Teaching the principles of medicine, addressing the whole person
6 MINUTE READ
Conceived as an initiative in postgraduate teaching in the UK in the 1990s, PRIME stands for Partnership in Medical Education. Its vision is to see that all people have access to healthcare for the whole person – the body, mind and spirit.
As stated on their website – PRIME’s goals are:
- “to transform patients’ experience and outcome by promoting excellent whole-person care based on the values shown by Jesus.
- to resource all involved in healthcare to pursue and encourage such practice, to find personal and professional satisfaction, and to maintain resilience.
- to enable others to promote this ethos and approach by example and teaching.
- where opportunity arises and resources allow, to extend our influence to other agencies engaged with health and healing, including the church.”
Put simply, this now-blossoming international network seeks not to teach the curriculum of medical schools, nor indeed postgraduate training programs, but rather to teach the principles of medicine addressing the whole person.
This may be addressed to people of all faiths and of none. It is based, however, on the principles of our Lord Himself, on who we model our teaching. In this way, opportunities for witnessing may be cultivated.
The following article by Dr Gill Horne, one of our UK partners, describes one particular PRIME teaching session. It is reprinted with her permission.
“The Beauty of Palliative Care”
– Dr Gill Horne (RN in the UK, specialising in palliative care)
Late in 2020, with the COVID-19 pandemic surging and PRIME considering other ways to support colleagues in low and middle income countries, Dr Martin Leiper (Scotland), Dr Richard Wong (Australia) and Gill Horne, RN (England), offered to write a basic palliative care programme that could be delivered on-line. It was hoped that it could potentially become a resource for any PRIME tutors to adapt for their use.
We based the content on a prior basic palliative care course some of us had developed and delivered in January 2020 to medical students in Cambodia, and also resources such as the Pallium India guidelines and iPal Global. We each took modules to develop from our areas of expertise and ended up with seven core modules, which included:
- Introduction to palliative care,
- Truth telling,
- Communication – breaking bad news,
- The safe use of morphine,
- Symptom assessment,
- Identifying dying, and
- Loss, grief and bereavement.
Martin developed a helpful template for us to use in planning each module, which provided tips for facilitating an interactive learning experience. We used the PRIME education principles and scripture as the basis for each session.
We are thankful to both Dr Ron Rhodes and Assoc Prof David Butler who reviewed the course outline and content for us. Following this we made a few adjustments, and it was suggested we then ‘road test’ it.
Through Richard and his colleague, Dr Michael Burke (PRIME Australia), we connected with Dr Ronald Jonathon (now PRIME Indonesia).
Ronald, a GP, works collaboratively with Maranatha Christian University. The Dean of that University kindly agreed that they would host the online platform, disseminate information and coordinate interested participants across Indonesia.
Ronald agreed to chair each session. A total of 39 participants enrolled, which included doctors, nurses, and a social worker from adult and paediatric care – hospital and community settings. Some of the university medical tutors also took part.
We agreed over our three different time zones to hold the sessions every Saturday morning at 0800 GMT (1500 in Indonesian, 1900 in Australia) for seven weeks, with a one-week break for Easter. It was truly good morning, good afternoon, good evening! Each session was scheduled to last two hours, but we were asked to extend to two-and-a-half hours to allow for more discussion. WhatsApp was a great tool for all partners to collaborate the logistics of each session and to keep in contact during the course.
“WhatsApp was a great tool for all partners to collaborate the logistics of each session and to keep in contact during the course.”
Although we had three core tutors at the start, Dr Michael Burke (Australia) and Dr Janet Gillett (England) joined us from week two when it became clear we needed smaller breakout rooms. This helped tremendously and set us up for some great breakout room discussions over the coming weeks and some excellent additional teaching.
Our Indonesian colleagues felt translation was not needed for the core teaching sessions, but where people struggled in break-out rooms, colleagues assisted in translation. The case study with accompanying questions was translated ahead of each session.
We invited Ronald to review the content of the planned sessions. He kindly adapted the case study we planned to use throughout all seven sessions to make it relevant to Indonesian culture. And so Mr Smith became Mr Joko!
We sought to find out what was clinically available in Indonesia in terms of medications and other culturally relevant information – learning together as we progressed throughout the programme. The title, “Beauty of Palliative Care,” was their choice and we were thrilled at this concept.
Each week’s session started with prayer amongst the presenting team and then, when participants arrived, with a Bible reading and prayer. Participants joined us from their homes, their work, or their cars, on whatever devices they had available. Broadband speed was important for participants with band-intensive video presentations, and worth considering for future planning so that participants are able to prepare accordingly.
“We evaluated each session and built on any learning for the following week. At the end of the programme, we invited participants to share one key take-away.”
We evaluated each session and built on any learning for the following week. At the end of the programme, we invited participants to share one key take-away. Some of our Indonesian colleagues had never had any teaching on palliative care, and those who did, had not had teaching on identifying dying or loss, grief, and bereavement.
What worked well for the team was having a lead tutor for each session (although we shared the teaching on different aspects of the session), quizzes, having small breakout rooms for discussions (within which some of the facilitators used impromptu role play), the online platform being hosted within the country we were training, alongside a consistent chair who coordinated all organisations in preparation for each week’s session.
The next step for our Indonesian partners is that they are hoping to make use of some of the training materials for their own teaching. We are also currently looking at potential opportunities to use this course in other countries. And of course, now we have an online training programme available, complete with PowerPoint slides and lesson plans, for any PRIME tutor colleagues who want to use this resource.
We all felt so honoured to have been able to develop this programme, learn from each other, and connect with wonderful colleagues across the world in different organisations. Praise God!
To finish, here are some examples of participant feedback on their learning:
“The application of genuine compassionate care and treatments toward this less fortune-filled population. All of you really reflecting Jesus’ heart, patience, and gentle approach in the real field (from sharing your experience in under-developed country people).”
“Although at first we were shy, later on we were so comfortable to share ideas. What I have learnt today is to always prioritise the most disturbing symptoms. Symptom control could be pharmacological but also non-pharmacological, thus it’s very important to search out the cause of symptoms first – how intense, how frequent. Listen and never assume. Then, follow up to assess the patient in a holistic way by trying to see the problem with the 4 pillars of palliative care in hand.”
“See from the patient’s perspective what would be the critical causes of the patient’s distress. Having the concern of the carer was also important. Sometimes, what makes the patient come to the clinic may not always be about the symptoms, but rather due to how he and his significant other sees and are affected by the disease from their own point of view.”
“Today, I’ve learnt about how to deliver the truth about the patient’s condition – what we have to do and not to dol steps and advice that I can use to build good communication with the patient and family.”
“Helps me to understand better how not to prolong suffering in order to prolong life; and how to make a comprehensive explanation from a big framework of the patient’s conditions to the family, so they can make a proper decision related to the patient’s condition and future treatments.”
Dr Richard Wong Dr Richard Wong MB BS BSc(Med) FRACGP DCH DRANZCOG Senior Lecturer ( JCU) CTh DBS, is a VR GP/hospitalist in Australia who is experienced in both urban and rural settings as well as progressively serving more on overseas medical mission trips. He is a long-term member of CMDFA and was its NSW secretary for a number of years before switching to continue in a similar role in Queensland. He is a trainer for the Saline Process as well as a PRIME qualified tutor and on the board for Healthserve Australia. He is interested in utilising whatever skills God has given him to enjoy and serve Him. You can contact Richard at email@example.com.