ECPD

• Medical professionalism


  A set of values, behaviors, skills and knowledge that define how a doctor should behave, deal with patients, colleagues and the community according to agreed professional standards
• Medical professionalism is very important for both medical students and doctors
• Medical professionalism is an essential part of the character of the doctor besides knowledge and practical skill
• What medical professionalism includes

  • Values
  • Behaviors
  • Skills
  • Knowledge
• Medical professionalism


  • Showing respect to patients and colleagues
  • Treating others with honesty and integrity
  • Never discriminating unfairly
  • Keeping knowledge and skills up to date
  • Being polite and compassionate
  • Being a good communicator
  • Keeping patient confidentiality
  • Maintaining patient privacy
  • Teamwork
• Knowing the standards of professional behavior is the first step in gaining good professionalism
• It's important to believe in and practice professional behaviors every day with every patient, in every condition and in every part of a health institute
• Moral/ethical aspect of medical professionalism


  Behaving according to ethical rules
• Emotional aspect of medical professionalism

  Being empathic, compassionate and patient with patients
• Relational aspect of medical professionalism


  Building professional relationships with patients, their families, colleagues, other healthcare workers, and the community
• Medical professionalism is evolving with new diseases, pandemics, and technological advancements which require new professional attitudes
• Cultural aspect of medical professionalism


  Being aware of and behaving according to the specific cultural features of the community
• Sources to learn professionalism

  • Professors and senior doctors (role models)
  • Lectures and learning activities
  • Life experiences
  • Reflection on actions
• Non-professional behavior by medical students

  • Laughing at a patient's rare skin condition
  • Posting a picture revealing a patient's identity on social media
  • Talking disrespectfully to an angry, frustrated patient
• Patient safety


  The avoidance of unintended or unexpected harm to patients during the provision of health care
• Patients should be treated in a safe environment and protected from avoidable harm
• Keeping patients safe during their journey is the core principle of medical professionalism, and it is one of the patient's rights
• Size of the problem

  • Around 1 in every 10 patients is harmed in health care and more than 3 million deaths occur annually due to unsafe care (WHO 2023)
  • About 50% of harm is preventable
  • The harm has a spectrum of severity or degree, ranging from mild to severe reaching the degree of death
• Types of adverse events or harms

  • Patient's misidentification
  • Medication errors
  • Unsafe surgical procedures
  • Hospital acquired infection
  • Patient Falls
  • Bed sores
• Patient's misidentification


  Failure to correctly identify the patient
• Steps to minimize patient's misidentification

  1. Use at least two identifiers like patient's triple name and date of birth

  2. Do not use patient's room number or patient's doctor or patient's diagnosis as an identifier

  3. Use of wrist band

  4. Check the patient's identity before any diagnostic or therapeutic procedure
• Medication Errors


  The most common type of harm that occurs in healthcare setting, with an incidence of 1 in every 30 patients, and can result in mild harm to the death of the patient
• Types of medication errors

  • Wrong patient (giving the correct drug to the wrong patient)
  • Wrong drug
  • Wrong dose
  • Wrong route of administration
• Steps to minimize medication errors

  1. Check the patient identity and patient allergic status before any medication

  2. Check the right drug with the prescription order, this should be done by two health care providers

  3. Calculate the right dose of the drug (work as a team with the pharmacist) and check the route of administration

  4. Document any drug administration
• Harm during surgical procedures

  • Surgical procedure passes into different stages from preoperative to operative stage then into immediate postoperative (recovery stage) then to the final post operative stage, so different places and different health care personnel share the care the patient and this increase the possibility of errors
  • Surgical procedures can be done in emergency situation and this makes harm and errors are more likely to occur
• Types of surgical harm

  • Wrong patient surgery (surgical operation done on the wrong patient due to error of identification)
  • Wrong side surgery (operation of the other normal side like removal of normal eye or operate of on the normal limb or normal kidney)
  • Retained surgical instruments
  • Surgical site infection
• Steps to minimize surgical harm

  1. Increase knowledge and awareness about safe surgical practice

  2. Adopt effective checklist and implement it during surgical procedures

  3. Adopting preoperative marking of the operative site

  4. Improve communication by improving the hand over (transfer of complete and clear information of the patient during transferred from one place to another or from one person to another)

  5. Accurate counting technique before and after any surgical procedure to detect any retained instrument or material
• Healthcare associated infections (HAI)


  Infections that occur more than 48 to 72 hours after admission and within 10 days after hospital discharge
• Healthcare associated infections


  • Global rate of 0.14% (increasing by 0.06% each year)
  • Can cause significant morbidity and mortality
  • Difficult to estimate or report as time of hospital stay may be shorter than incubation period, and infection may develop after patient discharge
• Susceptible patients for HAI

  • Immunocompromised patients (extreme age, underlying chronic diseases, immunosuppressive medications)
  • Patients who underwent invasive procedures or have implanted devices
• Sources of microorganisms for HAI

  • Individual patient
  • Medical equipment or devices
  • Hospital environment
  • Healthcare personnel
• Means of transmission for HAI

  • Contact transmission
  • Respiratory droplets
  • Common vehicle (contaminated food, water, medications, solutions, devices, or equipment)
• Steps to prevent HAI

  1. Proper use of personal protective equipment

  2. Use of aseptic technique

  3. Hand hygiene

  4. Environmental infection control measures

  5. Strict sterilization techniques
• Patient fall


  Common safety event, incidence of 250,000 cases recorded annually in UK
• Impact of patient falls

  • Serious injury including fracture
  • Fear from further fall (psychological trauma)
  • Prolonged hospital stay
  • Death
• Risk factors for patient falls

  • Age over 65 years
  • History of recent fall
  • Gait instability
  • Agitation and/or confusion
  • Urinary incontinence or frequency
  • Adverse drug reactions
  • Neuro-cardiovascular instability
• Measures to prevent patient falls

  1. Risk assessment for all admitted patients

  2. Medication review

  3. Orthostatic blood pressure checking

  4. Provision of mobility aids

  5. Using bed rails

  6. Fall identification wrist band
• Bed sore


  Pressure ulcers that develop when capillaries supplying the skin and subcutaneous tissues are compressed enough to impede perfusion, leading to tissue necrosis
• Risk factors for bed sores

  • Age 70 years and older
  • Current smoking history
  • Low body mass index
  • Impaired mobility
  • Malnutrition
  • Malignancy
  • History of pressure ulcers
• Effects of bed sores

  • Prolonged hospital stay
  • Infection that might lead to sepsis
  • Death