Teaching Biopsychosocial Competence and the Principles of the Primary Health Care (PHC) at the Patient's Bedside

The importance of behavioural and social determinants in health was recognised long ago; yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. A teaching pedagogy blending the biopsychosocialapproach and the principles of primary health care (PHC); as expressed in the Alma-Ata Declaration of 1978; is lacking in the literature. This report hopes to address this need.In 1994 the University of Cape Town (UCT); South Africa; adopted a PHC-based approach to health sciences education to equip its graduates with the necessary knowledge; skills and attributes required to meet the challenges of providing health care in a country with vast socio-political inequalities. This paper describes an educational pedagogy which weaves these principles into clinical practice in an undergraduate medical clerkship. The methodology uses real patient encounters linked to an interactive seminar and a portfolio of case studies. Students described the teaching pedagogy as interesting and informative. They recognised the importance of holistic; patient-centeredcare based on a biopsychosocial approach and the importance of the PHC principles. Barriers to implementing this approach were also highlighted. The pedagogy; in use for four years; is being adopted by another department; indicating the sustainability and success of the course

Teaching biopsychosocial competence and the principles of primary health care (PHC) at the patient's bedside

The importance of behavioural and social determinants in health was recognised long ago; yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. A teaching pedagogy blending the biopsychosocial appro- oach and the principles of primary health care (PHC); as expressed in the Alma-Ata Declaration of 1978; is lacking in the literature. This report hopes to address this need.In 1994 the University of Cape Town (UCT); South Africa; adopted a PHC-based approach to health sciences education to equip its graduates with the necessary knowledge; skills and attributes required to meet the challenges of providing health care in a country with vast socio-political inequalities. This paper describes an educational pedagogy which weaves these principles into clinical practice in an undergraduate medical clerkship. The methodology uses real patient encounters linked to an interactive seminar and a portfolio of case studies.Students described the teaching pedagogy as interesting and informative. They recognised the importance of holistic; patient-centered care based on a biopsychosocial approach and the importance of the PHC principles. Barriers to implementing this approach were also highlighted. The pedagogy; in use for four years; is being adopted by another department; indicating the sustainability and success of the course

Comparison of the clinical and pathologic staging in patients undergoing radical cystectomy for bladder cancer

PURPOSE: Radical cystectomy (RCx) is perhaps the most effective therapeutic approach for patients with muscle-invasive bladder cancer. Unfortunately, clinical staging is imprecise and the degree of understaging remains high. This study retrospectively evaluated patients undergoing RCx with regard to pathologic outcomes and degree of upstaging to better identify features that may lessen clinical understaging. MATERIALS AND METHODS: 141 consecutive patients with urothelial bladder carcinoma who were candidates for RCx with curative intent were retrospectively evaluated. Preoperative clinical and pathological (i.e. TURBT) features were compared to pathological outcomes in the cystectomy specimen. Patients were also evaluated as to whether cystectomy was performed as their primary (n = 91) versus secondary (n = 50) treatment for recurrent/progressive disease. Date of cystectomy (< 5 years vs. > 5 years prior to study) was also analyzed. RESULTS: Of the 141 patients, 54 percent were upstaged on operative pathology. The greatest degree of upstaging occurred in those with invasive disease preoperatively (cT2-T3). Twenty-six percent of all patients had node-positive disease, and 75 percent of cT3 patients were node-positive. Seven of 101 (7 percent) patients with clinical T2 disease were unresectable at the time of surgery. In the primary (vs. secondary) RCx group, more patients were upstaged (63 percent vs. 40 percent), non-organ confined (62 percent vs. 38 percent), and LN positive (31 percent vs. 20 percent). In the more modern cohort, the degree of upstaging was not improved. CONCLUSIONS: Pathologic findings after RCx often do not correlate with preoperative staging. Over half of patients undergoing cystectomy are upstaged on their operative pathology. An improved understanding of the relative frequency of upstaging in cystectomy patients may have important implications in the decision-making and selection for neoadjuvant and adjuvant therapies ...