tag:theconversation.com,2011:/fr/topics/health-professionals-17183/articleshealth professionals – The Conversation2023-09-13T18:40:20Ztag:theconversation.com,2011:article/2104252023-09-13T18:40:20Z2023-09-13T18:40:20ZSolving Canada’s shortage of health professionals means training more of them, and patients have a key role in their education<figure><img src="https://images.theconversation.com/files/547848/original/file-20230912-7671-ly0s9f.jpg?ixlib=rb-1.1.0&rect=131%2C186%2C5013%2C3523&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A fundamental component for training health-care professionals is interacting with patients and families.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/solving-canadas-shortage-of-health-professionals-means-training-more-of-them-and-patients-have-a-key-role-in-their-education" width="100%" height="400"></iframe>
<p><a href="https://www.ctvnews.ca/health/canadians-worried-about-the-state-of-provincial-health-systems-poll-1.6248713">Eighty-six per cent of Canadians</a> are worried about their health-care systems. Health-care professional organizations like the <a href="https://www.cma.ca/about-us/what-we-do/press-room/health-care-groups-call-premiers-make-canadas-collapsing-health-system-their-top-priority#:%7E:text=%22Canada%27s%20health%20care%20system%20is%20in%20crisis.%20While,only%20added%20fuel%20to%20an%20already%20raging%20fire.">Canadian Medical Association</a> and the <a href="https://www.casn.ca/2022/11/casn-releases-nurses-education-in-canada-statistics-report-2020-2021/">Canadian Association of Schools of Nursing</a> are sounding the alarm about the severe shortage of health-care providers. This shortage is contributing to Canada’s health-care crisis. </p>
<p>Canada urgently needs more trained health-care professionals. While they may not know it, everyone in Canada can play a key role in educating future health-care providers. </p>
<p>Each encounter that health-care students have with patients, families and communities helps them develop real-world understanding of the various needs of the diverse Canadian population.</p>
<h2>Canada’s shortage of health-care workers</h2>
<p>The House of Commons Standing Committee on Health’s March 2023 report titled <a href="https://www.ourcommons.ca/Content/Committee/441/HESA/Reports/RP12260300/hesarp10/hesarp10-e.pdf">Addressing Canada’s Health Workforce Crisis</a> explored and substantiated this shortage of health-care professionals. This report primarily focused on physicians and nurses. Canada anticipates a shortfall of <a href="https://www.canada.ca/en/employment-social-development/news/2023/06/canada-is-addressing-current-and-emerging-labour-demands-in-health-care.html">78,000 physicians</a> by 2031, and <a href="https://www.canadian-nurse.com/blogs/cn-content/2023/04/17/solutions-to-tackle-nursing-shortage#:%7E:text=A%202019%20analysis%20predicted%20a,care%20(OECD%2C%202022).">117,600 nurses</a> by 2030. </p>
<p>Other professions are also sounding the alarm of practitioner shortages, including <a href="https://www.ourcommons.ca/Content/Committee/441/HESA/Reports/RP12260300/hesarp10/hesarp10-e.pdf">dental professionals, medical laboratory specialists, occupational therapists</a> and <a href="https://www.longwoods.com/audio-video/longwoods-breakfast-series/Youtube/9588">pharmacists</a>. </p>
<p>In addition to these predictions, there are significant concerns about keeping the care providers we currently have. A 2022 report from the <a href="https://nursesunions.ca/wp-content/uploads/2022/11/CHWN-CFNU-Report_-Sustaining-Nursing-in-Canada2022_web.pdf">Canadian Federation of Nurses Unions</a> found that 94 per cent of nurse respondents showed signs of burnout, and over half wanted to leave their current job. Other health professions have raised similar concerns. </p>
<h2>Addressing the shortage</h2>
<p>There is no quick fix to these complex problems, and Canada is responding in a variety of ways. This includes recruiting <a href="https://www.canada.ca/en/employment-social-development/news/2022/12/government-of-canada-launches-call-for-proposals-to-help-internationally-educated-professionals-work-in-canadian-healthcare.html">internationally trained</a> practitioners, funding strategies to improve <a href="https://www.canada.ca/en/health-canada/news/2023/04/government-of-canada-announces-support-to-help-address-workforce-challenges-and-retention-in-nursing-field.html">retention</a> and increasing <a href="https://www.universityaffairs.ca/news/news-article/provincial-budget-round-up-2023-highlights-for-the-university-sector/">educational seats</a> to train more future health-care providers. </p>
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<img alt="A woman in scrubs shakes hands with a man using a wheelchair in front of two other people in scrubs" src="https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Each encounter that health-care students have with patients, families and communities helps them develop real-world understanding of the various needs of the diverse Canadian population.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>These responses are being created from <a href="https://www.canada.ca/en/health-canada/news/2022/11/health-canada-announces-coalition-for-action-for-health-workers.html">federal</a>, provincial (such as <a href="https://novascotia.ca/news/release/?id=20221114001">Nova Scotia</a>) and local levels. However, these strategies are not quick fixes and efforts may not be successful. </p>
<p><a href="https://www.cbc.ca/news/health/financial-perks-doctor-recruitment-1.6548194">Retention efforts</a> have not been as effective as anticipated, as financial incentives do not appear to have the same influence they might have had in the past. International recruitment is fraught with <a href="https://theconversation.com/the-ethics-of-recruiting-international-health-care-workers-canadas-gains-could-mean-another-countrys-pain-208542">ethical concerns</a> and complex processes applicants need to work through in order to become licensed to practice.</p>
<h2>Education investments</h2>
<p>Significant provincial investments are being announced to create more seats in education programs for health-care professional students. The <a href="https://edmontonjournal.com/news/politics/alberta-to-expand-seats-in-health-care-education-with-200-million-over-three-years">Alberta government</a> is investing $72 million for 3,400 new seats in a variety of health-related training programs and $20 million for the creation of 120 new physician seats. </p>
<p><a href="https://globalnews.ca/news/9448757/additional-seats-saskatchewan-health-care-training-programs/">Saskatchewan</a> is adding 550 health-care provider education seats. <a href="https://news.umanitoba.ca/manitoba-government-announces-80-physician-training-seats-to-be-added/">Manitoba</a> announced an investment of $200 million for 2,000 health-care professionals, including 80 new physician seats and four <a href="https://news.gov.mb.ca/news/index.html?item=56297">respiratory therapy</a> students. </p>
<p><a href="https://www.universityaffairs.ca/news/news-article/provincial-budget-round-up-2023-highlights-for-the-university-sector/">Other provinces</a> are also investing in a variety of ways such as educational program grants to expand enrolment in Ontario, and student financial support in Prince Edward Island.</p>
<p>While increased training opportunities can increase the future workforce, having more students also requires additional resources and learning opportunities. Education for health-care professionals varies by the type of provider, and can range from certificate programs to graduate degrees. </p>
<h2>How Canadians can help</h2>
<p>We are a team of interdisciplinary researchers who teach health-care professionals in their foundational training. We know that despite significant differences in health-care education programs, one fundamental component for all learners is interacting with patients and families. </p>
<p>That means all Canadians play an essential part in educating future health-care providers. With more students enrolling, Canadians will have even more engagement with students in health-care settings.</p>
<p>Most health-care education programs include public interaction. Some public members purposefully engage. For example, some become guest speakers in classes, and share personal experiences with illness and health care. But more commonly, people engage with health-care professional students while looking after their health needs. </p>
<p>Canadians can anticipate interacting with students in common health-care spaces such as pharmacies, physiotherapy clinics, dental clinics, public health clinics, doctor’s offices, hospitals or outpatient clinics. But students may also be found in less expected places such as food banks, non-profit community organizations, schools and community settings. </p>
<p>Members of the public may feel less inclined to interact with students. This can be due to the perceived increased time it takes, worries about students’ knowledge or abilities, or because they might feel that they <a href="https://doi.org/10.1016/j.ijnurstu.2018.04.010">don’t have anything to contribute</a>. However, it is important for Canadians to know about the benefits of these interactions for both students and patients.</p>
<h2>What Canadians can teach health-care professional students</h2>
<p>Research has identified that student encounters with public patients and family members contributed to the development of their <a href="https://doi.org/10.1007/s10459-022-10137-3">communication</a>, <a href="https://doi.org/10.1080/0142159X.2019.1652731">compassion and empathy skills</a>. It also helped decrease stigma towards traditionally stigmatized groups and conditions, such as those with <a href="https://doi.org/10.1111/1440-1630.12205">mental illness</a>. </p>
<p>Interacting with the Canadian public also increased students’ ability to <a href="https://doi.org/10.1111/j.1365-2850.2011.01858.x">use appropriate language</a> and <a href="https://doi.org/10.1111/j.1365-2850.2012.01955.x">work with patients</a>. It enhanced their <a href="http://dx.doi.org/10.1136/bmjopen-2020-037217">self-confidence</a> and their motivation in caring for the public.</p>
<h2>How does this impact Canadians?</h2>
<p>While these interactions benefit student learning and will help contribute to a larger health workforce, they have also been found to benefit the public. </p>
<p>Research has found that student encounters can increase a patient’s <a href="https://doi.org/10.1111/inm.12021">sense of empowerment</a> to participate in their own health with shared decision-making. Additionally, there is a potential for the improvement of overall <a href="https://doi.org/10.1007/s10459-022-10137-3">health outcomes</a> of patients. One study found patients were more knowledgeable and better able to <a href="https://doi.org/10.1016/j.japh.2021.08.014">manage their own medications</a> after engaging with student practitioners.</p>
<p>The shortage of health professionals in Canada, and globally, is of sincere concern. To address this, it is essential that we increase the number of professionals being trained. This requires the Canadian public’s assistance as they encounter more health-care professional students. </p>
<p>Investing your time in interacting with students has benefits for the students and for you. Canadians can all play a part in building the future health workforce we desperately need. As health-care professionals, we thank you for the important role you play in educating and shaping our students and future health workforce. </p>
<p><em>Bryn Keogh co-authored this article. She is an undergraduate student at the University of Calgary in communication and media studies and received an Alberta Innovates Summer Research Studentship.</em></p><img src="https://counter.theconversation.com/content/210425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Each encounter that health-care students have with patients and families helps them understand real-world patient needs. That means all Canadians have a role in educating future health-care providers.Lisa McKendrick Calder, Associate Professor, Nursing, MacEwan UniversityEleftheria Laios, Educational Developer, Queen's University, OntarioKerry Wilbur, Associate Professor and Executive Director, Entry-to-Practice Education, Faculty of Pharmaceutical Sciences, University of British ColumbiaLorelli Nowell, Associate Professor and Assistant Dean of Graduate Programs, Faculty of Nursing, University of CalgaryWhitney Lucas Molitor, Associate Professor and Program Director, Occupational Therapy Department, University of South DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2108792023-08-02T22:51:06Z2023-08-02T22:51:06ZDoes picking your nose really increase your risk of COVID?<figure><img src="https://images.theconversation.com/files/540914/original/file-20230802-26619-e8ybza.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-picking-his-nose-167161349">Shutterstock</a></span></figcaption></figure><p>Picking your nose is linked to an increased risk of COVID, according to a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288352">study</a> out today.</p>
<p>The study was conducted in health workers. This raises two main questions.</p>
<p>One, were these health workers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588529/">washing</a> <a href="https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/national-hand-hygiene-initiative/what-hand-hygiene/5-moments-hand-hygiene">their hands</a> at work? Two, what does this study mean for the rest of us nose pickers? </p>
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<em>
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Read more:
<a href="https://theconversation.com/when-you-pick-your-nose-youre-jamming-germs-and-contaminants-up-there-too-3-scientists-on-how-to-deal-with-your-boogers-185052">When you pick your nose, you're jamming germs and contaminants up there too. 3 scientists on how to deal with your boogers</a>
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<h2>What did the study find?</h2>
<p>Some 219 Dutch health workers were monitored for COVID infection. They had regular antibody testing, which tells us if they had been exposed to SARS-CoV-2, the virus that causes COVID. They also reported the results of their own COVID tests.</p>
<p>Some 12-18 months later, the health workers were asked about their nose picking habits, and exposure to COVID via symptomatic workmates or from contacts outside work.</p>
<p>Just over 17% of health workers who reported picking their nose caught COVID versus about 6% of those who did not report nose picking.</p>
<p>At first glance, it might appear feasible that people who pick their noses would be at increased risk of contracting COVID.</p>
<p>That’s because COVID infection relies on the SARS-CoV-2 virus coming into contact with mucous membranes that line the respiratory system, including those in the nose. </p>
<p>So if someone touches a contaminated object or hand, then sticks their finger up their nose, this so-called fomite transmission can occur. </p>
<p>But the risk is comparatively low. The United States Centers for Disease Control <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html">estimates</a> about one in 10,000 contacts with a contaminated surface results in SARS-CoV-2 transmission.</p>
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Read more:
<a href="https://theconversation.com/how-clean-is-your-hospital-room-to-reduce-the-spread-of-infections-it-could-probably-be-cleaner-122185">How clean is your hospital room? To reduce the spread of infections, it could probably be cleaner</a>
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<h2>Hang on a minute</h2>
<p>But there are some odd results. For example, people who picked their noses only monthly had a higher chance of infection than daily nose pickers. Logically, you would expect the daily nose pickers to have a higher risk of infection due to more transmission opportunities.</p>
<p>There were also several aspects of how the study was designed that may have influenced the results.</p>
<p>Just over half of the people approached to participate in the study actually did so, which may cause <a href="https://www.iwh.on.ca/what-researchers-mean-by/selection-bias#">selection bias</a>. This is where people who choose to participate may differ in some key characteristic from those who don’t. These different characteristics can be “<a href="https://www.sciencedirect.com/topics/nursing-and-health-professions/confounding-variable">confounders</a>” that influence the results.</p>
<p>This was a cohort study, which followed a defined group of people for a set time and asked them questions about their habits and exposure. This study design may also be subject to bias.</p>
<p>That’s because people tend to answer in ways that are <a href="https://www.ajan.com.au/archive/Vol25/Vol_25-4_vandeMortel.pdf">socially desirable</a>, even in anonymous surveys. They tend to under-report behaviours seen as socially unacceptable (such as binge drinking); they over-report those that are socially acceptable.</p>
<p>This study did not control for this type of bias. So we cannot say for certain if someone’s report of whether and how often they picked their nose is a true reflection of what actually happened.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker wearing surgical mask, scrubs and gloves outside carrying folder or clipboard" src="https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540705/original/file-20230802-17-b2qkwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">How often do you pick your nose? Your answer may not be accurate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-female-ems-key-worker-doctor-1844975320">Shutterstock</a></span>
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<p>People in the study may also have had trouble correctly remembering past behaviour (picking their nose) or exposures (to symptomatic people with COVID). The long time lag between when the infection data was collected and the retrospective survey increases the risk of recall error.</p>
<p>There is also some level of “guestimating” in the study, particularly when it comes to the risk of COVID exposure. Health workers were asked to note their contact with symptomatic people or working with COVID patients. But we can’t say if these were real “exposures”. That’s because people may not have symptoms and still have COVID (this would have under-estimated their exposure risk). Alternatively, COVID patients may not be that infectious if they don’t shed much virus (which may have over-estimated the COVID risk).</p>
<p>Then, it appears the analysis did not control for gender. This is potentially an issue as female health workers tend to be <a href="https://pubmed.ncbi.nlm.nih.gov/11743487/">better</a> at following hand hygiene guidelines. The study reported a higher rate of nose picking in males and doctors, and males and <a href="https://www.australiancriticalcare.com/article/S1036-7314(00)70630-8/pdf">doctors</a> are also worse at hand hygiene.</p>
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<a href="https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Surgeon washing hands in hospital" src="https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=285&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=285&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=285&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=358&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=358&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540700/original/file-20230802-15-ma6m83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=358&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">How often did health workers wash their hands? The study didn’t say.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgeon-hospital-washing-thorouughly-his-hands-1155417787">Shutterstock</a></span>
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<p>So the nose pickers may also be worse at sanitising their hands. In other words, we don’t know if nose picking is the reason for the reported increased risk of COVID, the lack of hand hygiene, or both.</p>
<p>Another way of saying this is the researchers reported a <em>correlation</em> between nose picking and an increased risk of COVID. We cannot say one <em>causes</em> the other or if additional factors are involved.</p>
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Read more:
<a href="https://theconversation.com/does-picking-your-nose-really-increase-your-risk-of-dementia-193463">Does picking your nose really increase your risk of dementia?</a>
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<h2>So, what now?</h2>
<p>Given the above limitations, the study conclusions seem overly confident. Overall, the risk of SARS-CoV-2 transmission via nose picking is probably comparatively low, particularly for the general public who are not working in high COVID environments. </p>
<p>But you can definitely decrease your risk through good hand hygiene (and using a tissue that you dispose of afterwards).</p>
<p>Better still, avoid inhaling airborne viral particles, which is the <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html">most common</a> mode of transmission of SARS-CoV-2. Wear a good fitting mask or respirator in public, particularly in poorly ventilated or crowded inside spaces.</p><img src="https://counter.theconversation.com/content/210879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Griffith University Master of Infection Prevention and Control program. </span></em></p>Health workers who picked their noses were more likely to contract COVID, according to a new study. But here’s what the study means for the rest of us.Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2018982023-04-11T14:35:17Z2023-04-11T14:35:17ZSouth African doctors are bound by many rules. Criminal charges for mistakes may have unintended consequences<figure><img src="https://images.theconversation.com/files/517947/original/file-20230328-4538-eylan5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Claims for financial compensation for medical mistakes in South Africa have been <a href="https://theconversation.com/legal-claims-for-medical-mistakes-are-on-the-rise-in-south-africa-whats-behind-the-trend-187393">on the rise since 2007</a>. Recently, however, criminal charges for medical errors have also become more prevalent. One such case is that of <a href="http://www.saflii.org/za/cases/ZACC/2020/19.html">Dr Danie van der Walt</a>, who was ultimately acquitted on a charge of negligently causing the death of a child. Another example is the case of <a href="https://ewn.co.za/2023/02/01/paediatric-surgeon-charged-with-murder-and-culpable-homicide-returns-to-court#:%7E:text=JOHANNESBURG%20%2D%20Murder%2Daccused%20paediatric%20surgeon,surgery%20Beale%20performed%20on%20him.&text=Beale%20was%20subsequently%20charged%20with,charge%20was%20upgraded%20to%20murder">Dr Peter Beale</a>, who was charged with, but not yet tried of, causing the death of a 10-year-old. Yet another is the ongoing case and charge of murder brought against <a href="https://www.news24.com/news24/southafrica/news/surgeon-faces-shock-murder-charge-after-death-of-patient-20220905">Dr Avindra Dayanand</a> for the death of a 35-year-old patient.</em> </p>
<p><em>These cases have raised questions about how the medical profession is regulated in South Africa. Is the regulation effective in preventing harm? How are medical practitioners held accountable for harm suffered? What are the consequences of the regulatory environment? The Conversation Africa’s Ina Skosana spoke to Larisse Prinsen, a medical law specialist, about what’s in place.</em></p>
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<h2>How is the medical profession in South Africa regulated?</h2>
<p>South Africa has a comprehensive framework for the regulation of the healthcare environment. </p>
<p>Healthcare in South Africa is overseen by the <a href="https://www.health.gov.za/">National Department of Health</a> along with its provincial departments. The medical profession is regulated by numerous authorities and pieces of legislation. </p>
<p>Practitioners, depending on their branch of medical practice, are regulated by certain bodies that have been created by legislation. These statutory authorities provide field-specific regulation. </p>
<p>They include the <a href="http://www.hpcsa.co.za/">Health Professional Council of South Africa</a>, which is perhaps the primary regulator of the medical profession. The council has professional boards which are responsible for various aspects of the profession. For example, the boards determine standards of education and training for practitioners, and set and maintain standards of ethical professional practice as empowered by the <a href="https://ethiqal.co.za/wp-content/uploads/2019/08/health_professions_act.pdf">Health Professions Act of 1974</a>. The professional boards, such as the Professional Board for Emergency Care Practitioners, also license practitioners and keep registers of them. </p>
<p>Health products are regulated by the <a href="https://www.sahpra.org.za/">South African Health Products Regulatory Authority</a>. And medical research is overseen by the <a href="https://www.samrc.ac.za/">Medical Research Council</a>.</p>
<p>These statutory bodies and professional boards also have the power to establish disciplinary committees and disciplinary appeals committees.</p>
<h2>Which laws are in place?</h2>
<p>Healthcare in South Africa is also regulated by the <a href="https://www.justice.gov.za/legislation/constitution/saconstitution-web-eng.pdf">Constitution</a>, medico-legal codes of conduct, the common law and precedents set by case law.</p>
<p>In addition, numerous acts of parliament exist which represent binding regulatory instruments. The <a href="https://ahpcsa.co.za/wp-content/uploads/2015/10/The-Allied-Health-Professions-Act-63-of-1982-_as-amended.pdf">Allied Health Professions Act</a> of 1982, <a href="https://sadtc.org.za/wp-content/uploads/2019/01/DENTAL-TECHNICIANS-ACT-1979-ACT-No.-19-OF-1979-as-amended-1.pdf">Dental Technicians Act</a> of 1979, Health Professions Act, <a href="https://www.gov.za/sites/default/files/gcis_document/201505/act-101-1965.pdf">Medicines and Related Substances Act</a> of 1965 and its 2002 amendment, <a href="https://www.gov.za/sites/default/files/gcis_document/201409/a33-050.pdf">Nursing Act</a> of 2005, <a href="https://www.gov.za/sites/default/files/gcis_document/201505/act-53-1974.pdf">Pharmacy Act</a> 53 of 1974 and <a href="https://www.samrc.ac.za/sites/default/files/attachments/2016-06-10/MRCAct.pdf">South African Medical Research Council Act</a> of 1991 regulate medicine and the medical profession.</p>
<p>Some of the most prominent pieces of legislation regulating the practice of medicine are the <a href="https://www.parliament.gov.za/storage/app/media/ProjectsAndEvents/womens_month_2015/docs/Act92of1996.pdf">Choice on Termination of Pregnancy Act</a> of 1996, <a href="https://www.gov.za/sites/default/files/gcis_document/201505/act-58-1959.pdf">Inquests Act</a> of 1959, <a href="https://www.gov.za/sites/default/files/gcis_document/201504/act-28-1974.pdf">International Health Regulations Act</a> of 1974, <a href="https://www.gov.za/sites/default/files/gcis_document/201409/a17-02.pdf">Mental Health Care Act</a> of 2002 and its 2014 amendment, <a href="https://www.gov.za/sites/default/files/gcis_document/201409/a61-03.pdf">National Health Act</a> of 2003 and the 2013 amendment and <a href="https://www.gov.za/sites/default/files/gcis_document/201409/a22-07.pdf">Traditional Health Practitioners Act</a> of 2004.</p>
<p>In theory, South Africa has a sound healthcare regulatory framework. However, as is often the case, its efficacy can be undermined by human factors. These may include ignorance of the law, poor implementation, lack of resources, breaking of the law or even the wrongful assumption of being above the law. All these factors may contribute to the rise in criminal charges now being brought against medical practitioners, as well as the <a href="https://theconversation.com/south-african-doctors-call-for-law-reform-fearing-a-harsh-penalty-if-patients-die-175185">shock and pushback this has generated in the medical profession</a>. </p>
<p>This is not only a South African trend but an <a href="https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=3817&context=cklawreview">international one</a>. For example, in the UK <a href="https://www.theguardian.com/uk-news/2018/aug/13/dr-hadiza-bawa-garba-wins-appeal-against-decision-to-strike-her-off">Dr Bawa-Garba</a> was convicted of culpable homicide over the death of a six-year-old patient. However, countries such as New Zealand, Australia and England require <a href="https://docs.mymembership.co.za/docmanager/1e9aea2c-b58d-4aed-b5a2-96187d705aee/00159348.pdf">gross negligence</a> when prosecuting doctors in negligence cases.</p>
<h2>How are medical practitioners held accountable?</h2>
<p>Healthcare practitioners may be held accountable through internal disciplinary action, civil claims or criminal charges. </p>
<p>The Health Professions Council of South Africa, and other bodies and professional boards, have the power to establish <a href="https://www.gov.za/sites/default/files/gcis_document/201409/a22-07.pdf">disciplinary committees</a>. These committees most often deal with instances of “unprofessional conduct” or conduct which is “improper or disgraceful or dishonourable or untrustworthy”.</p>
<p>An example of this type of conduct would be persuading patients to invest in a distressed company of which the medical practitioner is a director. These were the facts of a case involving <a href="https://www.medicalbrief.co.za/sca-doctor-must-face-hpcsa-over-investments-solicited-from-patients/">Dr David Grieve</a>. The
doctor tried and failed to appeal a decision by the health professions council. </p>
<p>This means that medical practitioners may be held accountable by way of internal procedures. These may lead to fines, suspensions or the loss of their licences. The precise number of instances where doctors have been struck off is unknown since the majority of these matters are dealt with behind closed doors.</p>
<p>Civil or criminal processes may be based on malpractice or negligence. For a civil claim of negligence, it <a href="https://www.medicalprotection.org/southafrica/casebook-and-resources/news/news-article/2020/01/21/prosecuting-healthcare-professionals-for-culpable-homicide-who-benefits">must be shown</a> that the healthcare practitioner owed a duty of care to the patient, that this duty of care was breached, and that the breach was responsible for the harm suffered. If this is shown on the balance of probabilities, the patient is entitled to compensation. The test applied here asks if a <a href="http://www.medicalacademic.co.za/post-summary/?post_refered=21564">reasonable medical practitioner</a> in the same position would have foreseen the possibility of harm and have taken steps to guard against it. If so, negligence is shown.</p>
<p>For criminal cases of negligently causing the death of another person – culpable homicide – the same requirements are used. But it must be proven beyond reasonable doubt. This is a <a href="https://www.medicalbrief.co.za/prosecuting-healthcare-professionals-for-culpable-homicide-who-benefits/">higher burden of proof</a>. </p>
<p>Criminal charges should be carefully considered. Medical practitioners should not be held liable for mere <a href="http://www.samj.org.za/index.php/samj/article/view/13491/10022">errors in judgment</a>. In South African law, you are either negligent or you are not. There are no degrees of negligence. The distinction between acceptable errors in judgment or punishable negligence will have to be decided case by case, taking all the facts into consideration. </p>
<p>Criminalisation of medical judgment may interfere with <a href="https://www.wma.net/policies-post/wma-statement-on-medical-liability-reform/">appropriate medical decision making</a>. It may discourage doctors from specialising in higher risk, yet much needed, fields already suffering from skills shortages – such as obstetrics or neurosurgery. It may also lead to the practice of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728884/">defensive medicine</a> – recommending diagnostic testing or treatment paths which are not necessarily the best available option but primarily serve to protect doctors against potential litigation or criminal charges.</p><img src="https://counter.theconversation.com/content/201898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Larisse Prinsen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Criminalisation of medical judgment may interfere with appropriate medical decision making.Larisse Prinsen, Senior lecturer in law, University of the Free StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921622022-11-14T01:52:17Z2022-11-14T01:52:17ZPharmacists could help curb the mental health crisis – but they need more training<figure><img src="https://images.theconversation.com/files/494050/original/file-20221108-16-f7uebu.jpg?ixlib=rb-1.1.0&rect=18%2C18%2C6164%2C4097&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/192162/edit">Shutterstock</a></span></figcaption></figure><p>Chances are you live within 2.5 kilometres of a community pharmacy and visit one about every <a href="https://www.guild.org.au/__data/assets/pdf_file/0020/12908/Vital-facts-on-community-pharmacy.pdf">three weeks</a>. </p>
<p>You don’t need an appointment. The wait time is usually short. These factors make <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">pharmacists highly accessible</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755826/">healthcare professionals</a>. </p>
<p>Pharmacists are regularly sought after for advice, including about mental health. In fact, pharmacists may be among the <a href="https://mhaustralia.org/general/pharmacists-role-mental-health">first</a> health professional contacted about a <a href="https://pubmed.ncbi.nlm.nih.gov/20225134/">health concern</a>. They are also in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">regular contact</a> with patients experiencing mental health issues or crises.</p>
<p>Despite the fact most pharmacists believe it is part of their role to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">provide mental health-related help</a>, they may <a href="https://pubmed.ncbi.nlm.nih.gov/34560826/">lack the confidence</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">respond to, raise or manage</a> mental health issues with patients. In our recent study, pharmacists report not intervening about <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">25% of the time</a> when they believe a patient is experiencing a problem or crisis. </p>
<p>Providing pharmacists with early intervention skills could help them address these challenges. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">Pixels are not people: mental health apps are increasingly popular but human connection is still key</a>
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<h2>The pandemic has seen mental health decline</h2>
<p>The COVID pandemic has seen anxiety and depression <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">increase by 25%</a> globally, signalling a broader mental health decline. </p>
<p>Poor mental health affects around 20% of the <a href="https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release">Australian population</a> each year, and <a href="https://www.abs.gov.au/media-centre/media-releases/study-paints-picture-mental-disorders-australia">44% of Australians</a> over their lifetime. In a <a href="https://psychology.org.au/about-us/news-and-media/media-releases/2022/bleak-new-figures-confirm-depth-of-mental-health-c">recent survey</a> of 11,000 people, 24% of them said their mental health had declined over the previous six months. </p>
<p>Most concerning is that about 60% of people experiencing a mental health issue <a href="https://www.blackdoginstitute.org.au/about/who-we-are/#:%7E:text=And%20roughly%2060%25%20of%20these,this%20through%20'translational'%20research.">won’t seek help</a>. This means people are more likely to remain undiagnosed and disconnected from support. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1438265092265623556"}"></div></p>
<h2>Pharmacists’ many hats</h2>
<p>While dispensing and consulting are critical activities for pharmacists, they also help patients with questions and advice about their health, including their mental health.</p>
<p>Generally, <a href="https://pubmed.ncbi.nlm.nih.gov/21070104/">pharmacists in Australia</a> have high levels of mental health-related literacy and <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">evidence-based treatments</a>.</p>
<p>Despite this, pharmacists report a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098086/">lack of confidence</a> which <a href="https://pubmed.ncbi.nlm.nih.gov/28153705/">prevents them</a> from raising mental health issues with patients. This is possibly because only 29% of pharmacists in Australia have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">mental health crisis training</a>.</p>
<p>A lack of confidence in raising and addressing mental health-related issues means patients are likely to remain undiagnosed, untreated, and unsupported.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scared-of-needles-claustrophobic-one-longer-session-of-exposure-therapy-could-help-as-much-as-several-short-ones-193525">Scared of needles? Claustrophobic? One longer session of exposure therapy could help as much as several short ones</a>
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</em>
</p>
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<h2>4 key elements of mental health first aid</h2>
<p>Many of us are familiar with first aid as immediate help offered to an injured or sick person. But what if the issue is not physical, but mental? Many people don’t know what immediate help they can offer. </p>
<p>As with physical injury or illness, timely and high-quality immediate help is critical. </p>
<p>There are a variety of not-for-profit and commercial mental health first aid training programs. A recent literature review of programs for mental health professionals suggests they can <a href="https://pubmed.ncbi.nlm.nih.gov/35500153/">minimise stigma</a> and <a href="https://www.tandfonline.com/doi/full/10.3109/09540261.2014.924910">increase knowledge</a>. They can also bolster <a href="https://www.sciencedirect.com/science/article/pii/S1551741122001991">confidence</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29851974/">intentions to help</a>. </p>
<p>Across the programs, there are four common elements to providing high-quality mental health first aid.</p>
<p><strong>1. Recognise someone may be experiencing a mental health issue or crisis</strong></p>
<p>Recognising a mental health issue or crisis involves taking notice of verbal, physical, emotional and behavioural indicators. Given pharmacists interact with patients about every three weeks, they may be in a good position to notice changes. </p>
<p>They may express sadness, anger, frustration, hopelessness, shame or guilt. Patients might say: “There’s no hope” or “I can’t go on like this”.</p>
<p>Physical indicators include fatigue, sleeping difficulties, restlessness, muscle tension, upset stomach, sweating, difficulty breathing, changes in appetite or weight. </p>
<p>Emotional indicators reflect how a person is feeling and include significant mood changes, teariness, agitation, anger, desperation or anxiety. </p>
<p><a href="https://www.blackdoginstitute.org.au/resources-support/fact-sheets/">Symptom guides</a> for anxiety, depression, bipolar disorder, and suicidal ideation are available. </p>
<p><strong>2. Approach and assesses the person</strong></p>
<p>Opening the dialogue can be as simple as, “How are you? I have noticed [symptoms] and am concerned.” </p>
<p>Your role is not to clinically diagnose a patient; however, it is valuable to assess the patient’s risk and level of urgency. Risk and urgency will help inform whether the person is in immediate danger or can use other non-urgent support services. </p>
<p>The TED acronym can guide first discussions in the following way: </p>
<blockquote>
<p>Tell me … </p>
<p>Explain how that has been impacting you … </p>
<p>Describe what is happening … </p>
</blockquote>
<p><strong>3. Listen in an active way and communicate without judgement</strong> </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636963/">Active listening</a> involves confirming you are hearing and understanding the other person. <a href="https://www.ucsfhealth.org/education/active-listening-strategies">Ways of doing this include</a>: nodding, appropriate eye contact, and summarising what has been shared. </p>
<p>Communicating without judgement involves demonstrating genuine concern for the other person and talking about their experience. </p>
<p>Open-ended questions usually use “how” and “what” queries. You could say something like: “I’ve noticed some changes recently, what’s happening for you?” or “I see you are filling a prescription for sleep tablets. How are you sleeping?” </p>
<p><strong>4. Refer the person to supports</strong></p>
<p>People who are struggling with their mental health can benefit from sharing details with professionals, like general practitioners, or family and friends – but they might need encouragement to seek this support out.</p>
<p>The support system recommended should match the level of urgency. Urgent services include Lifeline for free 24-hour <a href="https://www.lifeline.org.au/">phone, chat, and text message</a> support. The <a href="https://www.suicidecallbackservice.org.au/">Suicide Call Back Service</a> is also a free 24/7 counselling service. </p>
<p>If in doubt or in an emergency, dial 000. </p>
<p>Non-urgent and free online support is available from <a href="https://www.headtohealth.gov.au/">Head to Health</a>, the <a href="https://www.blackdoginstitute.org.au/">Black Dog Institute</a> and <a href="https://www.beyondblue.org.au/">Beyond Blue</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-look-after-your-mental-health-if-youre-at-home-with-covid-174536">How to look after your mental health if you're at home with COVID</a>
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<h2>Could training community pharmacists help?</h2>
<p>Studies in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">Australia</a>, <a href="https://www.sciencedirect.com/science/article/pii/S155174112200002X">New Zealand</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">Canada</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32580909/">abroad</a> all point to pharmacists’ believing <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">they need more training</a> in mental health first aid. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32139284/">Research</a> suggests almost 70% of patients believe all pharmacists should have mental health first aid training. Patients report feeling significantly more comfortable speaking about mental illness with a pharmacist with this training. </p>
<p>And emerging evidence shows mental health first aid training can increase the <a href="https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-8-46">quality</a> of help provided by pharmacists. </p>
<p>In our <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">study</a>, we found Australian pharmacists with mental health first aid training were more likely to intervene than untrained pharmacists. </p>
<p>While the overall quality of the first aid provided by both mental health first aid trained and untrained pharmacists was high, some key differences existed. Trained pharmacists assessed patients and encouraged other supports (such as from friends and family) more. They also felt more confident discussing suicide risk. </p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/192162/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Carpini collaborates with Mental Health First Aid (MHFA) Australia on research projects. Specifically, MHFA Australia has assisted in the dissemination of surveys and recruitment of participants for other research studies that do not overlap with findings related to pharmacists. MHFA Australia was not involved in the research examining pharmacists in any way. Joseph does not receive compensation, directly or indirectly, from MHFA Australia. He has completed Mental Health First Aid training. </span></em></p><p class="fine-print"><em><span>Deena Ashoorian collaborates with Mental Health First Aid Australia on research projects. In addition to being a pharmacist, Deena is an accredited Master Instructor of the Mental Health First Aid program.</span></em></p><p class="fine-print"><em><span>Rhonda Clifford collaborates with students and colleagues to deliver MHFA research projects and other projects related to Mental Health.</span></em></p>Pharmacists develop basic mental health knowledge as part of their formal training. But they report a lack the confidence about raising mental health issues with patients.Joseph A Carpini, Lecturer, Organizational Behaviour and Human Resource Management, The University of Western AustraliaDeena Ashoorian, Senior Lecturer, Pharmacy Discipline, The University of Western AustraliaRhonda Clifford, Professor, Allied Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1516622020-12-08T19:08:25Z2020-12-08T19:08:25ZHow universities and professions are preparing to meet the climate challenge<p>Getting ahead of climate change challenges is now a pressing need across our economy and society. Last month the bosses of 22 of Australia’s largest firms, including BHP, Rio Tinto, Wesfarmers and Commonwealth Bank, <a href="https://www.afr.com/policy/energy-and-climate/top-ceos-form-exclusive-climate-change-club-20201125-p56hvo">put their names</a> to the <a href="https://www.climateleaders.org.au/">Climate Leaders Coalition</a>. It signalled their collective wish to push down emissions and push up their international obligations under the Paris Agreement.</p>
<p>Australia’s politicians are increasingly on the back foot — something universities and professions cannot risk. The cockpit of the knowledge economy must remain fit for purpose in the face of global challenges. </p>
<p>The biggest of these of late has been marshalling expertise to tackle a global pandemic. Climate change is an even bigger challenge.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-is-the-most-important-mission-for-universities-of-the-21st-century-139214">Climate change is the most important mission for universities of the 21st century</a>
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<p>Universities as knowledge communities take pride in leading discovery and understanding. The pressures to update and reform can come from beyond the academy, sometimes in response to perceived failure (think of economics and the GFC) or in meeting demand for new skills (the rapid expansion of business education in the past two decades).</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cover of The Preparedness Report" src="https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=792&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=792&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=792&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=996&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=996&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373524/original/file-20201208-19-1qk8khm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=996&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.uwa.edu.au/institutes/public-policy/-/media/Public-Policy/Documents/Preparedness-report-WEB.pdf">UWA Public Policy Institute</a>, <span class="license">Author provided</span></span>
</figcaption>
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<p><a href="https://www.uwa.edu.au/institutes/public-policy/-/media/Public-Policy/Documents/Preparedness-report-WEB.pdf">The Preparedness Report</a>, launched today by the UWA Public Policy Institute, argues disciplines, and the practitioners they educate and train, are already changing fast in response to climate change. </p>
<p>The report highlights the nature and extent of retooling in six fields: engineering, architecture, law, economics, healthcare and oceanography (the same is true for around 20 more disciplines).</p>
<h2>Key questions for all professions</h2>
<p>All professions need to find timely answers to some core questions:</p>
<ul>
<li><p>What will be the practical impacts of climate change on the feasibility, processes, sustainability and operations of their professions?</p></li>
<li><p>How will future members of the professions need to be educated, trained and accredited?</p></li>
<li><p>How will the underlying disciplines change?</p></li>
<li><p>Which new fields of research and education will emerge?</p></li>
<li><p>How will different disciplines develop new cross-overs and synergies?</p></li>
</ul>
<p>Many new skills and competencies will have to be taught. Think, for example, of the need to engineer heat-tolerant public transport systems and plan water-sensitive cities. </p>
<p>Fresh mechanisms are also needed to ensure the value of current expertise, such as actuaries’ capacity to model commercial and household risk for insurance purposes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/water-may-soon-lap-at-the-door-but-still-some-homeowners-dont-want-to-rock-the-boat-124289">Water may soon lap at the door, but still some homeowners don't want to rock the boat</a>
</strong>
</em>
</p>
<hr>
<p>Greater use of cross-disciplinary collaboration will be needed too — for example, in building design and construction.</p>
<h2>How 6 disciplines are responding</h2>
<p>Engineering is synonymous with industrial society so has much to reflect on in terms of repurposing. Engineers will have to recalibrate their earlier assumptions. As UWA environmental engineer <a href="https://theconversation.com/profiles/anas-ghadouani-729335">Anas Ghadouani</a> notes:</p>
<blockquote>
<p>Consider the fact that the sectors at the top of the emissions pyramid, including transport, electricity production and manufacturing, contributed over 75% of emissions. These top emitting sectors have been flush with engineers and engineering companies.</p>
</blockquote>
<p>For architects to be credible in this new environment, they must grasp that “our modern experience of globalisation is predicated on three phenomena with spatial and environmental consequences: mobility, dispersion and density”, says UWA’s School of Design dean, <a href="https://www.uwa.edu.au/profile/kate-hislop">Kate Hislop</a>. Thus:</p>
<blockquote>
<p>Lowering CO₂ emissions involves regenerative design, adaptive reuse, life-cycle costing, carbon modelling, post-occupancy evaluation, waste minimisation and adoption of low embodied carbon materials and systems.</p>
</blockquote>
<p>Academic law is heavily exposed, and its challenges, reports <a href="https://theconversation.com/profiles/david-hodgkinson-6574">David Hodgkinson</a> from UWA’s School of Law, boil down to the laws and regulations that can be introduced to reduce emissions and assist people, species and ecosystems vulnerable to climate change. It is a question of intergenerational justice. He concludes: </p>
<blockquote>
<p>The main issue at stake is that if we agree to reduce emissions now, people living in the future will benefit, not those living today. But we will, today, bear the costs of reducing such emissions.</p>
</blockquote>
<p>For economists, whose counsel has become embedded in part thanks to the landmark <a href="https://www.lse.ac.uk/granthaminstitute/publication/the-economics-of-climate-change-the-stern-review/">Stern Report</a>, the greatest contribution has been in evaluating policy options that could reduce greenhouse gas emissions. Their very strong consensus is that the key policy response is to place a price on greenhouse gas emissions. <a href="https://theconversation.com/profiles/david-pannell-223">David Pannell</a>, who leads UWA’s Centre for Environmental Economics and Policy, states: </p>
<blockquote>
<p>There are differences of opinion about whether a tax or a market in permits would be superior [in reducing emissions], but there is almost no dissent among economists that one or the other of these is needed.</p>
</blockquote>
<p>In the field of health care, the emphasis is on training health-care professionals. For <a href="https://research-repository.uwa.edu.au/en/persons/sajni-gudka">Sajni Gudka</a>, from UWA’s School of Population and Global Health, climate change amounts to a public health emergency:</p>
<blockquote>
<p>Real capacity shortfalls are close by in responding to growing infectious diseases, heat stress, food insecurity, poor water quality and nutrition.</p>
</blockquote>
<p>Finally, for oceanography the urgency lies in mitigating the effects of climate change in coastal zones. <a href="https://research-repository.uwa.edu.au/en/persons/julian-partridge">Julian Partridge</a> and <a href="https://theconversation.com/profiles/charitha-pattiaratchi-110101">Charitha Pattiaratchi</a>, of UWA’s Oceans Institute, say a breakthrough depends on a grand alliance of disciplinary perspectives:</p>
<blockquote>
<p>Climate change challenges cannot be solved by engineers and scientists alone. They need alliances with social scientists, cultural heritage specialists and others to join this collective endeavour.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/this-is-how-universities-can-lead-climate-action-147191">This is how universities can lead climate action</a>
</strong>
</em>
</p>
<hr>
<h2>Waiting for political action</h2>
<p>The focus of the report is on the academic sector, related professions and the knowledge economy. But the preparedness question is also being asked of the political class and specific governments. As public attitudes become accustomed to environmental stewardship, heightened by the <a href="https://theconversation.com/humans-see-just-4-7km-into-the-distance-so-how-can-we-truly-understand-what-the-bushfires-destroyed-128539">bushfire crisis</a> last summer, voters are beginning to choose a direction of travel that was until recently dismissed.</p>
<p>In Western Australia, the government has just released its new <a href="https://www.wa.gov.au/service/environment/environment-information-services/western-australian-climate-change-policy">Climate Change Policy</a>, following several other states. <a href="https://www.dea.org.au/climate-change/">Doctors for the Environment Australia</a> is one of many campaigns that question the sagacity of short-term economic priorities.</p>
<p>How prepared is the country’s political class to use the advances made by universities and professions to address climate change?</p><img src="https://counter.theconversation.com/content/151662/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shamit Saggar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Universities and the professions are changing in response to climate change. When will the advances in knowledge and practice we are already seeing prompt governments to act with the required urgency?Shamit Saggar, Professor and Director, Public Policy institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1413202020-07-08T14:40:11Z2020-07-08T14:40:11ZStudents play an integral role in healthcare delivery: findings from South Africa<figure><img src="https://images.theconversation.com/files/345042/original/file-20200701-159811-dsx4uk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Thusong Multipurpose Center in Khayelitsha which will serve as a COVID-19 site in Cape Town, South Africa.</span> <span class="attribution"><span class="source">Brenton Geach/Gallo Images via Getty Images</span></span></figcaption></figure><p>Reports from around the <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742020000500007">world</a> show that the shortage of health professionals in public healthcare systems will be worsened by the increased demand for health services caused by the <a href="https://theconversation.com/africa/covid-19">COVID-19 pandemic</a>. As the pandemic continues to move towards the expected peak, the impact on the provision of healthcare, across all sectors, will be significant.</p>
<p>Research conducted in sub-Saharan Africa <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730703/">has shown the valuable role</a> that medical students can play in supporting healthcare delivery. This includes improving the quality of patient care. </p>
<p>Questions are sometimes raised about whether students in training can be a burden on the health system. A <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0626-0">Ugandan study</a>, for example, found that some managers believed students were a drain on resources. </p>
<p>Our view, however, is that undergraduate students training to be health professionals are an untapped resource. We conducted <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1412-y">research</a> into the issue by exploring the experiences of managers and clinicians with students learning in their health facilities in South Africa.</p>
<p>We interviewed staff from eight facilities that had been receiving students across a range of medical disciplines for many years. The students have been part of a programme initiated by the Faculty of Medicine and Health Sciences at Stellenbosch University in the <a href="https://www.hrhresourcecenter.org/node/5568.html">1990s</a> to train students to deliver primary healthcare services. </p>
<p>In the programme, undergraduate health professionals were placed in over 80 rural and urban public health facilities. They worked under the supervision of a clinician already at the facility. These sites included regional and district hospitals, community health centres, clinics, rehabilitation centres, hospices, and other non-governmental organisations. Students came from various disciplines – dietetics, medicine, nursing, occupational therapy, physiotherapy, and speech-language and hearing therapy.</p>
<p>Our research showed that involving senior health science students in the everyday practice of healthcare had a number of positive outcomes. The students helped address the workload in health facilities and improved the quality of patient care. They increased patient and staff satisfaction and encouraged a learning culture. </p>
<h2>What we found</h2>
<p>Our findings indicate that students can make a major contribution to healthcare, particularly during times such as this.</p>
<p>The students in the sampled facilities were training in medicine, occupational therapy, physiotherapy and dietetics.</p>
<p>Staff in the facilities described student involvement as being beneficial to the healthcare service, for both staff and patients. They also said having them there was valuable for the facility itself. Students were described as assisting with workload, increasing patient satisfaction, improving patient care, and enhancing community perceptions of the service. </p>
<p>The students were also seen to facilitate the development of a learning environment. Examples included stimulating clinicians to keep up to date with evidence, and encouraging the use of current protocols. Individuals experienced greater job satisfaction and personal growth through this engagement. Students were not felt to be a burden.</p>
<p>But we found that, to get these benefits, students needed to be involved in routine work activities. This gave them the opportunity to learn from everyday practice. </p>
<p>Other factors that contributed to the students’ effectiveness were: their skills and knowledge, their seniority, and clear guidance from the university.</p>
<p>Our findings echo <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-1050-9">earlier research</a>. A previous <a href="https://phcfm.org/index.php/phcfm/article/view/474/584">South African study</a> in rural communities described how healthcare staff, patients and community members all perceived that students provided benefits to healthcare, offering extra hands and easing the patient load. </p>
<p>In <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0626-0">Uganda</a>, the contribution of health science students working in peripheral health facilities was highly valued by communities, who saw them as caring, compassionate, and available anytime.</p>
<p>In <a href="https://www.ijme.net/archive/10/implementing-clinical-education-of-students">Sweden</a>, medical students in a hospital previously focused on healthcare delivery improved the learning climate of the organisation and enhanced the structure of the clinical work.</p>
<h2>What next</h2>
<p>Over the last 15 years, South African students have increasingly been drawn into a range of <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02046-z">training sites</a> outside the central academic hospitals. As a result <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742018000600005&lng=en&nrm=iso">guidelines have been issued</a> on their placement in a wider range of healthcare facilities. These call on higher education institutions and health services to work together in achieving distributed training.</p>
<p>All health professional students left health service sites when universities went into obligatory recess at the start of the national COVID-19 lockdown. Senior students can’t learn in the classroom because their training is very practical. And it hasn’t always been straightforward getting them back into their clinical placements. </p>
<p>Our hope is that healthcare facilities will welcome senior students back into these environments. We also hope the managers of these facilities will actively seek the placement of students. This is particularly true as the country responds to COVID-19. </p>
<p>In addition, some aspects of healthcare are receiving <a href="https://www.groundup.org.za/article/leading-sa-health-experts-warn-covid-19-response-hurting-other-health-priorities/">less attention</a> because resources are required to address the pandemic. These include <a href="https://www.spotlightnsp.co.za/2020/04/27/covid-19-sas-tb-response-already-impacted/">TB prevention and case finding</a>, routine under-five <a href="https://www.dailymaverick.co.za/article/2020-06-03-dont-forget-the-children-in-this-covid-19-storm/#gsc.tab=0">child health</a> activities, <a href="https://theconversation.com/community-based-workers-can-help-disabled-people-access-services-during-covid-19-137090">support and rehabilitation</a> for people with <a href="https://www.uwc.ac.za/News/Pages/Value-and-worth-should-people-with-disabilities-have-access-to-ICU-facilities-and-ventilators-during-COVID-19.aspx">disabilities</a>, and management of <a href="https://www.iol.co.za/the-star/news/patients-with-chronic-illnesses-left-in-the-cold-as-sa-focuses-on-covid-19-48476778">chronic illnesses</a>. </p>
<p>Given the current demands on health facility managers and clinicians, universities could valuably remind training partners of the role that students can play in supporting healthcare delivery.</p><img src="https://counter.theconversation.com/content/141320/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Couper previously received funding from the Stellenbosch University Collaborative Capacity Enhancement through Engagement with Districts (SUCCEED) project, funded by the USA Centers for Disease Control and Prevention.</span></em></p><p class="fine-print"><em><span>Jana Müller is affiliated with the not-for-profit group Rural Rehabilitation of South Africa (RuReSA). </span></em></p><p class="fine-print"><em><span>Susan Van Schalkwyk has previously received funding from the South African National Research Foundation. </span></em></p><p class="fine-print"><em><span>Julia Blitz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Involving senior health science students in the everyday practice helped address the workload in facilities, improved quality of patient care, and increased patient and staff satisfaction.Ian Couper, Director: Ukwanda Centre for Rural Health and Professor of Rural Health, Department of Global Health, Stellenbosch UniversityJana Müller, Collaborative care coordinator at Ukwanda Centre for Rural Health, Stellenbosch UniversityJulia Blitz, Vice-Dean: Learning and Teaching, Stellenbosch UniversitySusan Van Schalkwyk, Professor in Health professions education, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1420112020-07-07T14:16:09Z2020-07-07T14:16:09ZProfessor Akinkugbe: doyen of medicine in Ibadan has left a rich legacy<figure><img src="https://images.theconversation.com/files/345778/original/file-20200706-4000-63ckk6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Professor Oladipo Akinkugbe </span> <span class="attribution"><span class="source">UI Directorate of Public Communication</span></span></figcaption></figure><p>Nigeria’s medical world stood still for a moment when <a href="https://guardian.ng/features/health/akinkugbe-first-professor-of-renal%20medicine-dies-at-87/">news</a> of the death of Emeritus Professor Oladipo Akinkugbe was received on June 15, 2020. He was only one month short of his 87th birthday. </p>
<p>One year ago <a href="https://punchng.com/as-akinkugbe-hangs-his-stethoscope/">we celebrated</a> his 86th birthday. It was a special ceremony that was tagged “hanging the stethoscope” – the formal announcement of his retirement from clinical practice. This was the first such event in Nigeria. The occasion also marked 60 years of his qualification as a doctor and 50 years of his professorship.</p>
<p>Emeritus Professor Akinkugbe had a <a href="https://hallmarksoflabour.org/citations/prof-oladipo-olujumi-akinkugbe-con-md-nnom-hlr/">daunting resumé</a>. He was a distinguished and quintessential clinician. I was fascinated by his towering intellect and resounding achievements in various spheres of life as university administrator, teacher, researcher, public orator and mentor. </p>
<p>Professor Akinkugbe combined self-discipline, integrity, honesty, contentment and diligence with passion for excellence in his professional activities. He could be likened to a man with the Midas touch, and he undertook nothing without adorning it. He was very articulate and was aptly described by Dr Christopher Kolade, formerly Nigeria’s High Commissioner to the UK and his former classmate, as “an adroit communicator of ideas in English language”. </p>
<p>He was a role model par excellence and was simple and approachable. He had an uncanny ability for selecting the best brains for training and for administrative positions. </p>
<p>I knew him as a guru in the field of hypertension and tertiary education reforms. He fervently believed that a combination of present and past experiences would make for a better future in health and education, as echoed in his famous saying:</p>
<blockquote>
<p>The present should not be the enemy of the past, otherwise the future will suffer.</p>
</blockquote>
<h2>Contributions to medicine</h2>
<p>Professor Akinkugbe made <a href="https://renal.org/passing-emeritus-professor-oladipo-akinkugbe-frcp-dphil/">significant contributions</a> in hypertension and renal medicine research. He led a landmark survey on the burden and risk factors of non-communicable diseases in Nigeria. He was widely acclaimed as the authority on hypertension in African people. </p>
<p>He documented the rarer causes of hypertension in Ibadan and was the first to report the rarity of hypertensive retinopathy in Africans. His findings have stood the test of time. </p>
<p>He also carried out pioneering work on renal replacement therapy in Nigeria using peritoneal dialysis.</p>
<p>In a seminal article in the <a href="https://www.bmj.com/news?gclid=CjwKCAjwrvv3BRAJEiwAhwOdMyI0BNmh1hcqt5BQvzuKxNt6qmqBeHG6DH0Bz7JO2EvRPQZcTXLPGxoCM0MQAvD_BwE">British Medical Journal</a> in 1978, he defined the role of teaching hospitals in a developing country. He went on to make significant <a href="https://guardian.ng/news/obasanjo-lauds-medical-expert-akinkugbe/">contributions</a> to the revitalisation of the health sector through an initiative that equipped teaching hospitals. </p>
<p>His international recognition included serving on many World Health Organisation expert committees. These ranged from cardiovascular diseases and the development of health professions to the Global Advisory Committee on health research. He was a member of the advisory panel of the <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/9780470720851.fmatter">CIBA foundation</a> in London and the University Grants Commission in Uganda.</p>
<p>He held positions on the councils of the <a href="https://ish-world.com/index.htm">International Society of Hypertension</a> and <a href="https://www.world-heart-federation.org/">World Heart Foundation</a>. He held visiting professorial positions at prestigious universities such as Harvard (1974-1975), Oxford (1981-1982) and Cape Town (1997). In 1989, he received the Searle Distinguished Research Award for his contributions to hypertension in black populations. Earlier this year he received the Pioneer Award of the International Society of Nephrology. </p>
<h2>How Professor Akinkugbe inspired me personally</h2>
<p>I joined the academic staff in the College of Medicine, University of Ibadan in 1987 and got to know him well. Professor Akinkugbe was at that time the most senior academic staff member in the department. We all looked up to him and my mentor, <a href="https://history.rcplondon.ac.uk/inspiring-physicians/benjamin-oluwakayode-osuntokun">Professor Benjamin Oluwakayode Osuntokun</a> (1935-1995), for guidance and mentoring. </p>
<p>My calling is neurology. But I attended many continuing professional development programmes organised by Professor Akinkugbe in the department, and later at the Ibadan Hypertension Clinic as a resource person. He taught me discipline, simplicity and professionalism. </p>
<p>I emulated his lecturing style and always read through his published lectures before delivering any public lecture for historical content, ideas and anecdotes. Lastly, I was touched by his wise counsel whenever thorny issues arose. He was always at hand to proffer solutions that always worked. </p>
<h2>His legacy</h2>
<p>Professor Akinkugbe will be remembered as the doyen of medicine in Ibadan, eloquent teacher, clinician, and a great motivator who lived a fulfilled life. He also served humanity to the best of his ability and accomplished a lot. </p>
<p>His generosity is legendary. He bequeathed the textbook “A Compendium of Clinical Medicine” that he co-authored with Professor Ayodele Falase, former Vice Chancellor of the University of Ibadan. And he <a href="https://www.ui.edu.ng/gallery/ui-vc-commissions-emeritus-professor-oladipo-akinkugbe%E2%80%99s-corner-kdl-%C2%A0">donated</a> books, journals, theses, research documents and memorabilia to the Kenneth Dike Library, University of Ibadan.</p>
<p>Professor Akinkugbe will be missed as an excellent scholar who touched many lives positively, an illustrious teacher, clinician, university administrator, mentor and family man. And a man who toiled for reforms in Nigeria’s health and tertiary education sectors.</p><img src="https://counter.theconversation.com/content/142011/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adesola Ogunniyi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Professor Akinkugbe made significant contributions in hypertension and renal medicine research. He was widely acclaimed as the authority on hypertension in African people.Adesola Ogunniyi, Professor of Medicine, College of Medicine, University of Ibadan , University of IbadanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1387332020-05-21T10:10:22Z2020-05-21T10:10:22ZHow South Africa’s health system could take a hit from pandemic lawsuits<figure><img src="https://images.theconversation.com/files/336047/original/file-20200519-152298-aff9iq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health worker drags an electrocardiograph at the Charlotte Maxeke Hospital in Johannesburg. </span> <span class="attribution"><span class="source">Michele SpatariI/AFP via Getty Images</span></span></figcaption></figure><p>As the COVID-19 pandemic spreads around the world, there’s been an <a href="https://jamanetwork.com/journals/jama/fullarticle/2763136">outpouring of gratitude and support</a> for healthcare professionals. Communities have made extraordinary efforts to support them. These include ensuring they have protective personal equipment, meals and priority access in supermarkets. They’ve been given a break from indemnity payments and will most likely be prioritised for critical care and ventilators if they get sick themselves. That’s <a href="http://www.samj.org.za/index.php/samj/article/view/12907">because</a> they are risking their lives to save others. By the beginning of May, it was <a href="https://www.medscape.com/viewarticle/927976">estimated</a> that more than 1,000 healthcare workers from 64 different countries had died. </p>
<p>Civil society’s goodwill towards the health profession is justified. But how long will it last?</p>
<p>Doctors and hospitals have to make difficult decisions when treating COVID-19 patients. These include withdrawing patients from ventilators. And patients with other conditions might suffer because care was unavoidably diverted to COVID-19. It’s possible that patients or their families could litigate.</p>
<p>In South Africa, the health profession has been operating in a <a href="http://www.samj.org.za/index.php/samj/article/view/6457/4857">highly litigious context</a> over the past decade. One of the reasons is a growing awareness of <a href="http://www.sajbl.org.za/index.php/sajbl/article/view/115">patient rights</a>. That’s coupled with aggressive marketing by <a href="http://www.samj.org.za/index.php/samj/article/view/6457/4857">personal injury lawyers</a> eager to capitalise on this awareness. </p>
<p>It’s a concern for private and public hospitals, indemnity insurers and civil society because when doctors are preoccupied about future <a href="http://www.samj.org.za/index.php/samj/article/view/6457/4857">litigation</a> over decisions they are forced to make during the pandemic, they will be forced to practise <a href="https://www.medicalbrief.co.za/archives/malpractice-costs-put-sas-doctors-defensive/">defensive medicine</a>. Some were already doing so before COVID-19 – and it inflates the cost of healthcare.</p>
<p>Based on malpractice claims, costs for indemnity insurance cover have <a href="https://m.fin24.com/Economy/r1m-bill-no-one-left-to-deliver-our-babies-20170406">spiralled</a>. This has forced many specialists to reduce their scope of practice or increase their consultation fees. For example, many doctors who qualified as obstetricians and gynaecologists no longer practise obstetrics because of <a href="http://www.samj.org.za/index.php/samj/article/view/7233">exorbitant indemnity cover and claims</a> in this field of practice. Such claims are considerably higher than other fields of work; one reason is the lifetime costs of caring for a person who was disabled at birth. </p>
<p>This vicious cycle of litigation claims and more expensive service is having a negative impact on health service delivery. For one thing, <a href="https://www.justice.gov.za/salrc/ipapers/ip33_prj141_Medico-legal.pdf">spiralling claims</a> in the public health sector mean the health budget is spent on settling legal claims instead of on healthcare.</p>
<p>It’s possible that the huge pressures on the health system created by the COVID-19 pandemic could make the situation even worse. As patient numbers increase, ratios of staff to patients will worsen, as they have globally, which could affect quality of care, despite the best efforts of highly competent healthcare professionals. Infection of hospital staff, fatigue and moral distress related to the pandemic will also have an impact on service delivery.</p>
<h2>Why are doctors concerned?</h2>
<p>If the number of cases increases substantially, specialists such as paediatricians, dermatologists or surgeons would have to work in emergency medicine or critical care. <a href="https://www.forbessolicitors.co.uk/news/46941/covid19-should-emergency-measures-excuse-medical-negligence">Retired</a> doctors and nurses are <a href="https://www.hpcsa.co.za/Uploads/Events/Announcements/HPCSA_COVID-19_guidelines_FINAL.pdf">encouraged</a> to assist frontline healthcare professionals. Doctors without current <a href="https://www.psyssa.com/hpcsa-covid-19-guidelines/">re-registration</a> status with professional bodies are allowed to continue practising for now.</p>
<p>But if there’s a claim of negligence because of what they did or failed to do in these unusual circumstances, what <a href="https://www.forbessolicitors.co.uk/news/46941/covid19-should-emergency-measures-excuse-medical-negligence">standard</a> would be used to judge them? </p>
<p>The public health response to the COVID-19 pandemic requires some extraordinary measures. Professional bodies globally, including the <a href="https://www.hpcsa.co.za/Uploads/Events/Announcements/APPLICATION_OF_TELEMEDICINE_GUIDELINES.pdf">Health Professions Council of South Africa</a>, have recognised this. They have issued updated guidance on practising outside one’s profession, telemedicine and registration extensions. </p>
<p>The greatest concern for healthcare professionals working in critical care is the need to withdraw ventilation because there aren’t enough ventilators available. The country’s <a href="https://www.gov.za/sites/default/files/images/a108-96.pdf">constitution</a> says a person’s rights – such as access to healthcare – can be limited. And withdrawal of care is accepted by the Health Professions Council of South Africa as indicated in its <a href="https://www.hpcsa.co.za/Uploads/Events/Announcements/APPLICATION_OF_TELEMEDICINE_GUIDELINES.pdf">published guidance</a>. But <a href="http://www.samj.org.za/index.php/samj/article/view/7405/5790">withholding or withdrawing treatment</a> refers to futile care. During COVID-19 care, futility might not be the reason patients are removed from a ventilator. It might rather be deterioration in their condition while other patients with a better prognosis need intensive care. The guideline is therefore not entirely applicable in a COVID-19 pandemic context.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tough-choices-about-who-gets-icu-access-the-ethical-principles-guiding-south-africa-135227">Tough choices about who gets ICU access: the ethical principles guiding South Africa</a>
</strong>
</em>
</p>
<hr>
<h2>Protecting health professionals</h2>
<p>The New York state governor <a href="https://www.mlmic.com/blog/physicians/new-york-physician-immunity-during-pandemic">issued directives</a> to provide temporary immunity from civil liability for injury and death as a result of an act or omission during the pandemic for a limited period. In the UK, the British Medical Association issued guidance but this has been met with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203162/">legal challenges</a>.</p>
<p>The South African Health Professions Council <a href="https://www.psyssa.com/hpcsa-covid-19-guidelines/">acknowledges</a> that its response to complaints from the public will “consider the extraordinary circumstances in which practitioners are working and the heavy demands on them during this period”. The council’s mandate is to serve the profession and protect the public.</p>
<p>But Parliament has remained silent on any form of temporary legal indemnity for healthcare professionals in South Africa. Gross negligence in healthcare will not be excused under any circumstances. But we think standards for reasonableness will certainly not be the same as in pre-COVID-19 times.</p>
<p>National guidance (still awaited) on allocation of scarce resources, when developed, might protect healthcare professionals working in the public sector. It’s not known whether private sector doctors and independent practitioners will be included. </p>
<p>It’s also not clear how the legal and professional systems in South Africa will make provision for negligence claims and complaints that arise out of retired doctors and nurses returning to work in the pandemic or doctors working outside of their medical specialisation. This is a legal hiatus that needs to be addressed urgently.</p><img src="https://counter.theconversation.com/content/138733/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keymanthri Moodley receives funding from the National Institutes of Health, USA.
</span></em></p><p class="fine-print"><em><span>Anita Kleinsmidt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gross negligence won’t be excused under any circumstances. But standards for reasonable medical care can’t be the same as in pre-COVID-19 times.Keymanthri Moodley, Director, The Centre for Medical Ethics & Law, Stellenbosch UniversityAnita Kleinsmidt, Senior lecturer, Centre for Medical Ethics and Law , Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1245142019-11-13T15:26:05Z2019-11-13T15:26:05ZHow WhatsApp groups support Nigeria’s nurse graduates<figure><img src="https://images.theconversation.com/files/301108/original/file-20191111-194665-1xymbqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mobile instant messaging platforms are used by many health professionals to share information and professional experiences.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><a href="https://www.nmcn.gov.ng/docs/ApprovedSchools.pdf">Around 12,000</a> students are enrolled in Nigeria’s nursing schools each year. As it is in many health professions, these students often find it <a href="https://www.sciencedirect.com/science/article/pii/S0029655411002909">challenging</a> after graduation when they search for and start their first job. They feel unprepared and have difficulties to put their knowledge from school into practice. </p>
<p>In addition, many feel unwelcome in their teams, which results in a sense of professional isolation and high <a href="https://www.sciencedirect.com/science/article/pii/S0020748913002733?via%3Dihub">drop-out rates</a>. Yet, new graduates stand to gain a lot if they engage in <a href="https://nursejournal.org/articles/networking/">networking groups</a>. These are are known to be effective in creating a support system for young graduates, finding jobs, sharing knowledge and resources, and making connections. </p>
<p><a href="https://www.whatsapp.com/">WhatsApp</a>, a mobile instant messaging platform, is a potential platform for professional networking which has seen recent <a href="https://www.tandfonline.com/doi/full/10.1080/09718524.2018.1509490">remarkable expansion</a> in Nigeria and other African countries. The reasons for this development are the increased availability of smartphones and the <a href="https://nairametrics.com/2019/03/07/nigeria-has-one-of-the-cheapest-mobile-data-prices-in-africa/">relatively low</a> costs of data in Nigeria. </p>
<p>The platform can also be used easily without much technological knowledge and the connective features of the app enable up to <a href="https://www.independent.co.uk/life-style/gadgets-and-tech/news/whatsapp-group-chats-bigger-maximum-size-256-people-users-a6856491.html">256 users to exchange text</a>, emoticons, pictures, video, and audio messages. </p>
<p>These developments have created unprecedented opportunities for health professionals to share clinical information and professional experiences. It also helps them stay connected with each other after graduation. </p>
<p>The availability of this technology and lack of existing structures for professional networking among young nursing graduates has presented an opportunity to show how WhatsApp can be used to address this need among recent graduates of schools of nursing in Nigeria. </p>
<h2>The research</h2>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S0360131518302410">research</a> was part of a larger initiative that examined the use of social and mobile media in health professional contexts. It was funded by the Swiss Programme for Research on Global Issues for Development. </p>
<p>We randomised five schools with new nurse graduates in Oyo state, Nigeria, into two groups. In the first group, 77 graduates from three schools participated in three moderated WhatsApp groups. A further 37 graduates from the two other schools served as the control group, which didn’t engage in the moderated WhatsApp activities. </p>
<p>The two groups were comparable, as they had no significant differences on age, sex and the place of post-qualification practice. </p>
<p>The project team developed a script to guide moderators (group admins) whose responsibilities are to post messages, encourage full participation, respond to questions, and apply ground rules, in the facilitation and moderation of the group chat. The moderators were experienced nurses who shared clinical knowledge and stimulated professional discussions in the WhatsApp-based “online classrooms” for 6 months, December 2016 to May 2017. </p>
<p>The knowledge quiz “fastest finger” was aimed at stimulating the participants’ engagement. The first person who correctly responded to the moderator’s weekly question received a small amount of airtime. The moderators also rewarded the most active participants in every month with airtime. </p>
<p>Participants didn’t receive any other financial compensation; instead they used their own data bundles. At the end of the intervention, both groups completed an online survey that included knowledge tests. In addition, some participants from the WhatsApp groups took part in focus group discussions. </p>
<p>We found that participants in the moderated WhatsApp groups were more knowledgeable regarding the clinical topics discussed in the group chat and they expressed fewer feelings of professional isolation than their counterparts who didn’t take part in the moderated group chat. Similarly, those who engaged actively in the WhatsApp groups had more knowledge, experienced less isolation and showed higher levels of professional identification. </p>
<p>The positive quantitative results were affirmed in focus group discussion. Group discussants said that they learned from the interactions on WhatsApp and that they gained new knowledge about clinical topics: </p>
<blockquote>
<p>I gained a lot. It also made me learn even though I wasn’t reading textbooks. </p>
<p>It connects us as if we are still in school.</p>
</blockquote>
<p>In addition, some participants said they got jobs through adverts that the moderators posted in the chats. </p>
<p>The findings provide evidence that moderated WhatsApp groups can be a source of learning. In addition, they permit togetherness of geographically distant professionals. </p>
<p>The experience of isolation and a lack of knowledge are two very common issues that many health professionals encounter when they start their first job after graduation. The research points to the potential of instant messaging, which offers unique connective features, but is still an underused source of mobile learning in Nigeria. </p>
<h2>Going forward</h2>
<p>Health professional bodies may use the connective features of mobile instant messaging platforms to provide support for new graduates during their first few months of practice. Training institutions can also use these platforms to promote alumni activities that can enhance the development of the institutions. </p>
<p>The increasing use of WhatsApp by health professionals in Nigeria and elsewhere carries, however, considerable risks that also need to be considered. These include issues like the protection of privacy of both the health care provider and the patient and circulation of incorrect information. </p>
<p>To address these problems, health professionals need to be trained how to use social media apps responsibly and professionally. This kind of training and skills development should be included in pre-service and in-service education curricula. </p>
<p>Regulating agencies, such as the <a href="https://www.nmcn.gov.ng/">Nursing and Midwifery Council of Nigeria</a>, also need to develop new or adapt existing guidelines on professional usage of mobile phones and social media.</p><img src="https://counter.theconversation.com/content/124514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ademola Johnson Ajuwon receives funding from The Swiss Programme for Research on Global Issues for Development (r4d pro-gramme), which is a joint funding initiative by the Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation (SNSF); (r4d-grant IZ01Z0_160910).
</span></em></p><p class="fine-print"><em><span>Christoph Pimmer receives funding for this project from the Swiss Programme for Research on Global Issues for Development programm(r4d programme), which is a joint funding initiative by the Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation (SNSF), provided funding for this research (r4d-grant IZ01Z0_160910).</span></em></p>How Whatsapp supports nurse students in Nigeria and helps them transition into the workplace.Ademola Johnson Ajuwon, Visiting Professor at the School of Public Health, University of the WitwatersrandChristoph Pimmer, Researcher, lecturer and advisor, digital learning, University of Applied Sciences Northwestern SwitzerlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1233372019-10-02T21:47:18Z2019-10-02T21:47:18ZWhy is it so hard for your doctor to apologize?<figure><img src="https://images.theconversation.com/files/295121/original/file-20191001-173337-1fcjcuq.jpg?ixlib=rb-1.1.0&rect=448%2C269%2C6073%2C4148&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A culture of perfectionism that begins in medical school is one reason why doctors and other medical professionals struggle to apologize for their mistakes. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>You’ve just undergone surgery. Somehow, a mistake was made. Perhaps the preparation was inadequate or perhaps there was miscommunication. The result is that you were harmed when you expected to be healed.</p>
<p>Hurt, angry and scared, you look to your doctor and ask: “What now? What do you have to say?” And they are silent.</p>
<p>Medical errors like this occur regularly. One report estimates that <a href="https://secure.cihi.ca/free_products/cihi_cpsi_hospital_harm_en.pdf">for every 18 hospitalizations in Canada, one patient will experience harm</a>. Yet, doctors are hesitant to apologize for medical mistakes. </p>
<p>This occurs despite the fact that <a href="http://canlii.ca/t/52fmm">nine provinces</a> and <a href="http://canlii.ca/t/524p8">two territories</a> in Canada have “<a href="http://canlii.ca/t/kx9p">apology legislation.</a>” <a href="http://canlii.ca/t/52pn4">This legislation</a> allows doctors, and other medical professionals, to <a href="http://canlii.ca/t/539l9">apologize to patients</a> when <a href="http://canlii.ca/t/k5xb">things go wrong</a> without having this used as evidence of fault in court. <a href="http://canlii.ca/t/k94m">These laws</a> are designed to <a href="http://canlii.ca/t/jx9q">transform relationships</a> in medicine for the better by <a href="http://canlii.ca/t/53646">restoring trust</a> between <a href="http://canlii.ca/t/5385t">patients and clinicians</a>. </p>
<p>Research shows that <a href="https://global.oup.com/academic/product/on-apology-9780195189117?cc=ca&lang=en&">medical apologies help repair the relationship and sense of trust between patients and medical professionals</a>. So why is it so hard for your doctor to apologize?</p>
<h2>Fear of litigation and loss of respect</h2>
<p>To investigate the impacts and difficulties surrounding medical apology, we’ve <a href="https://doi.org/10.1017/S0008423918000227">conducted research on medical apologies</a> over the last two years. </p>
<p>Most recently, we have interviewed a variety of stakeholders including patients, caregivers, medical doctors, psychologists, patient safety advocates, medical school administrators and health-care administrators on their experiences with medical error and apology. </p>
<p>We heard from doctors and other medical professionals who wished to apologize but were constrained by different social and professional factors. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295123/original/file-20191001-173337-hdl8zn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows that one out of every 18 hospitalized patients in Canada will experience harm.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our preliminary results show that clinicians receive mixed messages on the topic of apology. Some messages are rooted in an understanding of the apology legislation and provide a supportive environment to allow an apology to the patient to occur. </p>
<p>Other messages are rooted in fear of litigation, loss of insurance coverage, loss of respect, a culture of perfectionism that starts in medical training and a feeling of shame about harming a patient. As one senior medical professional said:</p>
<blockquote>
<p>“Physicians are not designed to make mistakes … they see it as a horrific personal failure when… they have made an error. So it is a huge trauma to physicians.”</p>
</blockquote>
<h2>An apology is healing</h2>
<p>Our research shows that apologizing for medical errors is a crucially important step in healing — for patients, families and medical professionals. </p>
<p>Apologizing helps validate the harms experienced by patients, and helps doctors come to terms with their mistake and restore confidence in their practice. One patient participant in our study said that an apology is healing and that in the trauma of a critical incident, people expect apologies:</p>
<blockquote>
<p>“You do something wrong, you apologize.”</p>
</blockquote>
<p>Apologizing involves empathizing with patients and maintaining the integrity of medical relationships. As one senior doctor said: </p>
<blockquote>
<p>“From my point of view, the benefits of having apology legislation …is (to) allow you to take a different perspective in (your) relationship with patients… If that relationship is honest and fulsome… it provides you with an opportunity to feel it how the patient feels, or at least close to it.”</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295125/original/file-20191001-173358-1yl3cem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An apology can strengthen a medical relationship.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Forgiveness is not guaranteed</h2>
<p>If there is no apology, or there is a poor-quality apology, this has a detrimental effect on the relationship between a patient, their family and their doctor, and on the sense of trust the patient and family place in medical institutions. </p>
<p>The absence of apology also leaves patients and families in a communicative vacuum and fails to recognize the ongoing harms and trauma resulting from error. </p>
<p>To be sure, apologies are not a cure-all for harms resulting from a medical error, and forgiveness cannot be guaranteed. </p>
<p>Litigation and medical apology are also not mutually exclusive. While an apology is given, litigation may still be needed — especially if the medical error resulted in an inability to work, or death. But silence after an error is profoundly detrimental. </p>
<p>When a meaningful apology is given after an error, it can promote healing, strengthen medical relationships and transform our understanding of care in medical spaces.</p>
<p>More work is needed to help medical professionals understand the protections of apology legislation and the benefits of apologizing. In doing so, <a href="https://www.patientsafetyinstitute.ca/en/Events/cpsw/Pages/default.aspx">we can conquer the silence.</a></p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/123337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dempsey Wilford receives funding from The Michael Smith Foundation for Health Research. </span></em></p><p class="fine-print"><em><span>Fiona MacDonald receives funding from The BC Law Foundation, The Manitoba Institute for Patient Safety, The Michael Smith Foundation for Health Research, The University of the Fraser Valley. </span></em></p><p class="fine-print"><em><span>Karine Levasseur receives funding from the University of Manitoba (SSHRC TGP) and the Manitoba Institute for Patient Safety through the Dr. J. Wade Patient Safety Initiatives Grant.</span></em></p>Despite protective apology legislation across Canada, many doctors and other health-care professionals remain too afraid or ashamed to apologize after medical errors.Dempsey Wilford, Research assistant in Political Science, University of VictoriaFiona MacDonald, Associate Professor and Department Head, Political Science, University of The Fraser ValleyKarine Levasseur, Associate Professor of Political Studies, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/704842016-12-15T19:26:43Z2016-12-15T19:26:43ZFriday essay: can looking at art make for better doctors?<figure><img src="https://images.theconversation.com/files/150254/original/image-20161215-2529-19hnetw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Students ponder the meaning of Jinamoom by Peggy Griffiths at the Ian Potter Museum of Art.</span> <span class="attribution"><span class="source">Jodie Hutchinson/Ian Potter Museum</span></span></figcaption></figure><p>In 1984, artist Jon Cattapan’s sister Adriana died in a car accident. His painting, titled Sister, and some accompanying drawings, were a response to this tragedy.
Sister depicts a grey-shrouded body lying on a bright red structure. Behind it are five figures in two separate groups. One represents living relatives and friends; the other, the spiritual world. </p>
<p>Sister’s distorted figures reflect Cattapan’s interest in primitivism and animism. Its colours and twisted forms project his anguish, and express the heightened intensity of the state of grieving. Cattapan has written about the disorientation experienced in grieving and also how the “topsy-turvy” space in all the Sister images represents his sister’s schizophrenia. </p>
<p>One day, a few months ago, a group of third year medical students spent a long time looking at these works, which were on display at the Ian Potter Museum of Art at Melbourne University. </p>
<p>They were encouraged by the Museum’s Academic Programs Curator to describe aspects of the painting as objectively as possible - its style, colours, content. Then they began to share their personal interpretations of the narrative. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148385/original/image-20161202-25656-18ogewd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jon Cattapan, Sister, 1984 (oil on canvas). The University of Melbourne Art Collection, Gift of Jon Cattapan 2008.</span>
</figcaption>
</figure>
<p>Was the prone figure in the foreground dead or dying? What elements were more powerful? The Christian iconography and emotion on the figures’ faces? Their gestures? The insistent vibrancy of the colours? Or the apparently chaotic mix of formal elements? How did their interpretation change when the examination shifted to the Sister Drawings, hung alongside the painting, which are like snapshots of aspects of the story?</p>
<p>And how did the students’ initial gut reaction to the painting compare to the feeling it conveyed after 20 minutes of close, shared attention? </p>
<p>The aim was not to reach a consensus on what was going on in the artwork; rather it was to explore multiple alternative meanings. This was a practical demonstration of the medical method called differential diagnosis and the problems of rushing to a premature conclusion. </p>
<p>In response to the experience, one student wrote: </p>
<blockquote>
<p>Objective things can have a number of different subjective meanings. People can have different perspectives. There is a lot of empathy required in order to extract these thoughts.</p>
</blockquote>
<h2>Teaching empathy</h2>
<p>Healthcare professionals - doctors, dentists, physiotherapists, audiologists, optometrists - are now expected to have cultural, social and technical competencies that reach far beyond their biomedical training. And some clinical teachers have observed that graduates lack the capacity to demonstrate empathy or the skill of visually differentiating and prioritising what is important.</p>
<p>Can empathy be taught to these students? How can we ensure that they pay full attention to “the whole person” rather than just the disease? </p>
<p>Over the past two decades, there has been growing interest in the use of the humanities as a way of raising students’ awareness of emotions and the ethical dimensions of health care. Known as the “Medical Humanities”, many programs across the US and elsewhere engage students with theatre, literature, film and dance, as well as the creative arts. </p>
<p>The University of Melbourne began a pilot program at the gallery in June 2012 for six students in their Palliative Care rotation at Peter McCallum Hospital. It now provides programs to over 1000 students a year over 13 different areas in the health sciences, including Medicine, Dentistry, Optometry, Physiotherapy, Audiology, Nursing and Clinical Teaching. Unlike most such overseas programs, engagement is compulsory. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149561/original/image-20161212-31402-h0wsky.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most healthcare students entering the gallery are immediately out of their comfort zone.</span>
<span class="attribution"><span class="source">Jodie Hutchinson</span></span>
</figcaption>
</figure>
<p>Medical students visit the gallery in First Year, and again in Third Year, when they are studying and doing hospital placements in areas such as Geriatric Medicine, Rehabilitation Medicine, Palliative Care and Psychiatry of Old Age. Over three hours, they work on attentiveness, interpretation, reflection and consideration of their emotional response.</p>
<p>Medical students particularly, and health students generally, tend to believe that there is a right and wrong answer to everything. This comes from their early training in pathology, anatomy and physiology, which is delivered under the bio-medical model, as compared to the bio-psycho-social model that the art museum sessions address. </p>
<p>Most healthcare students entering the gallery are already out of their comfort zones and in a state of alert curiosity. Their experience there, and particularly the diversity of perspectives that emerge in group conversations, demonstrates that you can have different interpretations of the same thing, without either of those positions being “wrong”.</p>
<p>Their teachers hope that students are beginning to realize that medicine is not black and white, but many shades of grey. The museum sessions are designed to get these students thinking about the importance of a diagnosis that is not just based on physical symptoms, but also on the larger narrative that informs a patient’s health story.</p>
<h2>Moral imagination</h2>
<p>Final year Physiotherapy students, for instance, were asked to draw upon their visit to the gallery to explore the question of ethics in healthcare provision, and develop what’s known as “moral imagination”.</p>
<p>The idea is for students to increase awareness of their emotional reactions to ethical issues, through looking at art, and enhance their capacity to recognise the moral dimensions of clinical experiences. </p>
<p>Students then write assignments based on their visit, incorporating both an analysis of ethical principals and reflection on their emerging professional identity. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149553/original/image-20161211-31383-7gft4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Julia Robinson,
Twitch, 2012 (boiled wool, thread, timber, press studs, and fabric).</span>
<span class="attribution"><span class="source">courtesy of the artist and GAGPROJECTS | Greenaway Art Gallery, Adelaide</span></span>
</figcaption>
</figure>
<p>After looking at the sculpture Twitch by Julia Robinson, which takes the form of a pair of soft, cream-coloured Long Johns with one apparently mis-shapen, exposed wooden leg, one student wrote:</p>
<blockquote>
<p>There was no right or wrong way of deciphering the art piece and for once that was freeing. I left the museum somewhat changed…</p>
</blockquote>
<p>Responding to a ceramic artwork by Stephen Bird – depicting a hand pointing to a bird on a branch accompanied by the inscription, “Singing not allowed!” – another student wrote:</p>
<blockquote>
<p>The innocent looking bird, perched on a branch and trying to sing in its natural environment prompted me to think about a patient I saw lying in bed, calling out to medical staff, only to be dismissed as they are told that they are ‘doing fine’ or ‘need to continue with their course of treatment’. </p>
<p>This made me feel a little uncomfortable, as we are taught to practise with a patient-centred approach, listening to what others have to say and respecting their autonomy. What if the bird too, was singing out for help, only to be silenced? </p>
</blockquote>
<h2>Indigenous perspectives</h2>
<p>Cultural understanding, particularly in the context of indigenous health, is vital for graduating doctors. Students are aware that they need this knowledge, but they sometimes consider the teaching to be guilt-laden. They have challenged us to provide more innovative ways to engage with this part of the curriculum. </p>
<p>One medical student, Mahesha Dombagolla, noted that</p>
<blockquote>
<p>…a unanimously held sentiment by medical students is that we would find it valuable to gain some practical advice on how to provide care for Indigenous patients. Perhaps we can use Indigenous art to better understand their values and how we can incorporate these values when treating Indigenous patients? </p>
<p>For example, what are the Aboriginal perspectives on death/palliative care, caring for the elderly, women’s health, mental health, community and family, what things are respectful or disrespectful…?</p>
</blockquote>
<p>In our programs, we now explicitly address Indigenous health, drawing upon Indigenous art to prompt discussions around cultural understanding and cultural determinants of health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149765/original/image-20161213-25492-pl8lc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Looking at My Life My Family (2013) by Shirley Purdie.</span>
<span class="attribution"><span class="source">Jodie Hutchinson</span></span>
</figcaption>
</figure>
<p>In recent months, we were able to engage students with the touring exhibition In the Saddle - On the Wall, which included both visual art and digital stories of Indigenous Elders from the Kimberley. </p>
<p>What students might assume as homogeneous experience of Aboriginality, and a “sameness” in life stories, was turned on its head as they explored the diverse life experiences of the 13 artists in the exhibition, and the different ways they expressed their life narratives and culture through paintings and interviews.</p>
<p>Our sessions focused on “other ways of seeing”, and the power of place in health and wellbeing. One painting the students examined,<a href="http://kimberleyaboriginalart.com.au/view/photo-gallery/20091006185121/inTheSaddleGallery.html"> My Life My Family</a> by Gija artist Shirley Purdie, gave a rich context for these conversations. A large square artwork created with natural ochre and pigment, it depicts aspects of the life of the painter, her parents and grandparents. </p>
<p>The visual narrative moves from the top right in a clockwise direction. A series of vignettes trace the violent events that caused Purdie’s family to move from Violet Valley Station to Mabel Downs station in the Kimberley, where they eventually settled and created a more peaceful life. </p>
<p>The work is testament to the agency and survival of Purdie’s family in a brutal, colonial world. The power of this story can only be unpacked by students through long and careful attention to both the artwork and the artist’s accompanying digital story. This is a great parallel to the care and attentiveness needed to provide professional, compassionate, and culturally appropriate care in Indigenous health contexts. </p>
<p>This narrative painting was in great contrast to many others that depicted Dreamtime stories and lore. Most students found these more abstract works harder to understand and interpret.</p>
<p>Looking at these paintings, students talked about the need to be patient, attentive, and to learn how and where to ask appropriate questions. While practising these skills with the artworks in group discussions, students considered their wider application in healthcare settings.</p>
<p>In contrast to the visual complexity of many of the artworks, the personal stories of the artists in the digital narratives were delivered in “matter of fact” style. This contrast prompted students to consider the different communication styles of people of different backgrounds - which will be relevant in their professional lives.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149371/original/image-20161209-31367-1ocx1x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students drawing their idea of ‘place’ at the end of a session.</span>
<span class="attribution"><span class="source">Jodie Hutchinson</span></span>
</figcaption>
</figure>
<p>Students’ reflective essays give us great insights into the transformational experiences they had while viewing exhibition. One student said it “challenged
my assumptions”. Another said the experience:</p>
<blockquote>
<p>…enriched my knowledge about the hardship and troubles Indigenous Australians encountered. Whilst I was aware of the discrimination, abuse, and abduction, among other things that have occurred, it was still difficult to process these events, especially when hearing it from those who experienced it firsthand. I found it challenging to comprehend how the events happened and how these artists coped, as their lives are polar opposites to my own…</p>
</blockquote>
<p>The combination of digital audio stories and paintings was especially powerful for the Audiology and Optometry students. One student observed that the way an artist spoke about his work was very different to the emotions expressed in his artwork.</p>
<blockquote>
<p>… The artist I chose was discussing his childhood working on cattle stations and how it was a time of purpose and fulfilment for him. However, his body language in the video and the emotion in his artwork conveyed a more melancholy nostalgia. He talked in depth about how it gave him a purpose in life but skimmed over how he had to leave his family to do so. This example illustrates how in our profession we have to really listen (to verbal and non-verbal cues) to get the more personal information because people are not naturally comfortable opening up to strangers… </p>
</blockquote>
<p>This exhibition also challenged students’ conceptions of ageing and agency by showing the influence the Elders exert both within their communities and beyond, in contexts that include health, welfare, and culture.</p>
<p>As one of the Mental Health Nursing students later tweeted, </p>
<blockquote>
<p>Every painting is like every patient … they all harbour a story which we need to explore to better appreciate & understand them. </p>
</blockquote>
<h2>How effective is it?</h2>
<p>While we know that museums can be agents of social change, there is as yet very little research around the pedagogical utility of art museums in intercultural understanding. Program evaluation is essential to convince academics and students alike that there are tangible as well as intangible benefits to their art museum visits. </p>
<p>At the Ian Potter Museum we have begun three ethics-approved research projects. The first is in Special Needs Dentistry, where we sought to develop students’ capacity to pay closer and more empathetic attention to patients, “beyond the tooth”.</p>
<p>Our research sought to identify any changes in empathy in the students, with tests done before and after the museum intervention. It found that the second year dental students had significantly high levels of empathy and generally perceived the art museum session as a worthwhile experience in terms of widening the scope of core clinical skills including observation and empathy.</p>
<p>Whilst the intervention itself did not alter empathy levels at a single time point, the findings did highlight the need for further investigation into dental student empathy over the course of their studies, and opportunities for increased targeted humanities interventions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149554/original/image-20161211-31383-cijuzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Students at the In the Saddle - On the Wall exhibition.</span>
<span class="attribution"><span class="source">Jodie Hutchinson</span></span>
</figcaption>
</figure>
<p>A qualitative survey of medical students’ experience of the program in the year following their gallery experience included interviews with museum and health practitioners about their perception of the educational value of these encounters. </p>
<p>Student responses in this study showed they valued the opportunity to learn observational, critical thinking and intra/interpersonal skills, but acknowledged difficulties in incorporating the humanities into the heavily scheduled and bio-medically-focused curriculum. </p>
<p>Another project in Medicine records students’ immediate responses after gallery sessions, followed by an online survey a few weeks later, exploring Indigenous health contexts as well as engagement more generally. Results from this study will be explored by a fourth year Medical student in 2017.</p>
<p>Clearly, for the majority of students, the experience is seen to be a valuable and memorable one. Fourth year Medical Student Kim Pham wrote that her sessions at The Ian Potter Museum of Art taught her about “taking the time to observe”. They also enabled critical discussion, which is essential to science but “often ignored during a packed medical curriculum”. </p>
<blockquote>
<p>I left feeling more capable of engaging with the emotional narrative of my patients and being more open to their perspective.</p>
</blockquote>
<p>Other universities around Australia are now creating their own programs for health students using their art collections. Flinders University, for instance, is teaching psychiatry students utilising works that include those in their rich collections of Indigenous art. </p>
<p>But in a crowded curriculum, sceptics might ask, is a visit to an art museum really a good use of students’ time? </p>
<p>We can’t yet prove conclusively that it is, but let’s end with more words from Kim Pham. Art, she says, has, </p>
<blockquote>
<p>a capacity to make us critical and deep thinkers, using our capacity to observe to the full extent. And this should be a defining part of university education.</p>
</blockquote>
<hr>
<p><em>This article was written with the assistance of A/Prof Eleanor Flynn, A/Prof Clare Delany, A/Prof Mina Borromeo, Ms Bronwyn Tarrant, Dr Caitlin Barr and Ms Anthea Cochrane, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, all of whose students participated in engagements at The Ian Potter Museum of Art.</em></p><img src="https://counter.theconversation.com/content/70484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Gaunt works for The Ian Potter Museum of Art at the University of Melbourne, where the programs described take place. She is currently an Advisory Team Member with Flinders University Art Museum, Adelaide, on an Australian Office of Learning and Teaching Grant.
</span></em></p>Can empathy be taught to students in the healthcare professions? A groundbreaking project is using visual art to ensure they pay attention to the whole person, not just the disease.Heather Gaunt, Curator of Academic Programs at the Ian Potter Museum of Art, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/581802016-05-05T14:03:44Z2016-05-05T14:03:44ZHow spirituality can help us cope with the trials of ageing<figure><img src="https://images.theconversation.com/files/119621/original/image-20160421-27017-8f0ux1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our perceptions of spirituality change as we age.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-162942518/stock-photo-social-worker-visit-sick-old-male-patient-in-hospital.html?src=cWoeuj07_hdVK8Z21Vq9zw-1-96">www.shutterstock.com/ChameleonsEye</a></span></figcaption></figure><p>Old age is a time of many challenges. Retirement brings opportunities, but for many people it also results in loss of role and income. Loved ones may die, leading to the need to grieve and reconstruct life, sometimes without a partner of many years. In advanced old age, physical and mental frailty may lead to further loss of role and greater dependence on others. </p>
<p>Many older people cope well with these social, psychological and physical losses. They do so using personal resources developed over many years, resources that can aptly be described as “spiritual”. This term is distinct from religion since it embraces people of all faiths and none. Broadly, it covers what gives life meaning, purpose, hope, connectedness and a sense of value.</p>
<p>The specific challenges of old age mean that people may have to define what gives their life meaning in a new way, developing new connections, re-evaluating their role in society and sometimes finding the strength to cope with unavoidable suffering. </p>
<p>Viktor Frankl – an Austrian Jewish psychiatrist who survived three years in Nazi concentration camps when he was in his late 30s – stressed the <a href="https://www.amazon.co.uk/Mans-Search-Meaning-Holocaust-Paperback/dp/B0163E7446/ref=sr_1_4?s=books&ie=UTF8&qid=1461152718&sr=1-4&keywords=man%27s+search+for+meaning+2004">importance of having a purpose in life for survival</a>. His work before World War II included successful initiatives in suicide prevention. During his incarceration, however, he refined his ideas through observing how he and others dealt with the experiences of the concentration camps. </p>
<p>Frankl identified finding new meaning through love, dedication to a life’s work or coping with unavoidable suffering as being of vital importance. He also developed a form of existential therapy which he called <a href="http://www.logotherapyinstitute.org/About_Logotherapy.html">logotherapy</a> – for him, existential issues were <a href="https://www.amazon.co.uk/Mans-Search-Meaning-Holocaust-Material/dp/B00CB5EL98/ref=sr_1_1?s=books&ie=UTF8&qid=1461152850&sr=1-1&keywords=man%27s+search+for+meaning+2011">related to God and spirituality</a>.</p>
<h2>Spiritual resources</h2>
<p>As old-age psychiatrists, we have long been interested in how people’s personal, spiritual resources help them to face the challenges of ageing, including the challenges of ill health and even the existential threat of impending death. We see this as a kind of spiritual resilience that helps them cope with social, physical and psychological challenges. </p>
<p>However, while spiritual resilience can help an individual cope with their own ageing, their spiritual well-being may be challenged by these losses and threats. Those who provide health and social care need to take this into account, and support patients and clients in finding the resources to cope with these challenges </p>
<p>Modern medicine and nursing are proud to be “evidence-based” in approach. We have careful scientific evaluations of how to match treatment to diagnosis – but sometimes we neglect the equally important science of human relationships. Put at its simplest level, it is no use prescribing the right treatment if the patient is unwilling to take it because we have failed to win their confidence. The technical and the interpersonal aspects of clinical care should go together. Being prepared to <a href="http://www.gmc-uk.org/guidance/good_medical_practice/apply_knowledge.asp">assess spiritual need</a> and deal with it – or signpost the patient to those who can help – should be part of good medical practice.</p>
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<img alt="" src="https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119622/original/image-20160421-27001-zs6u3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Spirituality is about more than simply religion.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-307246967/stock-photo-portrait-of-an-old-man-with-a-gray-head-with-the-wisdom-of-looking-into-the-distance.html?src=kpGwJwnfWMuLLDnQZ1zWZg-1-12">www.shutterstock.com/Ana_Sun</a></span>
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<p>With colleagues in the spirituality special interest group at the University of Huddersfield we have developed a <a href="http://journals.rcni.com/doi/abs/10.7748/ns.29.39.51.e9726">description of spiritually competent practice</a> that:</p>
<blockquote>
<p>Engages a person as a unique spiritual being, in ways which will provide them with a sense of meaning and purpose, connecting or reconnecting with a community where they experience a sense of well-being, addressing suffering and developing coping strategies to improve their quality of life. This includes the practitioner accepting a person’s beliefs and values, whether they are religious in foundation or not, and practising with cultural competency.</p>
</blockquote>
<p>This kind of approach takes time. Repeatedly in our group’s research, we came across narratives of how spiritually competent practitioners have to “fight” the system, for example to ensure elderly patients are not discharged from hospital prematurely before their legitimate anxieties have been dealt with and the connections with their wider communities sufficiently established. This necessitates addressing the whole person, including their sense of meaning and purpose, and connection with others.</p>
<p>At the moment health and social care are under enormous pressure to become ever more “efficient”. Time spent with a patient or client is easy to measure – but the quality of the care offered may be reduced if workers are too rushed and stressed. Older people’s health and care issues are often more complicated: coupled with hearing loss and other sensory problems this may mean that more time is needed with them than with younger adults. </p>
<p><a href="http://www.rcpsych.ac.uk/usefulresources/publications/books/rcpp/9781909726451.aspx">Some headway</a> has been made in developing narratives that explore how older people cope with the spiritual challenges of ageing and how healthcare workers can help, for example, by finding time to listen and taking these less tangible needs into account in planning management and care with rather than for the individual. Spiritual needs can be crushed by an impersonal approach that emphasises technical performance at the expense of humane care, and finding the time to listen begins to address this problem in a person-centred way that takes into account spiritual as well as technical factors.</p>
<p>Only by considering the specific needs of older people can we make sense of what old age brings without the benefit of personal experience. Old people themselves often have tremendous spiritual resources to cope with these difficulties, but health professionals need to ensure these are fully respected at all stages of treatment. The way services are managed and evaluated needs to maximise the potential for this kind of action and to respect the role of family and friends in providing essential connectedness and support. </p>
<p>We need a health and social care system that is motivated by a spirit of compassion and not by a spirit of fear. This is important for people of all ages but especially for older people who often face multiple challenges. Some organisations manage to sustain this positive spirit, even in the face of monumental challenges. Others fail.</p>
<p>Clinical and caring professions should be built on concern and compassion for the whole person, regardless of their age of capacity. Human beings should not be treated as though they are machines and that mechanical repair is all that is needed.</p><img src="https://counter.theconversation.com/content/58180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Spiritual engagement is losing out to efficiency when it comes to older age.John Wattis, Professor of psychiatry for older adults, University of HuddersfieldStephen Curran, Professor, University of HuddersfieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/581772016-04-25T13:49:37Z2016-04-25T13:49:37ZDoctors look after our mental health but who looks after theirs?<figure><img src="https://images.theconversation.com/files/119837/original/image-20160422-17417-1kad7ut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No matter their age, gender or experience, health professionals from all walks of life have experienced mental health problems.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-80484097/stock-photo-tired-doctor-sitting-alone-in-hallway.html?src=DPvo1eeBZKIkkWQ58XexcA-1-29">www.shutterstock.com/Tyler Olson</a></span></figcaption></figure><p>A new study from Cardiff University has revealed that nearly <a href="http://www.newstatesman.com/politics/health/2016/04/why-doctors-mental-health-should-be-concern-us-all">60% of doctors</a> have experienced mental illness and psychological problems at various stages in their career. That is bad enough in itself, but what is much worse is that very few of the 2,000 surveyed <a href="http://occmed.oxfordjournals.org/content/early/2016/03/29/occmed.kqw024.abstract">said that they had sought help</a>.</p>
<p>A number of health and professionals from other industries have <a href="https://www.ucl.ac.uk/medical-education/reprints/2007-StressInHealthProfessionals-CambridgeHandbook.pdf">been studied in recent years</a>
and many, not unsurprisingly, also show high levels of stress. Sadly, however, it seems that this failure to seek help is not a phenomenon that is confined purely to the medical profession.</p>
<p>Findings from the British Psychological Society and New Savoy, for example – reporting on their 2015 staff well-being survey – showed that <a href="http://www.bps.org.uk/system/files/Public%20files/Comms-media/press_release_and_charter.pdf">nearly half of psychological professionals report being depressed</a>, along with admitting feelings of being a failure.</p>
<p>Work again was a culprit, with 70% of those who responded saying that they were finding their jobs stressful. For both medical doctors and psychological doctors, therefore, the current climate in the NHS is not, sadly, a healthy one. Workers on the front line of care are becoming governed more and more <a href="http://www.theguardian.com/society/2015/sep/29/junior-doctors-contract-row-nhs-explainer-health">by contracts</a> and targets rather than by the imperative of caring for people. The threat of cuts, <a href="http://www.itv.com/news/update/2015-11-25/22bn-of-efficiency-savings-for-department-of-health/and">often presented as efficiency savings</a> and the <a href="http://www.express.co.uk/news/uk/615890/Junior-Doctors-third-trainee-medics-stress-work">imposition of contracts on junior doctors</a> are just two of many current examples.</p>
<h2>Risk and resolution</h2>
<p>Across the caring professions – medical, psychological, nursing, professions allied to medicine, and caring – there is, overall, <a href="http://www.bps.org.uk/system/files/Public%20files/Comms-media/press_release_and_charter.pdf">a picture of worrying levels of depression and stress</a> leading to low morale and burnout.</p>
<p>Burnout is something experienced by people who have been working on the front line of human services in a context where they are caring for, and committed to providing services to, others. Its features are a combination of high levels of depersonalisation – where a person no longer sees themselves or others as valuable – and emotional exhaustion together with low levels of feelings of personal accomplishment. <a href="http://www.theguardian.com/commentisfree/2016/apr/19/burnout-depression-doctors-struggling-mental-health">This is exactly what we are seeing</a> reported here in the Cardiff study.</p>
<p>The Cardiff study found that the likelihood of doctors reporting mental health problems differed between different stages of their careers: young doctors and trainees were least likely to disclose any problems. <a href="http://www.cardiff.ac.uk/news/view/239910-doctors-mental-health">Female doctors were found to be particularly at risk</a> of burnout, as were GPs and trainee and junior doctors.</p>
<p>Almost certainly, <a href="http://www.kcl.ac.uk/ioppn/news/records/2014/February/Stigma-key-deterrent-in-accessing-mental-health-care.aspx">the reason why is stigma</a>. People throughout society – particularly frontline professionals – are afraid of disclosing that they are having problems because they fear the repercussions and possible effects that disclosure may have on their careers.</p>
<p>This was also recently demonstrated in <a href="http://www.kcl.ac.uk/ioppn/news/records/2014/February/Stigma-key-deterrent-in-accessing-mental-health-care.aspx">a wider paper by Sarah Clements of Kings College London</a> who, with colleague Graham Thornicroft, carried out a meta analysis of 144 studies involving more than 90,000 people. Their resulting global report showed that although one in four people – both inside and outside the healthcare profession – in Europe and the USA have a mental health problem, as many as 75% of people do not receive treatment.</p>
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<img alt="" src="https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119849/original/image-20160422-17409-1mezgd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">How can we care for our carers?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-65304214/stock-photo-depressed-tired-male-surgoen.html?src=DPvo1eeBZKIkkWQ58XexcA-1-42">www.shutterstock.com/stefanolunardi</a></span>
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<p>What – if anything – can be done about this situation? Do we really want to consult with professionals who are less able to confront their own difficulties than we are? How can we help them confront their own issues to help others in society overcome the stigma?</p>
<p>There have been moves towards a more open mental health culture within the health professions, with some senior members of staff sharing their experiences. Retired GP Chris Manning, for example, has been greatly involved in the promotion of doctors’ psychological health and self-care after <a href="http://www.pulsetoday.co.uk/views/opinion/my-experience-of-burnout-has-led-me-to-help-other-doctors-facing-it/20002801.fullarticle">experiencing depression and burnout</a>.</p>
<p>Clare Gerarda, former chair of the Council of the Royal College of General Practitioners, has also been a long-time advocate for doctors’ health and is the medical director of the <a href="http://php.nhs.uk/what-is-the-practitioner-health-programme/the-php1-team/">practitioner health programme</a> – a free and confidential NHS service for doctors and dentists who are experiencing psychological or physical health concerns. Additionally, Dr Gerarda established the <a href="http://foundersnetwork.uk/">Founders Group and Founders Network</a>, a coalition working together to promote psychologically healthy environments within the NHS.</p>
<p>A <a href="http://www.bps.org.uk/system/files/Public%20files/Comms-media/press_release_and_charter.pdf">new Charter on Psychological Staff Wellbeing and Resilience</a> was also launched recently by the British Psychological Society and New Savoy. Building on this, a collaborative learning network of employers in health and social care has been established and will have its first meeting on June 21 in order to begin working together to establish and maintain psychologically healthy working environments. </p>
<p>Fundamentally, though, there has to be a change in culture. People need to be able to speak freely about their feelings of stress and psychological needs – and be supported to seek help. I have tried, personally, to model this as the president of the British Psychological Society over this past year and have talked openly about <a href="https://www.mentalhealthtoday.co.uk/stress-and-depression-increasingly-common-among-nhs-psychological-therapies-staff-survey-finds.aspx">my own experiences of burnout, stress, depression and bipolar disorder</a> while working as a clinical psychologist.</p>
<p>It is my belief that this culture change could begin to be enabled for doctors, both medical and psychological, nurses, allied health professionals and all in the caring professions too, if senior additions and managers begin to talk openly about their own psychological health.</p>
<p>To do so is a sign of strength and humility.</p>
<p><em>This article does not reflect the views of any research councils the author has been funded by, nor the societies and groups he is a member of.</em></p><img src="https://counter.theconversation.com/content/58177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hacker Hughes has previously received funding from BLESMA, the Forces in Mind Trust and the Ministry of Defence. He is current President of the British Psychological Society, member of the Founders Group and the British Psychological Society/New Savoy Collaborative Network for Psychological Wellbeing and is a Viisiting and/or Honorary Professor at Anglia Ruskin, Hertfordshire and Lomonosov Moscow State Universities.</span></em></p>Throughout the medical profession, there is a culture of fear surrounding mental illness.Jamie Hacker Hughes, Professor of Military Psychology (Visiting), Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/416482015-05-21T04:32:25Z2015-05-21T04:32:25ZA human step to equal health care in South Africa’s rural hospitals<figure><img src="https://images.theconversation.com/files/81897/original/image-20150515-25444-h1ytjb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Student doctor Livhuwani Mashanzhe (R) from the University of Johannesburg takes a blood test from a patient at Kimberley train station in South Africa in this file picture. </span> <span class="attribution"><span class="source">Juda Ngwenya/Reuters</span></span></figcaption></figure><p>Rural communities in South Africa, similar to other countries worldwide, have <a href="http://rhap.org.za/wp-content/uploads/2014/03/International-review-of-rural-proofing-practices-.pdf">less access</a> to health care. Facilities are limited, the information insufficient and there are fewer health professionals to attend to the population, which results in them having a <a href="http://www.rhap.org.za/re-imagining-rural-health-20-years-democracy/">poorer health status</a>.
It is estimated that in South Africa over <a href="http://www.kznhealth.gov.za/Clinical_Associate/clinical_associates.pdf">70% of doctors</a> work in the private sector, leaving just over 27% to serve the vast majority in the public sector. The unequal health care distribution favours richer people, even though illness is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029937/">greater for poorer people</a>.</p>
<p>To improve the availability of health professionals, particularly for rural communities, in 2008 the South African National Department of Health created a <a href="http://www.wits.ac.za/files/1u8u7_556748001420534309.pdf">clinical associates</a> position as part of the mid-level health worker programme.</p>
<p>Clinical associates are competent health professionals with the necessary knowledge, skills, and attitudes to be part of a district hospital clinical team, which is accessed as part of community based primary health care services in provinces. They function under the supervision of doctors and can do certain procedures; assess patients in casualty and emergency wards and in other wards and theatres. They are there to lighten the workload of their teams. Their presence means that doctors are able to do outreach work <a href="http://www.kznhealth.gov.za/Clinical_Associate/clinical_associates.pdf">in rural clinics</a>. </p>
<p>But seven years after the programme was set up, despite <a href="http://www.globalhealthaction.net/index.php/gha/article/view/19282">anecdotal positive responses</a> from hospital staff about the assistance they provide, the clinical associate programme has not yielded the number of mid-level health care workers it envisioned. </p>
<h2>Stifled by financial constraints</h2>
<p>The programme has faced challenges, particularly around its financing. Initially 1350 were to be trained and sent in groups of five to over 200 district hospitals across the country. But by 2014, when the third set of Clinical Associates was to graduate, the Health Professions Council of South Africa had only <a href="http://indicators.hst.org.za/healthstats/288/data">registered 369</a>). </p>
<p>Securing donor funding at the onset of the programme to create the curriculum was challenging, exacerbated by miscommunication between the Health Ministry and the National Treasury about the programme’s special allocations. A shortfall of funding to the universities also hampered targets being met.</p>
<p>The universities have had to stretch existing resources for teaching to the maximum because subsidies from the Department of Education could only be accessed once the clinical associates had graduated.</p>
<p>Hospitals have also been struggling to finance the training costs, including teaching posts. The funding situation has not encouraged universities to scale up production. And because there have been so few clinical associates in practice, the full impact of the programme has not yet be established.</p>
<h2>A tailor-made training programme</h2>
<p>Although clinical associates are trained at medical schools and regulated by the same body as the medical doctors, they are not doctors. Their training differs from the doctors in a number of ways. Their degree is three years long compared to the six-year medical degree for fully fledged doctors. They get trained in the wards while learning the theory of their profession. On the other hand, doctors do their in-service training after completion of their studies.</p>
<p>All clinical associates have the same national curriculum and exam, ensuring that they are exposed to comparable standard across the country. Some local flexibility and innovation during training has been built in at the different universities.</p>
<p>Several features of the clinical associates training programme contributed to its initial <a href="http://www.globalhealthaction.net/index.php/gha/article/view/19282">success</a>. </p>
<p>Training alongside medical doctors fosters synergy between the clinical associates and doctors because they have to work together. Because their work has to be supervised by doctors, they are assured of adequate support and the quality of patient care is maintained.</p>
<p>The scope of practice for clinical associates is tailored for the district hospital’s needs and context. It emphasises general skills but responds to the district hospital patient profile.</p>
<p>The programme is addressing another major challenge facing medical schools: how to attract students from rural areas. Studies have repeatedly shown the background of the student as the main factor for rural practice retention.</p>
<p>The programme is designed to recruit students from rural settings and train them to work in those areas, giving marginalised communities a new way to enter the medical field. Staff retention in rural areas has been enhanced and patients get to be treated by health care workers who can speak their languages.</p>
<p>The benefits of clinical associates doing service-based learning is that they become familiar with local health circumstances and immediately relieve the workload of the staff they shadow. However the full benefits of the programme will only be established once adequate number of clinical associates have qualified. </p>
<p>In the United States, where the <a href="http://journals.lww.com/jaapa/Abstract/2014/04000/The_roles_of_primary_care_PAs_and_NPs_caring_for.9.aspx">physician assistants</a> programme has been running since the 1960s, there are around 90 000 assistants operating in 50 states.</p>
<h2>Keeping the programme going</h2>
<p>To sustain the early achievements in the clinical associates programme, more must be produced in greater numbers. Retention might also be a problem. The apparent poor working conditions and management systems that, in the past, have contributed to poor staff retention in rural settings especially, might stifle the aspirations of the clinical associates who may still seek to grow professionally.</p>
<p>There have also been tensions between clinical associates and existing health professionals around what the clinical associates are allowed to do. One challenge is that the Pharmacy Council had stopped clinical associates from prescribing medicines.</p>
<p>But the most concerning challenge is that, given the known health personnel shortage in South Africa, there is a risk that doctors may not be available to supervise the clinical associates. This could result in clinical associates not functioning to their full capacity.</p>
<p>The clinical associate program has the potential to improve the quality of care especially for poor, marginalised and rural communities. However the success of the programme requires strong district health systems, good health management and enough medical doctors to supervise them.</p><img src="https://counter.theconversation.com/content/41648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daphney Nozizwe Conco does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Skilled mid level health care workers can relieve the workload of other health care workers and can help make universal health care a reality for South Africans.Daphney Nozizwe Conco, Honorary lecturer at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.