Table 3 OCIP experience and learning outcomes mapped onto ACGME framework
Domain | Themes | Illustrative quotes | No. of relevant responses |
|---|---|---|---|
Patient care (PC) | Humanism | “She did something that perhaps none on the trip did which is to spend time to listen a patient extensively…I was more focused on getting a good spirometer result that helping the patient get better. Hopefully, I will remember this lesson for time to come, to open my mind and listen to patients.” “The patients should always be placed on the highest priority and doctors should not lose sight of the human side of medicine.” | 10 |
Socioeconomic determinants of health | “At night, K shared about an elderly couple with social issues that greatly outweighed their medical ones, leading me to rethink how we treat patients. The medical issues they face are probably often only a small area of what affects them, and in saying so, it is up to us to build a rapport with the patient and be able to discern what the patient is facing and needs.” “Often a times, social factors such as financial difficulties, inconvenience and language etc are the ones which limit the treatment of patients…Hence, social factors have to be considered very carefully in large scale policy planning and also in smaller scale dealing with patients and getting to understand them better so as to propose the best possible treatment plan.” | 13 | |
Cultural determinants of health | “Since menstruation and menstrual health practices are closely linked to the culture and beliefs of the society, it is not right to condemn their practices or beliefs outrightly even if it doesn’t align with what we are used to.” “I learnt that culture and personal beliefs are sensitive things that should be treated carefully as most of these people have had these beliefs majority of their life. If we were to try to educate them on some aspects of their practices that we think can be improved, we would have to be sensitive and polite about it.” | 11 | |
Medical knowledge (MK) | Application of medical knowledge | “While examining patients, we used our medical knowledge to correlate the clinical presentation with the disease.” “Today also provided me with exposure to some clinical cases and helped me sharpen my clinical acumen.” | 9 |
Practice-based learning and Improvement (PBLI) | Investigating and evaluating the needs of the population | “Firstly, I think the lesson on rationalising what we do is important. When thinking of strategies to help our patients in the future, whatever we advise must make sense. Like the health post in Bung, a lot of good can be rendered useless if we don’t rationalise what we do…” “Our surveys being conducted on healthcare accessibility and awareness feel more relevant and of greater importance as it will help us to understand the situation better and allow us to design programmes that will benefit the communities the most” | 10 |
Feedback to drive improvement | “…I realised that it is very important to receive feedback to gauge the effectiveness of what you are doing. Only after the first aid teaching, during the practical demonstration did I realise that many [local] students had poor grasps of English, yet during the first aid teaching, the translators overestimated the English-speaking ability of the students, leading to translation of only mainly the technical or complicated parts.” “I felt inspired that the hospital management team in Birat Eye Hospital were so receptive to feedback to improve the lives of the patients. Likewise, I’ll adopt a spirit of self-improvement” | 8 | |
Interpersonal and Communication Skills (ICS) | Use of non-verbal cues | “Working through translators, good communication skills become even more essential. I managed to apply the skills that the school taught us when working through translators, such as how we should still try to directly engage with the patient through things such as body language, hand gestures or facial expressions. I learnt a lot about how to make patients feel engaged and connected to you even though I was speaking through a translator.” “….I am the first contact with the patient and a lack of professionalism on my part will diminish their trust in our health screening. This included things like being nonjudgmental when villagers reported histories like they started smoking 4–5 cigarettes from 12…” | 8 |
Communicating across language barriers | “I also learnt the value of learning another’s language in building trust - the action of putting in effort to learn simple phrases creates a comfortable and warm atmosphere in a foreign place.” “One of my goals over the next 1–2 years is to bring it up to a level whereby I can conduct a medical consultation in their native language. This is especially important as many senior citizens in Singapore are not able to converse in English; if concepts are boiled down to first principles, they can be communicated even through cultural and language barriers.” | 9 | |
Systems-based Practice (SBP) | Healthcare systems | “I learnt how a hospital could be run efficiently and effectively, despite less resources (compared to Hospitals in Singapore for example)” “This experience in understanding the bigger picture of the healthcare system will help me along the way as it I will begin to consider these factors in the management of patients in the future.” | 11 |
Healthcare delivery | “I learnt about the healthcare delivery chain, which starts from transport to the hospital all the way to acute care in the hospital and finally rehabilitative care in the community setting. If there is a break at any point of the chain, it compromises the effectiveness of the healthcare system.” | 10 | |
Resourcefulness & adaptability | “Improvising & using the bottom of the mineral water bottle for collecting the urine for urinalysis” “We learnt to be practical in resource management, using the structures and resources available to conduct screening camps.” | 9 | |
Health equity | “Patients should be treated equally, without bias, no matter their racial, financial, ethnic background, among others. Healthcare is not reserved for any specific class of citizens.” “I will remember that not everyone is as privileged as Singaporeans are to have such an accessible healthcare system and easily accessible basic health knowledge (+ education in schools). I will also try to explore the fields of public health and health education to learn more about what can be done in less developed countries.” | 10 | |
Health accessibility | “I learnt that healthcare accessibility is a major problem in countries such as Nepal. The most obvious visible reason was income inequality. Most of the villagers lived in simple houses made of hay and worked in the agricultural sector. Hence, they do not have the financial means to afford a cataract surgery or pay for travel to the Hospitals. “The health post in Bung is not frequented and used maximally since it is located high up the mountains and it is inconvenient for the people, especially the sick, to travel there.” | 11 | |
Professionalism (P) | Ethics | “In discussions, the team discussed how maintaining proper surgical conditions were important. Although we were providing the services free of charge and providing it in a different country, we should still try to replicate the same standards that we uphold in Singapore. “I learnt about the importance of having a good local partner to ensure success of the project when doing community work in a foreign place as without a good local partner, our project would not be sustainable as no work will be done when we are away from the country.” | 8 |
Role modelling | “I believe that the Dr A and Dr B have set a very good example in showing that healthcare is about the heart, and that we should always reach out to those in need of greater help.” “It was very heartwarming as Dr A decided then and there to help provide free eye screening and treatment to all the students from the school. “ | 7 | |
Teamwork & Leadership skills | “When working with a team on a project, I will Ensure that everyone is on the same page first before anything else. Failure to do so will increase the chances that the work we do will be less effective and will also increase the chances of miscommunications and misunderstandings. “Setting the direction for the project and discussing with team members to ensure that everyone’s goals are aligned” | 7 | |
Interprofessional skills | “I think it is great that we have a sonographer onboard as she lets us investigate complaints which we would otherwise be unable to investigate beyond a superficial examination” “Saw teamwork between doctor and healthcare workers in Sotang to give best care to patients” | 8 | |
Resilience | “.chatting with Dr K where he shared about the emotional resilience needed as doctors. Listening to each patient with an open heart and mind is not something easy and is emotionally exhausting. While I am not sure how we can build on this emotional depth, one important takeaway from that is to find our source of emotional avenue where we can express our emotions and recovering. It was also a good reminder to not shunt our emotions as an unhealthy defense mechanism.” “Seeing how the people cope despite the limitations of the healthcare system and infrastructure has given me a better insight into what it means to be resilient and to cope with difficult situations” | 7 |