HSC 4608L: Critical Thinking in Health Care



HSC 4608L: Critical Thinking in Health Care

Fall 2008

Please use separate sheets of paper and number your answers.

Answer both of the following two questions. Each is worth 10 points.

1) Recent data suggests that, after menopause, women’s risk of developing heart disease rises to become equal to that of men. Drawing on this data, a researcher concludes that hormonal fluctuations occurring during the menstrual cycle help protect women from developing heart disease. Critically evaluate this conclusion.

2) Discuss the advantages and potential disadvantages of an interdisciplinary health care team model compared to a single practitioner model in delivering complex health care.

Answer two of the following four questions. Each is worth 10 points.

3) Proponents of seat belt legislation assert that, “Seat belts save lives.” Discuss some issues and problems in firmly knowing just how many lives are saved.

4) Cite two pieces of evidence (data, symptoms, history, etc.) that most clearly influenced your diagnostic decision on Rose Farrow.

5) In Patient Problem II, Mike Smith generally tended to minimize the severity of his injury and insisted that he would be walking again soon. Discuss one way this belief might be an asset to him in his rehabilitation and one way this belief might be a liability.

6) One finding from the insurance appeal problem (Benjamin Dover) was that good data on efficacy or effectiveness of health professions interventions are hard to come by. Why is this the case? What are your reactions to this? What should be done to solve this problem?

Answer one of the following two questions. Each is worth 10 points.

7) In your opinion, should health care practitioners advocate for health related issues such as promoting healthy lifestyles or supporting legislation that that will have a positive impact on health? Why or why not? Do you intent to advocate when you become a professional? If so, what will be your cause?

8) Drawing on your work from Professional Problem I, briefly describe the responsibilities that health care professionals have in enhancing patient compliance with healthcare prescriptions.

Extra Credit (Worth 5 points)

Discuss how your experiences in HSC 4608L correspond to the distinction between education for “competence” and education for “capability” described in Fraser & Greenhalgh (2001).

Happy Holidays!

ANSWER KEY

1) Answer should reflect an experimental or quasi-experimental evaluation that points out that there are other factors (e.g., increasing age, increasing age-related illnesses, genetics, etc.) that can explain the result. Concluding that menstrual fluctuations in hormones actually “protect” women from heart attacks cannot be logically concluded on the basis of the evidence. Students may make reference to “logical fallacies”, which is ok, but the real problem is that causation cannot be inferred. The absolutely perfect answer would suggest that specific studies linking heart disease and hormonal levels would be needed. Give full credit if the analysis contains the major points above.

2) Advantages: multiple points of view, multiple sets of competencies/capacities brought to bear on a problem, emphasis not only on medical but on full biopsychosocial aspects of health and illness; focus on rehabilitation is more likely if full team is involved. Disadvantages: communication problems possible, costs likely more, unclear/uneven distribution of power and decision making (this can be a problem if team doesn’t ‘get along’ or lines of decision-making authority are not clearly drawn)

3) The major problem is that controlled experiments are not possible in this area. The presumption of lives saved is just that; a presumption, based on inference due to accident physics, etc., but it is not systematic and there is no clear way to determine whether someone would have actually died if they didn’t wear their seatbelt. So, both design and measurement issues are involved. Also, other factors correlated with seatbelt use (e.g., speed, substance abuse, risk-taking, etc.) play roles that are difficult, if not impossible, to measure. The perfect answer describes both design and measurement issues.

4) Any two reasonable pieces of evidence from the Rose Farrow casebook are permissible for the answer to this question, as long as the evidence cited should reasonably lead to the conclusion the student renders.

5) Asset: motivation for treatment (thinks he will walk); Liability: may signal lack of insight or deficit unawareness, which bodes poorly for rehabilitation outcome; may make it difficult for him to clearly assess his strengths and weaknesses and for him to select target behaviors/skills to work on.

6) Good data is difficult to come by because (a) the practitioners doing the practice aren’t often the people doing the research, (b) good, clean, clinical trials are difficult to perform and are not typically funded by granting agencies, (c) ethical issues in “no treatment” or “control treatment” conditions may discourage researchers from constructing theoretically meaningful control groups; (d) measurement of outcomes is in its infancy (issues of internal v. external validity). Give 4 points for this part. Give 3 points for the student’s reaction (should be ‘deeper’ than, “That’s too bad”). What should be done about it? If you look at (a-d) above, each can be remedied in some way. (a) train practitioners to be science-practitioners so that they can do program evaluation or research in their practice; (b) support funding of clinical trials; teach people clinical trials methodology; (c) offer treatment after participation in a control group; (d) develop appropriate measures. Give up to 3 points for this part.

7) A range of answers are possible here – this is an ‘opinion’ question. Some students will say that they shouldn’t/wouldn’t advocate because they are trained to be professionals, not lobbyists. As long as they justify this adequately, it’s ok, but you should comment that the best lobbyists are the folks “in the trench”. Others will say that they should lobby because if they don’t, no one else will, which is ok, too. Basically, you should judge the degree to which the student supports their decision with an appropriate answer. “Because I feel like it” (or, “Because I don’t feel like it”) are poor answers.

8) Answer should emphasize that it is the mutual responsibility of health care provider and patient to insure the maximum compliance possible. The health care provider, not the patient, is responsible for conceptualizing compliance as a contractual issue and communicating that to the patient. The health care provider should work with the patient to address barriers to compliance and should then try to remove or minimize as many of those barriers as possible. The HCP should try to understand compliance from the patient point of view (i.e., to understand their health care beliefs) so as to address this issue. The HCP should work with other members of the team to address barriers. If the answer addresses all of these issues, give full credit.

Extra Credit: “Competent” people have extensive toolboxes or skills that they can apply in clinical situations, or with patient populations, in which they have received training. “Competent” people can pass tests and possess knowledge that forms the basis of their clinical care and scholarly work. “Capable” people are able to adapt to novel, challenging situations for which they were not directly trained, because they have flexible skills, critical thinking capacity, and adaptability that can be modified to fit an almost infinite variety of clinical or conceptual problems. The key difference is “adaptability” or “creativity” in the capable person. Education for competency is “knowledge-based”, and evaluation of the outcomes of such education focus on possession of particular skills and knowledge. Education for capacity is based on teaching critical thinking skills by exposing students to ambiguous, ill-defined problems that they have to think through with guidance, thus developing their adaptive skills.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download