Universitat Internacional de Catalunya - BarcelonaAppropriate Decision Making in Medicine
Main language of instruction: Catalan
Head instructor
Dr. Xavier CORBELLA - xcorbella@uic.es
Office hours
Dr. Xavier Corbella xcorbella@uic.es
This is a compulsory subject that the UIC incorporated in a pioneering way in its curricula of the Degree of Medicine from the beginning. It was designed by Dr. Albert Jovell (e.p.d.), and since 2013 we continue his legacy the current team of teachers. Appropriate Decision-Making in Medicine was awarded the year 2015 in the XIV edition of the Diario Médico awards as one of the best ideas of the Spanish National Health System.
Its main objective is to bring to the 4th year medical students the knowledge of the reality of health systems where they will have to work once graduated, and to offer them a space for structured debate and critical thinking about the decision making that they should make in their medical practice. The subject wants to help future doctors to face the different technological, economic and social conditions that will determine the environments that will be found throughout their professional life, learning how to open their minds, learning how to have a critical vision of health systems, and learning how to understand the professional and human role of doctors and their patients.
For all these reasons, we recommend to attend the classes with interest and willingness to participate, knowing in advance that although the subject is compulsory, the attendance at the lectures and the case methods is voluntary, and no list of attendance in class will be checked.
Making appropriate decisions relating health care is a necessary and essential competence of physicians.
There are many aspects to consider in a decision-making process in medicine (medical decision -making), including those that are determined by our environment, either 1) at the "Macro-management" (Health Policy, health care model and system planning, funding), 2) "Meso-management" (type of institution in which we serve, our place in the organization, type of activity we do), or 3) at the "Micro-management" (role of doctor/physician, level of evidence, available resources, the role of the patient and their wills).
The knowledge of the constraints that determine our decisions in medicine at these three levels (macro, meso and micro) will help us making appropriate decisions, since we should not forget that all of them are part of our medical practice. The "macro" and "meso-management" determine our thinking and our clinical decision-making depending on we work in a public or private health care system, a hospital or primary care setting, the operating room or the emergency department, or the availability of resources assigned or others. At the “micro” level, physicians take medical decisions depending on their level of knowledge of the scientific evidence, their personal experience, the clinical practice guidelines, the degree of recognition of their limitations or the established relationship with the patients and their opinions.
Decision making in medicine is not always done in ideal conditions of access to a complete and certain, knowing fully the predictable effects of our decisions and with enough time available to calibrate the consequences of it. In fact, most of the processes of decision-making in medicine usually are performed under conditions of uncertainty, incomplete information, complex situations, with uncertain consequences and lack of time and resources.
The subject "Appropriate Decision-Making in Medicine" is the scope of the degree in Medicine which teach “how to decide" by knowing the set of agents, variables and indicators that act when we make decisions during medical practice. The knowledge of the health care sector, the value of the so-called evidence-based medicine and the patient opinion will be part of the matter. Beyond uncertainty, variability and limited resources, a proper decision-making will allow us to provide the maximum value possible to our patients, and every euro spent on health care.
1.- Be familiar with our health care system.
2.- Basic knowledge of clinical practice.
3.- Basic knowledge of Catalan, Spanish and English.
1.- To understand the determinants of decision-making in medicine from the perspective of the three levels of healthcare management organization ("macro”, "meso“ and "micro-management”).
2.- To understand the basis of health economics and the management and organization of the healthcare system to respond to the health needs of the population.
3.- To know how the different health actors (stakeholders) think and decide (politicians, health planners, funders, providers, professionals, patients) and how to understand their different point of views.
4.- To encourage critical thinking among medical students, facing scenarios in which uncertain and difficult decision-making are needed, either organizing complex health care processes or sharing decisions with patients during clinical practice.
5.- To understand the dilemmas of efficiency, effectiveness, efficiency, equity and access to health care system.
6.- To understand the ethical point of view of the medical decision-making in terms of social justice and benefit to the patient, either individual or collective.
1. – Have developed critical thinking about the agents that influence appropriate decision-making in medicine.
2. - Having understood the usefulness of the different tools, methods and indicators that help proper decisions at different levels of performance.
3. - Have learned to apply logical reasoning in solving complex cases.
7 Master Classes (2 h x 7 = 14 hours) and 5 Case Methods (2h x case = 10 hours, for 2 groups)
1. - Decision-Making in Medicine
Introduction to thought, reflection, reasoning and critical thinking in medicine, the value of theoretical knowledge, the value of the experience, the concept of sources of evidence and clinical knowledge, moral and ethical approach, meet and communicate with the patient, recognition of our limitations, the guidance and support of other experts, the support of the organization.
2. - Decisions on Macro - Management (I-II): Health Policy, Health Systems and Models.
Introduction to Health Policy, difference between health model and health system, functions of a public health system, introducing its history and goals, health care in the current, dysfunctional health systems, national health system and health system in Catalonia, accountability to citizens and control systems.
3. - Decisions on Macro - Management (III): Bases of Health Economics
Introduction to health economics and health care studies, broad concept of health technology assessment and evaluation of health policies and systems, introduction to the ideas of prioritization, allocation, market, supply and demand care.
4. - Decisions on Macro - Management (IV): Social Justice, Bioethics and Resource Allocation
To describe the main theories of social justice, libertarian, egalitarian, utilitarian, and the impact on the organization of health care systems and the distribution of health care resources.
5.- Decisions on Macro-management (V): Health plan
Concept of organisation for delivery settings: primary care, inpatient care, long-term care and mental health. Concept of integrated care organisation. Concept of process: ambulatory, surgical, hospitalization, and emergency. Efficacy, effectiveness, efficiency and quality of care. The Health Plan as a tool of strategic planning.
6.- Decisions on Macro-management (VI): Financing and Purchasing Health Services
Systems of Financing and payment of health services: by fix budget, fee for service, capitation fee, and pay per performance.
7.- Decisions on Meso-management (I): Governance and Leadership in Health Institutions
Description of the types of healthcare providers, councils of government, health institution as a company, stakeholders, functions of the organ of corporate government, corporate social responsibility, and best practices. Concept of Leadership: styles, dimensions, cathegories.
8.- Decisions on Meso-management (II): Strategic Planning
To analyse and diagnostic of the status quo (SWOT). To define strategic lines and objectives, to design the Action Plan, to define Outcome Indicators and how to follow-up and appraisal.
9.- Decisions on Meso-management (III): Clinical Management and Participation of Professionals in Healthcare Management
Concept of clinical management, direction by objectives, orientation to results, implication of the professionals on management, autonomy of management and policy of incentives, management agreements.
10.- Decisions on Meso-management (IV): Quality Plan and Outcomes Evaluation
Models of management based on Quality of Care. Plan of Quality and systems of quality evaluation. Balanced score card: Indicadors of activity, quality and cost. Concept of benchmarking.
11. - Decisions on Micro - Management (I): Professionalism
Description of the physician as a clinician, teacher, researcher and manager, present values of professionalism, involvement in the process of clinical decision-making, concept clinical leadership, clinical decision analysis models as a strategy to provide information for clinical judgment, critical reasoning and decision-making in complex processes and under conditions of uncertainty.
12. - Decisions on Micro - Management (II): Clinical reasoning and judgement. Clinical Practice Guidelines
Evidence-based Medicine, sources of evidence, the elements of an economic analysis and valuation techniques applied in the health sciences, particularly cost-effectiveness, concept and description of the methodology of drafting guidelines clinical practice, application and evaluation of specific clinical conditions .
13. - Decisions on Micro - Management (III) : Aging and Chronicity
The impact of aging on healthcare system, changes description of epidemiological pattern of acute and chronic illness, strategies to address and manage the challenge of chronicity.
14. - Decisions on Micro - Management (IV): Patient Safety
Concept of patient safety indicators, measures of adverse effects and complications of health care, strategies to prevent medical errors
Case Methods (2 hours per case, 2 groups)
1.- Case Method 1. Applying Population Based Screening Programs, yes or not?
The example of early detection programs for breast, prostate and lung cancer.
2.- Case Method 2. (Class in English). Quality of Care: Addressing adverse events and Medical Errors.
Analysis of consequences, causes, and solutions to address adverse events and medical errors in clinical practice.
3.- Case Method 3. (Class in English). Moving from fragmented to integrated health and social care.
The example of managing transitions of care in chronic patients by bridging the gap between healthcare providers at different levels, and the gap between inpatient and outpatient worlds.
4.- Case Method 4. (Class in English). A contingency plan for the 2019 novel coronavirus outbreak
Planning for community spread of COVID-19 is critical for maintaining healthcare servicies during the ongoing COVID-19 pandemic. Your hospital should be prepared for the possible massive arrival of patients with COVID-19.
5.- Case Method 5. Patient Rights and Shared Decision-Making.
To guarantee the rights of patients and to share decisions with healthcare providers.
https://ec.europa.eu/health/sites/health/files/state/docs/2018_healthatglance_rep_en.pdf
https://salutweb.gencat.cat/web/.content/_departament/pla-de-salut/Pla-de-salut-2016-2020/documents/Pla_salut_Catalunya_2016_2020.pdf