|Pan-American Federation of Associations of Medicals Schools (PAFAMS)|
A non-governmental, academic and educational organization that gathers information on medical schools in the Western Hemisphere from Canada to Argentina. Founded in 1962 in Chile, PAFAMS is striving through collaboration toward the improvement and development of innovative medical education. The constituency is integrated by 12 national Associations of Medical Schools, and comprises over 354 Medical schools. The mission is: "The promotion and advancement of medical education and the biomedical sciences in the Americas and the Caribbean"
|Patient Management Problem (PMP)|
A written method that attempts to assess clinical problem-solving abilities. To improve its validity, recent improvements include an attempt to focus testing on the key features within a clinical case, which represents the diagnostic or problem-solving challenge. The main advantage of this innovation is that many more 'clinical cases' can be administered to candidates in a given period of time than with conventional PMP.
Computer-Based Patient Management Problem (e-PMP) is a related method that has been used for some years, which more recently has been enriched with the ability to link computers to various audiovisual inputs such as videodiscs and optical holograms produced by lasers extending realism of the simulations and conceivably providing enhanced educational opportunities. The cost of developing, establishing and maintaining the required facility may constitute a significant constraining factor for broader use.
Questionnaire used to assess patient satisfaction with different aspects of their health care. The questions address general aspects of the physician's care such as the amount of time spent with the patient, overall quality of care, physician competency (skills and knowledge), courtesy, and interest or empathy. Specific patient care competencies can be assessed including interpersonal and communication skills, professional behavior, listening skills, provision of information about examination findings etc. Each rating may generate a single score overall or separate scores for different clinical care activities or settings. Most patient satisfaction surveys are completed at the time of service and require less than 10 minutes. Improvements to this tool may include utilizing more effective survey design and using computers to collect and summarize survey data.
|Peer Review or Peer Evaluation|
Method for evaluating professional attitudes and behavior, used by trainees to assess each other and also used by supervisors, nurses and patients to assess trainees. Typical measurement tools for this form of testing are checklists and questionnaires.
Denotes what an individual actually does in a real life situation. In medicine, it denotes what a student or doctor actually does in an encounter with a patient when applying learned knowledge and skills, mediated by clinical judgment and the use of interpersonal communication skills. From this standpoint, competence implies professional maturity and ease in making difficult decisions. And, although these elements are inherent in good practice, it is not easy to demonstrate them. Assessment of clinical performance is of the greatest importance but is often difficult to measure.
An evaluation that demands trainees be engaged in specified clinical activities. This permits evaluation of an ability to perform clinical tasks and not merely the recitation of medical knowledge. Typical measurement tools for this form of testing are checklists, observation logs, and anecdotal reports.
|Personal Development Plan (PDP)|
A list of educational needs, development goals and actions and processes, compiled by learners and used in systematic management and periodic reviews of learning. It is an integral part of reflective practice and self-directed learning for professionals. It can be equally valuable in teacher-directed medical training for maintaining learner-centered approaches and shared objectives. PDP can be used to manage learning needs systematically, to set development and performance improvement goals, organize learning activities and review outcomes. Some educational organizations accept completed plans for accredited professional development and health managers link them with appraisals.
A professional, qualified by education and authorized by law to practice medicine. The essence of being a professional is an ability to find solutions to difficult problems for which there are no easily discovered answers and to effectively handle medical situations where no two patients are identical even if they have the same condition. This differentiates the professional, who must deal with complex problems that tend not to have unambiguous, clear-cut solutions, from the technician.
Organized efforts focused on the health of defined populations in order to promote and maintain or restore health, to reduce the amount of disease, premature death and disease-produced discomfort and disability. Programs, services and institutions here emphasize the prevention of disease and the health needs of the population as a whole. Among a broad scope of disciplines, various knowledge and skills are utilized such as bio-statistics, epidemiology, planning, organization, management, financing and evaluation of health programs, environmental health, application of social and behavioral factors in health and disease, health promotion, health education and nutrition.
|Portfolio-Based Learning or Portfolios|
assessed against specific targets of achievement. In essence, portfolios contain material collected by the learner over a period of time. They are the learner's practical and intellectual property and the learner takes responsibility for the portfolio's creation and maintenance. Because the portfolio is based upon the real experience of the learner, it helps to demonstrate the connection between theory and practice, accommodating evidence of learning from different sources, and enabling assessment within a framework of clear criteria and learning objectives. The use of portfolios encourages autonomous and reflective learning which is an integral part of professional education and development. Candidates are expected to produce evidence and process such evidence with relation to a pre-determined standard. Since the portfolio approach includes both content and a reflective component, one must first determine which components are to be assessed. Portfolios provide a process for both formative and summative assessment, based on either personally derived or externally set learning objectives or a model for lifelong learning and continuing professional development.
|Practicability of Assessment Procedures|
As there are always restrictions on the resources available to conduct assessments, expertise and creativity are required to develop the best compromise between ideal and practical procedures and tools for assessment. Time and resources are required to develop a proper examination possessing minimally acceptable standards of validity and reliability. This applies particularly to the assessment of clinical skills where much longer or more frequent observations of student performance are required than are usually undertaken. The planning of exams should take into account the number of students to be assessed. An assessment procedure appropriate for 20 students may not be practical where 100-200 have to be evaluated. Important factors are the number of staff available, their status and specialties, number of available patients, available space or accommodation and the end-use of the assessment; for instance, if results are used to determine "pass or fail" status or to probe for areas of competence in which students are deficient.
The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress. These goals are embodied in the word prevention, which is easiest to define in the context of levels, customarily called primary, secondary and tertiary prevention:
Primary prevention refers to the protection of health by personal and community wide effects, such as preserving good nutritional status, physical fitness, and emotional well-being, immunizing against infectious diseases, and making the environment safe.
Secondary prevention can be defined as the measures available to individuals and populations for the early detection and prompt and effective intervention to correct departures from good health.
Tertiary prevention consists of the measures available to reduce or eliminate long-term impairments and disabilities, minimize suffering caused by existing departures from good health, and to promote the patient's adjustment to irremediable conditions. This extends the concept of prevention into the field of rehabilitation. There are no precise boundaries between these levels.
A specialized field of medical practice composed of distinct disciplines that focus on the health of defined populations in order to promote and maintain health and well-being and prevent disease, disability and premature death. It aims at the application of preventive measures within all areas of clinical medicine. In addition to the knowledge of basic and clinical sciences and the skills common to all physicians, practitioners of preventive medicine possess knowledge of and competence in other disciplines. Among a broad scope of such disciplines are: bio-statistics, epidemiology, planning, organization, management, financing, and evaluation of health programs, environmental health, application of social and behavioral factors in health and disease, health promotion, health education and nutrition.
|Primary Health Care|
The World Health Organization defines primary health care as the principal vehicle for the delivery of health care at the most local level of a country's health system. It is essential health care made accessible at a cost the country and community can afford with methods that are practical, scientifically sound and socially acceptable. Everyone in the community should have access to it, and everyone should be involved in it. Beside an appropriate treatment of common diseases and injuries, provision of essential drugs, maternal and child health, and prevention and control locally endemic diseases and immunization, it should also include at least education of the community on prevalent health problems and methods of preventing them, promotion of proper nutrition, safe water and sanitation.
|Primary Medical Care|
Primary medical care begins when a patient with a new health problem encounters the first-level provider of care. The provider initiates care, may screen for referral to a specialist, and secures overall responsibility for continuity of care provided by all medical personnel in both outpatient and in-patient settings.
|Problem-Based Learning (PBL)|
In this approach, students learn in small groups supported by a tutor. They initially explore a predetermined problem. The problem contains triggers designed to evoke objectives or concepts which are used to set the agenda for individual or group investigation and learning after the initial session. Subsequent group meetings permit students to monitor their achievements and to set further learning goals as required. The tutor's role is to offer support for learning and to help reach the expected outcomes. PBL enables students to develop the ability to translate knowledge into practice at an early stage, encourages individual participation in learning and also allows the development of teamwork skills. Students in PBL courses have been found to place more emphasis on "meaning" (understanding) than "reproduction" (memorization). Students must engage in a significant amount of self-directed learning; lectures are kept to a minimum. PBL originated at McMaster University in Canada, and then at Maastricht University, and is now widely adopted in medical schools in many countries. Each school makes its own adjustments to the basic model. It does require a heavy investment in resources (library books, IT, tutorial rooms) as well as requiring education and training for tutors.
Adherence to a set of values comprising both a formally agreed-upon code of conduct and the informal expectations of colleagues, clients and society. The key values include acting in a patient's interest, responsiveness to the health needs of society, maintaining the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge. In addition to medical knowledge and skills, medical professionals should present psychosocial and humanistic qualities such as caring, empathy, humility and compassion, as well as social responsibility and sensitivity to people's culture and beliefs. All these qualities are expected of members of highly trained professions.The American Board of Internal Medicine's Project Professionalism indicates the most important elements of professionalism to be: altruism, accountability, duty, excellence, honor and integrity, and respect for others.
Professional Altruism: constitutes the essence of professionalism and is based on the rule that the best interest of patients and not self-interest is the professional obligation.
Professional Accountability is an important element of professionalism which is required of physicians at several levels: to their patients for fulfilling the implied contract governing the patient/physician relationship, to society for addressing the health needs of the public, and to their profession for adhering to medicine's time-honored ethical precepts.
Professional Duty can be expressed by the free acceptance of a commitment to service, availability and responsiveness when "on call," accepting inconvenience to meet the needs of ones patients, enduring unavoidable risks to oneself when a patient's welfare is at stake, and 0advocating the best possible care regardless of the patient's ability to pay. It is willingness to seek an active role in professional organizations and volunteering ones skills and expertise for the welfare of the community.
Professional Excellence entails a conscientious effort to exceed ordinary expectations. Commitment to excellence is an acknowledged goal for all physicians and includes a commitment to life-long learning.
Professional Honor and Integrity implies being fair, being truthful, keeping one's word, meeting commitments, and being straightforward. It also requires recognition of the possibility of conflict of interest and avoiding any situation in which the interest of the physician is placed above that of the patient or allowing personal gain to supersede the best interest of the patient. It constitutes an integral part of professionalism. The importance of professionalism in the patient/physician relationship cannot be overstated.
Professional Respect for Others is reflected in the respect towards the patients and their families, other physicians and professional colleagues such as nurses, medical students, and residents. It is the essence of humanism, and humanism is both central to professionalism and fundamental to enhancing collegiality among physicians.
Organized efforts of society to protect, promote, and restore people's health. It is the combination of science, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programs, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with variations in technology and social values but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. Public health is thus a social institution, a discipline, and a practice.