On Being Morally Relevant: Principles to Frame Our Professional Development

1. On Being Morally Relevant: Principles to Frame Our Professional Development SI – Friday Anchoring Lecture Daniel Duffy OU School of Community Medicine

2. The Objective of Moral Action is the Avoidance or the Relief of Suffering At its core, the practice of medicine is a morally relevant act

3. Patient’s Predicament Vulnerable Frightened Unable to help self Dependant on others Low social status Physicians swear a public oath that they: Can be trusted Will use specialized knowledge and training for the good of the sick Will keep patients from harm to the best of their ability Will put aside self-interest for the good of their patients Morally Relevant Professional Sulmasy D. The Rebirth of the Clinic: An Introduction to Spirituality in Health Care. 2006 The Georgetown University Press, Washington, DC.

4. We make a personal commitment to improve the health of our patients Devote our collective efforts to improve the health care system for the welfare of society Being Morally Relevant The ABIM Foundation, The American College of Physicians Foundation, The European Federation of Internal medicine,Ann Intern Med & Lancet, March 2002

5. Community Medicine Goes Beyond Care for Our Patients It is the morally relevant actions of a community of professionals that prevent and relieve suffering for all persons in the community

6. Being human means being in community Desmond Tutu A person is a person because he recognizes others as persons

7. Person in Community BIO- PSYCHO- SOCIAL- SPIRITUAL

8. Social Vulnerability Breeds Illness and Early Death • Vulnerability is a vicious cycle produced by the interaction of genes, behavior, environment, and chance. • Interventions to help vulnerable people and populations should be focused at important stages of the life cycle – perinatal and early childhood and prepuberty and adolescence.

9. Social Vulnerability Destroys Health • Social Stress: exclusion, challenging circumstances, cruelty • Social coping includes a neighborhood of people with similar life situations • Vulnerability is cumulative over a life course • early life adversity continues to reverberate throughout life (ACES)

10. Science of Vulnerability “Studies at the intersection of the social, behavioral, and biological sciences add to an emerging field of physiological evidence supporting the idea that children’s development is greatly affected by the social environment in which they are raised.” Furumato-Dawson, A et. al Health Affairs, 2007 BIO- PSYCHO- SOCIAL- SPIRITUAL

11. Science of Vulnerability “The influence of chronic psychological stress on gene expression via neurological and hormonal dysfunction is important to understanding the biological bases of adult health vulnerability (e.g. CVD, cancer)” “During intense periods of development (perinatal, peripubertal) whole suites of genes are expressed and interact with the social and physical environment experienced by the child.” BIO- PSYCHO- SOCIAL- SPIRITUAL

12. Genes Physiological Environment Food & water Toxins, drugs Family Mother Father Others Neighborhood Hazards Aesthetics Services Social place Isolation Marginalization Education Behavioral norms Leisure activity Attitude about future Choices Access to healthcare Medical home Specialty services Mental & spiritual care We learned that health depends on…

13. Downloading Observe, observe, observe Act in an instant NOUS Retreat and reflect: Allow the inner knowing to emerge

14. CO-INITIATINGListen to others and to what life calls us to do CO-EVOLVINGGrow innovation systems by seeing and acting from the whole community CO-SENSINGGo to the places of most potential and listen with our minds and hearts wide open CO-CREATINGPrototype new solutions to explore the future by doing CO-PRESENCINGRetreat and reflect, allow the inner knowing to emerge

15. With our minds, our hearts, and our wills wide open to the health needs of our community, and presencing future possibilities, we are ready to learn together how to apply the facts, theories, and methods of our diverse professions to improve the health of our community

16. Professions • Lengthy training • Specialized knowledge and method • Help others solve their problems • Reflective and self-regulating practice • Continuous learning and improvement • Discovery and innovation • Serve the interests of other persons first

17. Professional Independence

18. Patient-Centered Medical Home Leadership/citizenship - Quality Innovation Treatment Intervention Screening & Diagnostic Work-up Patients with needs: Acute, Chronic, & Prevention care Recovery, Rehab, Pt Self-Care Patients needs met: Clinical, Satisfaction, Economic Monitor & Follow-up Access & Arranging Care Patient Education - Self-Care Support Teamwork – Proactive Care Management Clinical Information Management Tests – Consults – Referrals - Admits - Rx Community 6-6-08 FDD revision

19. School of Community Medicine Track • Educational track within the OU College of Medicine • Summer Institute I and II • Scholarship and debt burden reduction plans • Community Medicine focus in OKC courses • Public Health coursework opportunities • Clinical education on Tulsa SOCM campus • Longitudinal clinic and service-learning acute clinics in Tulsa • OU College of Medicine MD Degree

20. The Cycle of Learning Listen, read, experience, and question Test your success in answering questions Reflect: How might I use this knowledge? Form prototype groups to imagine and discover applications

21. Learning Objectives in Medicine

22. OUCOM MS-I Curriculum

23. OUCOM MS-I Curriculum Human Biology – The theory, principles, facts about how the human body works under idealized circumstances – The Basic Medical Sciences MEDICAL KNOWLEDGE

24. OUCOM MS-I Curriculum Human Psychology – The theory, principles, facts about how the idealized human being senses, makes sense, and acts in the world MEDICAL KNOWLEDGE

25. Methods of Medical Practice – The skill in interviewing patients to obtain the narrative of their illness experience and perform an examination of their bodies to determine variations in structure and function in order to diagnose problems PATIENT CARE COMMUNICATION & INTERPERSONAL SKILLS PROFESSIONALISM OUCOM MS-I Curriculum

26. Methods of Medical Practice – The skill in interviewing patients to obtain the narrative of their illness experience and perform an examination of their bodies to determine variations in structure and function in order to diagnose problems PATIENT CARE COMMUNICATION & INTERPERSONAL SKILLS PROFESSIONALISM OUCOM MS-I Curriculum School of Community Medicine Track 2 modules of 10 students from the SI have an OU-Tulsa Faculty Facilitator (Matt Sideman or Erik Wallace) Option – May perform clinical practicum in Tulsa clinical settings

27. OUCOM MS-I Curriculum “Thinking like a doctor” – The cognitive skill of making a diagnosis and prognosis for a specific patient, based on the clinical data and the theories of human biology and pathology that define them SOCM Track Faculty will participate MEDICAL KNOWLEDGE PATIENT CARE

28. The scientific tools Medicine uses to disprove “pet” theories of medical practice and causes and mechanisms of disease and its treatment Overlap with Public Health: Epidemiology, Biostatistics PRACTICE-BASED LEARNING & IMPROVEMENT OUCOM MS-I Curriculum

29. OUCOM MS-I Curriculum Finding meaning from life, suffering, and the human experience of vulnerability in one’s personhood Overlap with the Presencing of the Summer Institute PROFESSIONALISM

30. Summer Institute II • Summer between MS-I and MS-II • Service-Learning with a stipend • Community service agencies • Community Medicine research • Public Health coursework • Tulsa safety-net experience • Plan Summer Institute-I for 2009

31. Public Health Coursework • May enroll for any courses in any semester • Wait until 2nd semester MS-1 • Use summer semester • Elective time in MS-4 • PH and MS curriculum is NOT integrated now

32. OUCOM MS-2 Curriculum

33. OUCOM MS-2 Curriculum Learn the biological causes of disease and the body’s healing response to injury MEDICAL KNOWLEDGE

34. OUCOM MS-2 Curriculum Learn the criteria, appearance, theory, and natural history of human disease – pathology and pathophysiology MEDICAL KNOWLEDGE

35. OUCOM MS-2 Curriculum Learn the criteria, appearance, theory, and natural history of mental illness – psychology and psychiatry MEDICAL KNOWLEDGE

36. OUCOM MS-2 Curriculum Learn the theory, facts, and principles for using pharmaceuticals to treat human disease MEDICAL KNOWLEDGE

37. OUCOM MS-2 Curriculum “Thinking like a doctor” – The cognitive skill of making a diagnosis, prognosis, and developing a plan of treatment for a specific patient, based on the clinical data and theories of human biology and pathology SOCM Track Faculty will participate MEDICAL KNOWLEDGE PATIENT CARE

38. Methods of Medical Practice – The skill in interviewing patients in order to make a diagnosis, communicate prognosis, and motivate patients to pursue treatment or modify their behavior to improve health. COMMUNICATION & INTERPERSONAL SKILLS PATIENT CARE PROFESSIONALISM OUCOM MS-2 Curriculum School of Community Medicine Track 4 modules of 10 students in the SOCM Track with OU-Tulsa Faculty Facilitators Option – May perform clinical practicum in Tulsa clinical settings

39. OUCOM MS-2 Curriculum The systems of health care and its financing; the approach to making moral decisions in medicine and the ethics of medical practice SOCM Track Faculty participate Overlap with Public Health SYSTEMS-BASED PRACTICE PROFESSIONALISM

40. OU-SOCM Track MS-3 & MS-4 Curriculum

41. OU-SOCM Track MS-3 2010 Curriculum Clinical Clerkships - Reporter-Integrator-Early Manager Longitudinal Clinic in a Medical Home Clinical Medicine Applied to Community Health Acute Care Service-Learning (Bedlam)

42. OU-SOCM Track MS-4 2010 Curriculum Electives – Reporter-Integrator-Manager-Educator Longitudinal Clinic Senior – Integrating Specialty Care Service Learning in Community Medicine & Research Acute Care Service Learning (Bedlam)

43. Our Faculty • We are beginners and experts from all of the helping professions building a community of healers and scholars. • We are co-creators of a future Oklahoma where the highest health is pro-actively provided for all • We are patients, citizens, elected officials, architects. nurses, administrators, managers, physicians, physicians assistants, pharmacists, social workers, technicians, medical assistants and many others

44. Our Culture • Supports mutual support, collaboration, and passionately seeking solutions to problems that threaten the the health of our communities • Our passion drives our scholarship, teaching, professional practice, and advocacy for health • Our curriculum, our research agenda, and our work plan for service will continually emerge from conversations within our community. • We will measure our value of our work by the impact it has on the health status of our community • We will use the results of these measures to drive and guide our effort.

45. Community Stakeholder Dialogue Interviews Build a Morally relevant community together World Café – Share what learn for the source of need Co-Create prototypes that bring the future to light Develop a shared meaning that moves us to action

46. A Learning Community committed to demonstrate how Community Medicine improves the health of all Tulsans and all Oklahomans