties in identifying situations. Clinical decision: main models of problem solving.
The clinical interview. negotiating phase. Persuasion, negotiation techniques and assignment. The clinical decision in the patient's bedside. Patient empowerment in their own health and shared decision making.
How to give bad news. The doctor and patient to bad news. Basics and guidance elements. Objectives of communication at the end of life. Stages of acceptance and adaptation to the bad news. Difficulties in communication with the patient in palliative care.
Mourning and its process. most common reactions to grief. performance before the match. Pathological mourning. The grieving process in children.
 Seminars (small groups)
Seminar 1. Exploration of different types of patients. Trials in different models interview. Role playing.
Seminar 2. How to give bad news. The Latin model and the Anglo-Saxon model. Addressing the conspiracy of silence.
Seminar 3. Informed consent as a way of clinical setting. The concept of adequate information. The patient's ability in decision-making and assessment. Voluntariness and ethics of external influences: persuasion, manipulation, coercion.
Seminar 4. Ethical Recommendations for the medical student during their clinical practice (Guide prepared by the Student)
 
 LAW I: 3 ECTS
PROGRAM:
- Introduction to Forensic Medicine
- Introduction to Law: Concepts and general principles.
- Health medical law: concept and legal marcjo.
- Legal and illegal exercise of health professions.
- Medical and health Act: health professions and activities, legal regulation of medical and health act, forms of practice.
- Medical Professional Responsibility: concept, principles and types of professional responsibility.
- Duty of medical and health care.
- Right of users of health:
    - Right to information
    - The right to autonomy
    - Right to privacy
    - Right to medical records

5.4. Course planning and calendar

5.5. Bibliography and recommended resources

BB [Care communication] - Borrell i Carrió, Francesc. Clinical interview: practical strategies manual / Francesc Borrell i Carrió. Barcelona: Spanish Society of Family and Community Medicine, D.L. 2004
BB [Care communication] - Borrell i Carrió, Francesc. Clinical practice centered on the patient / Francesc Borrell i Carrió. Madrid: Triacastela, 2011
BB [Care communication] - Gómez Sancho, Marcos. How to give bad news in medicine / Marcos Gómez Sancho. 3rd ed. Rev. And amp, [Madrid]: Arán, D.L. 2006
BB [Communication of care] - Neighbor, Roger .. The internal consultation: how to develop an effective and intuitive style of consultation / Roger Neighbourg; With drawings by Patrick Reade; Spanish version supervised and coordinated by Juan José Rodríguez Salvador; Review Roger Ruíz Moral ... [et al.]. Barcelona: J & C Ediciones Médicas, D.L. 1997.
BB [Care communication] - Ruiz Moral, Roger. Clinical relationship: a guide to learning, teaching and research / Roger Ruiz Moral. Barcelona: semfyc, D.L. 2004
BB [Care communication] - Tauber, Alfred I. .. Confessions of a doctor: a philosophical essay / Alfred I. Tauber. Madrid: Triacastela, 2011
BB [Care communication] - Ansola Bowl, María Pilar. Relationship and communication / María Pilar Ansola Bowl, Javier García Campo, Lide Aseguinolaza Chopitea. 2nd ed. Madrid [etc.]: Dissemination of Advances in Nursing, 2002
BB [[Welfare Communication]] - Winckler, Martin. The confessions of Dr. Sachs / Martin Winckler; Translation, Naomi Ruiz de la Prada. Tres Cantos, Madrid: Akal, D.L. 1999 [There is film of the same title]
[Medical ethics] - Andorno, Roberto. Bioethics and dignity of the person / Roberto Andorno; Spanish version of the author. [1st ed.] Madrid: Tecnos, D.L. 1998
BB [Medical ethics] - Beauchamp, Tom L. Principles of biomedical ethics / Tom L. Beauchamp, James F. Childress. 1st ed., Reim. Barcelona; Madrid [etc.]: Masson, 2002
[Medical ethics] - Better doctors, better patients, better decisions: envisioning health care 2020 / edited by Gerd Gigerenzer and J. A. Muir Gray. Cambridge, Massachusetts; London: MIT, cop. 2011
BB [Medical Ethics] - Code of Medical Ethics: Medical Ethics Guide / [Medical College Organization of Spain]. [Reim. Of the ed. Of 2011] [Madrid]: WTO, 2015
[Medical ethics] - Grace, Diego. As archers to the target: bioethics studies / Diego Gracia; Edition of José Lázaro. San Sebastián [etc.]: Triacastela, D.L. 2004
[Medical Ethics] - Hope, Tony. Medical ethics: a very short introduction / Tony Hope. [1st ed.] Oxford; Madrid [etc.]: Oxford University Press, cop. 2004
[Clinical ethics: a practical approach to ethical decisions in clinical medicine] / Albert R. Jonsen, Mark Siegler, William J. Winslade. 7th ed. New York; Madrid [etc.]: McGraw-Hill, cop. 2010
BB [Medical ethics] - Ward ethics: dilemmas for medical students and doctors in training / edited by Thomasine K. Kushner and David C. Thomasma. Cambridge; Madrid [etc.]: Cambridge University Press, 2001
BB [Medical Ethics] - Williams, John R. Medical ethics manual / [by John R. Williams]; World Medical Association. . France: World Medical Association, cop. 2005.
BB [Legislation I] - Amorós, E .. Medical-Legal Advice. Practical guide for all patients. . - 2nd ed. Ed. Colimbo. Hermes Group Ed.General SA
BB [Legislation I] - Bonnet, E.F.P. Legal Medicine / E.F.P. Bonnet. 2nd ed. Buenos Aires: López Libreros, 1980
BB [Legislation I] - Sanitary and bioethical law: current issues / coordinators Marina Gascón Abellán, Mª del Carmen González Carrasco, Josefa Cantero Martínez. Valencia: Tirant lo blanch, 2011
BB [Law I] - Law and medicine: legal issues for health professionals / Pilar Rivas Vallejo, María D. García Valverde, directors; Prologue, José Luis Monereo Pérez. 1st ed. Cizur Menor (Navarra): Civitas, 2009
BB [Law I] - Law and medicine: legal issues for health professionals / Pilar Rivas Vallejo, María D. García Valverde, directors; Prologue, José Luis Monereo Pérez. 1st ed. Cizur Menor (Navarra): Civitas, 2009
BB [Legislation I] - Encyclopedia of Biowealth and Bioethics / Carlos María Romeo Casabona (Director). Granada: Comares, 2011
BB [Legislation I] - Hinojal Fonseca, Rafael. Manual of legal medicine and toxicology / Rafael Hinojal Fonseca. [Gijón]: Arcano, D.L. 1990
BB [Legislation I] - Materials of bioethics and law / Edition by María Casado; Joaquín Aguirre ... [et al.]. 1a. Ed. Barcelona: Cedecs, 1996
BB [Legislation I] - Legal medicine and toxicology / editor, Enrique Villanueva Cañadas. 6th ed., Reim. Barcelona: Masson, D.L. 2005
BB [Legislation I] - Vargas Alvarado, E. Forensic medicine and medical deontology. Mexico: Trillas, 1991
 
LIST OF URLs:
 
 Code of Medical Ethics
[Https://www.cgcom.es/codigo_deontologico/index.html]
 Documents of the Central Commission