NOSM prof guided by other-centredness

Dr. David Clarke takes third-year NOSM clerks to a clinic in Nicaragua every year and developed an iTunes app to help learners practise patient-centred care.

Parry Sound family physician Dr. David Clarke

Whether he’s in the role of a physician caring for patients or a teacher imparting his knowledge to medical students, Dr. David Clarke is guided by the principle of other-centredness.

Winner of a teaching excellence award bestowed by Northern Ontario School of Medicine students last year, Clarke goes to great lengths to instill the same principle in the third year clerks and other learners who spend time in Parry Sound as part of the school’s distinctive model of distributed, community-engaged education.

Clarke believes in and practices a learner-centred approach to teaching.

“It’s creating an environment that’s supportive of a learner’s needs,” he explained. “You start by understanding where a student is at. You get to know them as people, welcome them into your community, orient them, have them over for dinner and make them feel part of the profession.

“A lot of it has to do with your approach to establishing a relationship. I don’t formally mentor students, but I try to come alongside them when they’re having issues and challenges, and everybody does in third year. They’re out of their element. They’ve come to a small town and it’s the first time they’re seeing patients. It’s a hard year to begin with and they all feel overwhelmed.”

Clarke graduated from the University of Western Ontario’s school of medicine in 1982, completed his residency in family medicine in 1984 and began practising in Parry Sound in 1985. He figured he’d stay for a year and move on, but he and his wife fell in love with the community, put down roots and raised four kids.

In 2007, with Parry Sound selected as one of 13 third-year Comprehensive Community Clerkship sites, Clarke volunteered to serve as the physician site co-ordinator. Every year, between four and six third-year students make Parry Sound their home for eight months. They spend time shadowing primary care providers and specialists at the Parry Sound Family Health Team and the West Parry Sound Health Centre and spend time with chiropodists, physiotherapists and dietitians among others, to broaden their knowledge of the allied health-care professions.

They also participate in formal, case-based learning sessions two afternoons a week moderated by Clarke and other physicians in the community.

“They have broad objectives for learning about such things as hypertension and GI bleeds, and, hopefully, they’ll encounter patients who fit those cases,” said Clarke. “They present the cases, prepare a report and get marked.”

At the conclusion of the eight-month clerkship, Clarke takes his students to the Skylark Centre in Nicaragua, where they set up a clinic and see between 800 and 1,000 patients over a two-week period.

Team-building

“It allows the students to practise in a very collaborative environment,” said Clarke. “They have to set everything up, live together, work together and get along together, so it’s a good team-building exercise.”

The Skylark Centre, a project of Threefold Ministries of Parry Sound, is dedicated to the communal and spiritual development of the people of Nicaragua and is a project of St. Andrew’s Presbyterian Church in Parry Sound. By coincidence, third-year NOSM student Emily Robinson’s dad, Gary, is a director of the Skylark Centre.

“We piggyback on what they’re doing,” said Clarke. “The students see the disparity between public and pri­vate health-care, get an idea of the social determinants of life and learn that poverty is the number one driver of health.

“They learn to be other-centred because it’s not just about our own needs. It’s about serving others, so this is what I do to try to model that.”

Teaching patient-centredness has also drawn Clarke into the world of app development.

The challenge was to put some real meaning into what might otherwise remain an empty buzzword.

Feedback

“I came across a paper making the point that one of the best ways to know if you’re patient-centred in your encounters is for the patient to tell you. I thought that was interesting, so I developed an app called Patient Centred Feedback.”

The learner hands patients an iPad at the conclusion of an encounter and asks them to complete an anonymous survey that scores the learner in relation to connection and empathy, active listing skills, respect, shared decision-making, risk management and planning for follow-up.

Patients indicate whether the learner greeted them in a friendly manner, explored their expectations, listened to what they had to say without jumping in every five seconds and spoke in a way that was understandable instead of using jargon.

It asks if the learner clearly explained the treatment and if the patient is able to accomplish what was agreed to. In other words, said Clarke, did the learner ask if the patient needs a ride to the specialist, or a northern travel grant?

The app, which is available as an iTunes download, calculates the learner’s scores over a period of time and links to a companion website with resources for improving patient-centred skills.

Like most physicians in Northern Ontario, Clarke came to Parry Sound to practise medicine, not to teach, but he clearly has an avocation for both.

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