The Family Attachment Scheme

1. The Family Attachment Scheme Introduction to First Year October 2007 Dr Kieran McGlade

2. BEGIN WITH THE END IN MIND“By the end of the study I felt much more competent as an interviewer. Controlling theinterview was a difficulty at the outset but myself and my partner both felt that we gained control with later visits......... Finally, we grasped the most important concept. That every patient is an individual who will react differently to their illness. They must be treated with respect at all times and in a way that best suits them individually”

3. Contacts Course Organiser k.mcglade@qub.ac.uk Course Secretary c.agnew@qub.ac.uk

4. Learning Outcomes(Figures in parentheses refer to programme outcomes for the entire curriculum) • Describe the cultural and social environment of the families/household visited (10,15); • Describe how social class, accommodation, neighbourhood, schooling, work, and leisure pursuits inter-relate with illness and disease (15,16); • Construct a family tree using this to describe the household and the broader family structure (15, 28); • List the family's recent and continuing illness events (10, 12, 28); • Describe how the family has dealt with these illness events including occupancy of the sick role (16);

5. Learning Outcomes(Figures in parentheses refer to programme outcomes for the entire curriculum) • Describe the definition of illness from the standpoint of the family and the professional (12, 16); • List the medical and social resources available in the community (9); • Evaluate the extent to which family/household health care needs have been met by available resources and identify why needs remain unmet (9,12);

6. Learning Outcomes(Figures in parentheses refer to programme outcomes for the entire curriculum) • Discuss how community efforts to prevent disease and promote health impinge on the family (9,12); • Discuss the specific family visited in relation to the known demography, epidemiology and psychosocial factors of illness and disease (10); • Demonstrate an ability to work as a team member and discuss the potential impact of the student's presence on the family (36,45); • Demonstrate appropriate respect for patients and their rights to confidentiality and informed consent (11,27,38); • Demonstrate an ability to gather information efficiently and synthesise relevant information in the form of a report.

7. Objectives • Get to know your family soon • Establish an efficient way of working with your colleagues • Elect a contact person • Keep a log diary of your LEARNING

8. Aims - 1 • observe at first hand the processes of family life and health care; • begin to gain an understanding of human relationships; • begin to acquire and develop good communication skills; • appreciate the importance of good communication with both patients and their relatives and with other professionals involved in their care;

9. Aims - 2 • become aware of the organisation of the provision of, and health care in, the community; • become aware of the importance of Health Promotion in the community. • become aware of the ethical responsibilities involved in patient care; • begin to understand the interactions between patient, illness, social and physical environment.

10. Duties of a Doctor • make the care of your patient your first concern; • treat every patient politely and considerately; • respect patients' dignity and privacy; • listen to patients and respect their views; • give patients information in a way they can understand; • respect the rights of patients to be fully involved in decisions about their care; • keep your professional knowledge and skills up to date;

11. Duties of a Doctor (contd) • recognise the limits of your professional competence; • be honest and trustworthy; • respect and protect confidential information; • make sure that your personal beliefs do not prejudice your patients' care; • act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise; • avoid abusing your position as a doctor; and • work with colleagues in the ways that best serve patients' interests

12. Course Structure • Three tutorials in First Semester • Communication Skills • Patient Introductions • Follow up tutorial • Three Tutorials in Second Semester

13. Tutorials: Semester 1 • Communication Skills (9th – 18th October) • Introductions to patients /families(6th – 15th November) • Review of first visits & planning for next(4th – 13th December)

14. Tutorials: Semester 2 • Present findings to date. Discussion about structure of reports. GP led topic.(5th – 14th February 2008) • Opportunity to view notes (with consent)GP led topic.(26th February – 4th March) • Students give PowerPoint presentations outlining the main elements of their reports.(22nd April – 1st May)

15. Course Structure visit GP Tutorial 8 – 10 students Pairs of students GP Tutorial 8 - 10 students visit visit

16. Times of Tutorials • Tuesday • Thursday • NB arrangements for visiting patients should be made independently • All tutorials will take place at your GP tutor’s surgery

17. Assessment • 4000 word Report • Needs to be concise, but at the same time reflective. • Still to be produced in pairs • Additional 500 words each for personal reflection. • Portfolios • Deadline is Monday 12th May 2008

18. The Report • For regulations see para 12.3 of the study guide • Combined effort (two or three students) • Main part (4,000 words) • Personal reflection (750 words) in appendix

19. Writing your report • An account of your visits • An account of your impressions • Draw on what you have learned in the “Science, Society and Medicine” course. • Draw on what you have learned from others in your tutorial group.

20. Getting the most out of it • Prepare in advance • both for your visits and your tutorials • Don’t try to achieve too much on your visits • plan in advance one or two objectives for each visit but be prepared to “play things by ear. • Keep a diary of your visits and tutorials • Helps when planning your next visit • Helps when writing up your report • Remember confidentiality • Recognise the opportunities

23. Relevant Courses • Communication Skills • Science Society and Medicine • The Individual and Society • All Courses!

24. Reading Sociology as applied to medicine / edited by Graham Scambler. - 5th ed. - Edinburgh; London : Saunders, 2003. - 0702026654

25. Coomunication Skills Reading Communication Skills for Medicine M Lloyd and R Bor Churchill Livingstone 1996

26. “ If the truth be known, I must admit that I had many reservations about the Early Medical Contact scheme ...... I thought it was just something else the faculty gives us to keep us busy. Now I can look back and confidently say I am glad I had this opportunity ...”

27. “Mrs X was an elderly lady living on her own and had very little company. She welcomed two complete strangers into her home, who fumbled their way through interviewing their first patient. But she was appreciative of the time we spent with her and felt that she was doing good in taking part in our education. Although we may not have relieved Mrs X of pain or had a great impact on her life, I will certainly never forget her.”

28. “Contact with the GP was very helpful. She gave us worthyguidelines on how to approach each meeting and her ownperspective on the family’s situation. By observing and listening to her, we gained an idea of the complex and demanding role of a general practitioner and her time and effort in aiding us with this attachment is much appreciated”

29. “Now that I have entered the clinical years of teaching, I feel that if I had not had the chance to see the patient in their own home I might view the ward patients differently. There is a danger ofseeing them only as ‘sick people’ and forgetting about the many problems they face. This scheme has allowed me to view these problems first hand. Also, because more and more patients are being treated at home rather than in hospital, a chance to view this side of medical practice was invaluable.”

30. Sources of Information http://www.qub.ac.uk/cm/gp/Courses/Undergraduate/FAS.html http://www.qub.ac.uk/cm/undergrad/year1/0405/family/ • Queens Online • NB Other Courses!