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  1. 1. Exploring students' Feelings Counts in Education: The Use of Gibbs Reflective Cycle in Teaching Clinical Ethics Borahmah A [1] , AlRasheedi S [1] , Al-Braheem A [1] , Elamir H [3] , Jacob S [1] , Bouhaimed M [1,2] [1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine. [2] Department of Surgery, Kuwait University Faculty of Medicine. [3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH Background: Learning consists of cognitive, emotional and social dimensions. In medical education, the cognitive dimension (Fig 1) is usually measured through assessments of performance, while the social and emotional dimensions are more challenging to capture. One of the objectives of the ethics and professionalism elective course on “Patient Safety: Better Knowledge for Safer Care” is to apply different reflection tools to the students’ hospital experiences to enable their development as future doctors. The Gibbs Reflective Cycle (Fig 2) was applied to the students’ experience of one of the nine World Health Organization "Patient Safety Solutions" (Fig 3) adopted by the Ministry of Health in Kuwait. In this case presentation, the four steps of the Gibbs cycle: to describe, to express feelings, to evaluate and finally to make sense of experience were applied to the “Performance of Correct Procedure at Correct Body Site” protocol. The first step in the protocol is the verification of the intended patient, procedure, site laterality (right or left without abbreviation) and any implant or prosthesis. Remembering Understanding Applying Analyzing Evaluating Creating 1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956. http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy Fig 1: Bloom’s Taxonomy (Revised) Can the student distinguish between different parts? Appraise, compare, contrast, criticize, differentiate, discriminate, distinguish, examine, experiment, question, test Define, duplicate, list, memorize, recall, repeat, state Can the student recall or remember the information? Can the student explain ideas or concepts? Can the student use information in a new way? Classify, describe, discuss, explain, identify, locate, recognize, report, select, translate, paraphrase Choose, demonstrate, dramatize, employ, illustrate, interpret, operate, schedule, sketch, solve, use, write Can the student justify a stand or decision? Appraise, argue, defend, select, support, value, evaluate Can the student create a new product or point of view? Assemble, construct, create, design, develop, formulate, write Look-alike,Sound-Alike (LASA) Medication Names Patient Identification Single Use of Injection Devices Performance of Correct Procedure at Correct Body Site Improved Hand Hygiene to Prevent Healthcare-Associated Infection Assuring Medication Accuracy at Transitions in Care Avoiding Catheter and Tubing Misconnection Control of concentrated electrolyte solutions Communication During Patient Handovers Patient safety Solutions Fig 3: Description What happened? Description What sense can you make of the situation? Fig 2: Gibbs Reflective Cycle Feelings What were you thinking and feeling? Action Plan If it arose again, what would you do? Conclusion What else could you have done? Evaluation What was good & bad about the experience? Reflection can be used as a tool to facilitate the teaching of hospital based clinical ethics and patient safety in medical education. Conclusion: Contacts: For further information, please contact Dr. Manal Bouhaimed Email: manal_q8 @hsc.edu.kw Tel(office): 24636532 Acknowledgement: We would like to acknowledge the assistance provided by Quality Nurses: Abeer G. Dossokey, Amal T. Mohamed, Asila A. Alrasheedi, Lea Martinez & Rinto Francis. Case Summary: The students were able to identify that in a recent retrospective audit of 33 medical records of surgical procedures involving a body part that needed to be specified in terms of side laterality, there were 6 records that included at least one wrong entry (Fig 4). Out of a total of 86 different opportunities to enter the specific site of the procedure in the 6 patients’ records the following sources were identified (Fig 5a, b): The students’ feelings were initially those of “shock and frustration, fear and need to be precautious going into the world of medicine, motivation to learn, and finally excitement and ambition to attain new perspectives about clinical ethics and patient safety". 0 20 40 60 80 100 Correct & Not Abbreviated Abbreviatted Missed Wrong & Abbreviated 38% Medical Forms 31% Anaesthesia Forms 23% Nursing Forms 8% Investigation Forms Patient (1) had WRONG SIDE surgery Procedure:Right Pyelo lithotomy # of opportunities = 33 Correct & not abbreviated= 4 Wrong & abbreviated= 7 Correct & abbreviated= 15 Missed= 6 Patient (2) Procedure: Mesh repair for Right Inguinal Hernia # of opportunities = 11 Correct & not abbreviated= 1 Wrong & abbreviated= 1 Correct & abbreviated= 7 Missed= 2 Patient (3) Procedure: Amputation for gangrenous Left big toe # of opportunities = 10 Correct & not abbreviated=4 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 0 Patient (4) Procedure: Amputation for Left Lower Limb Ischemia # of opportunities= 6 Correct & not abbreviated=1 Wrong & abbreviated= 2 Correct & abbreviated= 2 Missed=1 Patient (5) Procedure: Mesh repair for Left Inguinal Hernia # of opportunities= 16 Correct & not abbreviated= 9 Wrong & abbreviated=1 Correct & abbreviated= 4 Missed= 2 Patient (6) Procedure: Mesh repair for Right Inguinal Hernia # Of opportunities =10 Correct & not abbreviated=2 Wrong & abbreviated= 1 Correct & abbreviated= 6 Missed= 1 Fig 4: Findings of laterality opportunities in 6/33 patients L E F T R I G H T (Fig 5a) (Fig 5b)

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