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Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Institute of Medicine, University of Brunei Darussalam WEB: http://omarkasule.tripod.com
BACKGROUND PHILOSOPHY and CONCEPTS (5%) RELIGIOUS BACKGROUND Islam: The 3 fundamentals (Islam, Iman, & Ihsan), monotheism (Tauhid), Messengers and messages (risaalat), eschatology (aakhirat), Ithm (sinning), Dhulm (transgression). Pre-determinism: qadar / taqdiir Other creeds (milal): The academic definition of religion. Dogmas with medical implications in other religions. HISTORICAL BACKGROUND Civilization: Start of human civilization. Cycle of civilizations History of medicine: Ancient medicine; Concept of Islamic Medicine. Prophetic Medicine. European TCM Chinese TCM. Ayurdevic TCM. Unani TCM. Borneo TCM. Critique of biomedicine vs. holistic medicine EPISTEMOLOGICAL BACKROUND Theory Of Knowledge (epistemology): Knowledge. The duality/dichotomy crisis. The empirical methodology / scientific method. Integration of knowledge. BASIC SCIENCES BACKROUND Creation and afterlife: Creation of the universe. Cosmology. Creation of the human being. Nature of the human. Superiority of humans. Mission of humans on earth. Diversity of humans. After-life. The concept of personhood. Transitions in the status of life and health: Life. Issues in definition/recognition of life. Death. Health. Disease / illness. Treatment of disease. The human life cycle (growth and senescence): Intrauterine period. Infancy and childhood. Adolescence. Youth. Middle age. Old age. After life The Biological Miracle: The human organism. Interaction of the external and internal environments. Functional unity of the organism. Correlation of structure and function by organ systems | ETHICO-LEGAL-FIQH CONCEPTS & PRINCIPLES (15%) BASICS OF LAWS Fundamentals of the Law: Sources of Islamic Law. Sources of European Law. Purposes of the Law: maqasid al shariah. Principles of the Law: qawa’id al shariah. Types of legal rulings. Relation of ethics to law. Islamic perspective of human rights. Secular European perspective of human rights. The link between human rights and health. Equality before the law. Practical: visits to Mufti Office and Attorney General’s Chambers Brunei legal systems: civil and shariah laws: The Brunei civil and criminal justice system. Brunei laws related to health. The Brunei shariah legal system. Practical: Attending a Brunei High Court session & Moot court THEORIES AND PRINCIPLES OF MEDICAL ETHICS Islamic theory of medical and biomedical ethics: maqasid al shariah: protection of morality, life, progeny, intellect, and resources. Secular European theories of medical and biomedical ethics: Deontology vs. teleology. Consequentialism / utilitarianism. Principlism. Kantianism. Virtue theory. Relationship theory. Casuistry. Communitarian ethics. Libertarianism. Feminist ethics. Narrative ethics. Empirical ethics. Ethical theory based on social sciences. Deriving ethics from thought experiments. Deliberative ethics based on democratic discussion. Principles of medical and biomedical ethics: Islamic ethical principles. Secular European ethical principles. Relation between Islamic and European ethical principles. Christian bioethics. Buddhist ethics. Hindu/Jain/Sikh bioethics. Jewish bioethics. East Asian bioethics. International ethical codes. Practical: visit to Brunei Medical Board offices ISSUES OF CONSENT Medical consent for competent patients: Patient autonomy. Physician autonomy. Competence / ahliyyat: Islamic perspective. Competence / capacity: secular perspective. Informed consent. Why is informed consent important? Scope of consent. Conditions for validity of consent. Information for informed consent. Capacity to consent. Process of consent / refusal for the competent. Practical: Visit to the emergency room in the evening. Medical consent for incompetent patients: Consent / refusal for the incompetent. Physician assessment of best interests of the patient / best interest standard. Proxy decisions / substituted judgment standard. Advance statements / directives. Consent by the court. Consent for children. Consent in emergencies. Practical: consent procedures in surgical and obstetric wards. PRIVACY, CONFIDENTIALITY AND DISCLOSURE Privacy and confidentiality: Privacy. Confidentiality. Basis/ rationale / justification of confidentiality. Truthfulness: Patient veracity as a necessity for good clinical care. Physician veracity between clarifications vs. confusion. Obligation to tell the truth. Harm of deception vs. harm of truthfulness. Information patient does not need/want to know. Partial disclosure / white / technical lies. Giving bad news. Paternalism in thinking patient cannot handle the whole truth. Dissonance between the physician’s body language and his words. Truthfulness in uncertainty about the diagnosis and the prognosis Disclosure: Disclosure by the patient. Disclosure by the healthcare worker. Conflict of duties regarding confidentiality and disclosure. Disclosure of family history / genetic information. Generation and handling of medical records. Disclosure to the mass media. Disclosure by doctors with dual obligations. Physician in court: as a witness. Practical: visit to hospital medical records department. RESEARCH Research policies and procedures: Disparities in allocation of research resources. Composition of Institutional research committee. Functions of an Institutional research committee / basis for ethical approval. Types of fraud in research. Avoiding research fraud / malpractice. The pharmaceutical industry Practical: visit to the Ministry of Health research ethics committee. Animal research: Moral status of animals. Handling animals before. Purposes of animal research. Purposes and principles of the Law in animal research. Relevance to humans. Choice of animals for research. Solutions to controversy. Use of great apes. Toxicity testing on live animals. Capture of wild animals for research. Practical: visit to the animal house. Human research: History. Phases of clinical trials. Therapeutic vs. non-therapeutic research. Ethical requirement of systematic review before new research. Assessing benefits and harms of clinical research. Good clinical practice guidelines. Autonomy / informed consent. Consent procedures for different types of research. Freedom to withdraw. Material inducements. Confidentiality. Research in emergency rooms. Inclusion of women and minorities. Research on the mentally incompetent. Record based research. Research on cadavers. Research on Children. Research on the elderly. Research on the mentally incapacitated. Research on prisoners. Research on students and employees. Research on members of uniformed services, army and police. Research on biological samples, organs, and tissues from living donors. Research on organs and tissues from dead donors. Research on embryos. Research on fetal tissues. Biomedical research. Public health research. Health services research. Practical: visit to a clinical trials operations office ISSUES AT THE BEGINNING AND END OF LIFE (5%) Beginning of life issues: Prenatal / pre-implantation gender testing in IVF. Induced abortion. Human reproductive cloning. Practical: visit IVF / fertility clinic Stem cell technology: Stem cells (definition, methods, use in disease therapy, use in research, sources of stem cells and ethical controversies). Embryo/fetal research: Sources of embryos. Types of research that uses embryos (contraception, sterilization, reproductive cloning). Ethical guidelines and controversies. Obtaining human eggs for research (buying, donation). Genetic technology: Genetic therapy. Genetic banks and patenting issues. Human-animal hybrids. The Human genome project. Genetic counseling. Genetic testing. Genetic screening. Pre-implantation diagnosis. Genetic engineering and therapy. Human gene transfer // genetic engineering. End of life issues: Terminal illness. Palliative care. Diagnosis of brain death. Initiating / withdrawing artificial life support. Euthanasia. Physician assisted suicide. Solid organ transplantation. Post-mortem examination. Cadavers for research and education. | ETHICO-LEGAL-FIQH ISSUES IN CLINICAL PRACTICE (20%) NORMAL PHYSIOLOGICAL CONDITIONS Issues in normal reproduction: Menstruation. Pre-menstrual tension. Irregular menstruations. Prolonged menstruation. Dysmenorrhea. Menopause. Human sexuality & sexual behavior. Contraception. Pregnancy. Prenatal screening & diagnosis. Labor. Delivery. Postnatal care. Breast-feeding. Practical: visits to gynecological and ante-natal clinics. . Issues in activities of normal living: Physiological secretions and wudhu / salat. Environmental hygiene. Foods & drinks. Physical activity. Standing, sitting, walking and running. Sports. Sleep and rest. MEDICAL PROCEDURES Diagnostic procedures: History. Physical examination. Radiological examination. Laboratory tests. Esophagoscopy and colonoscopy. Aggressive investigation of common symptoms. HIV testing. Practical: visit to outpatient clinic, laboratory and radiology departments. Therapeutic procedures: Balance of benefit and injury. Prescriptions and administration of medications. Medication and wudhu. Medication and puasa. Surgical procedures. Pharmacogenetics / pharmacogenomics. Anesthesia. Blood transfusion. Resuscitation. Cosmetic / reconstructive surgery. Solid organ transplantation. Xenotransplantation. Doctrine of double effect:. The slippery slope. Ordinary vs. heroic / extraordinary means /measures in treatment. Acts of omission vs. acts of commission: Islamic vs. secular civil law perspective. Use of drugs in sports. HIV treatment. Enhancement technologies. Psychosurgery, neuro-implantation, and endocrine implantation. Practical: visit to a hospital emergency room CONDITIONS OF ILLNESS Physical Acts Of Worship For The Sick: Toilet hygiene. Wudhu. Tayammum., Ghusl for the sick.. Salat for the sick. Puasa for the sick. Zakat, and hajj. Practical ibadat pesakit: video, simulated patients, real patients. Input/output systems: alimentary and urinary: Upper GIT conditions. Lower GIT conditions. GIT infection / food poisoning. Appendicitis. Inflammatory bowel disease. Hepatitis. Chronic renal failure. Urinary incontinence, fistulae, and catheters.. Renal colic. Transport systems: cardiovascular & respiratory: Dyspnea due to cardiovascular causes. Dyspnea due to respiratory causes. Congestive cardiac failure. Reproductive system: Menopausal disorders. Dysfunctional uterine bleeding. Pre-natal diagnosis / screening / genetic testing/treatment. Assisted reproduction for infertility. Locomotion, support, and connective system: Orthopedic problems. Limb disorders. Gait disorders. Involuntary movements. Myasthenia gravis. Joint disorders with restricted/painful movements. Vertebral column pain. Laryngeal, pharyngeal, or oral disease. Drugs to enhance sports performance. Practical: visit to the orthopedic department. Sensory system: Blindness and deafness. Olfactory disorders. Taste disorders. Tactile disorders. Temperature disorders. Pain disorders. Hunger and thirst. Practical: visits to the eye, ENT, and pain clinics. Neurological disorders: Stroke. Epilepsy. Parkinson disease. Dementias. Brain tumors. Brain /skull trauma. Spinal cord injury. Multiple sclerosis. Encephalopathy. Aphasia/dysphasia. Vestibular disturbances. Peripheral neuropathies. Practical: visit to neurology clinic. Psycho-social conditions: Legal impact of loss of competence. Human drives and the genesis of emotions. Anxiety disorders. Stress. Loss of consciousness. Personality disorders. Psychiatric conditions /psychosis/schizophrenia. Depression and suicide / para-suicide. Psychogenic sexual disorders. Neurotic / anxiety / compulsive-obsessive disorders. Non-therapeutic use of psychoactive drugs. Practical: visit to psychiatry clinic Endocrine and metabolic disorders: Diabetes Other conditions: Patho-physiological disturbances: fever, dehydration, infections. Hematological disorders. Skin disorders: eczema, psoriasis, SLE. Issues of special groups: Women and maternal conditions. Neonatal and infant conditions. Congenitally abnormal fetii / infants. Child conditions. Geriatric physical dysfunction. Geriatric psycho-neurological conditions and dementias. Geriatric psychosocial dysfunction. Disabilities. Mentally retardation. Research on the elderly. Refugees / displaced |
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ETHICO-LEGAL-FIQH ISSUES IN COMMUNITY PRACTICE (5%) COMMUNITY HEALTH The Family: Gender. The family as a natural social unit. Marriage. Parents and relatives. Children. Child protection. The Community: Description of culture. Trans-cultural ethics. Community institutions. Community diagnosis. Life-style. Sexual perversions. Unwanted pregnancy. Addiction and substance abuse. Poverty. Violence. Child abuse & neglect. Issues of women. Injury control. Tobacco control. Community Action: enjoining the good and forbidding the bad, health promotion / education, social change, professional and occupational organizations, social welfare, disaster relief, refugees, Civil Transactions: Health-related ethico-legal issues in marital contracts. Divorce & annulment. Inheritance. Endowments & gifts, PUBLIC HEALTH Public health ethics: Public health. Public health measures in an epidemic without consent. Disease screening and surveillance. Control of infectious disease. Sexually transmitted disease. HIV. HIV prevention. HIV stigmatization and discrimination. Vaccination / immunization. Tobacco control. Occupational health ethics: Risk assessment and risk management. Occupational injury and work-related disease. Pre-employment testing. Testing during employment. Environmental health ethics: Poverty eradication vs environmental degradation. Risk assessment and risk management. Health services ethics: Needs vs wants/demands in health care. Commercialism. Justice. Economic analysis in health. Health policy. Health finance. Health services delivery. Medical tourism. Primary health care. Medical humanities: sociological and psychological theories. Introduction to sociological and psychological methods. Social control. PROFESSIONALISM (15%) Professional physician etiquette / conduct with patients: Physician competence, responsibility, and accountability. Patient etiquette, duties, obligations, and responsibilities. Doctor-patient relationship. Dealing with violent / abusive / uncooperative patients. Fidelity obligations. The disabled patient. Professional etiquette with the terminally ill/dying: palliative care. The terminally ill / dying. Death. Burial. Bereavement. Collegial relations / etiquette in a health team: principles of successful group work. General and special group dynamics. Student-teacher relation. Mutual respect and cooperation. Conflict resolution. Whistle blowing on unethical behavior. Cooperation with traditional healers. Professional misconduct: Abuse of privileges. Private misconduct derogatory to the profession. Financial misconduct. Un-ethical business practices. Felonies. Dealing with the pharmaceutical industry. Conflict of financial interests. Licensing and registration. Promises of wonder cures. Malpractice & negligence. Definition of negligence/malpractice. Ingredients of a negligence suite. Avoiding negligence suits. Bolam principle as modified by Bolitho. Patient complaint / grievance system as a tool to prevent malpractice. | PERSONAL DEVELOPMENT (5%) INDIVIDUAL DEVELOPMENT Success as a medical student: Etiquette of the student and the teacher. Time management. Study techniques and strategies. Speed reading. Group study and teamwork. Motivation. Management of student stress. Conflict resolution. Cheating and plagiarism. The nature of medical education. Physician rights. Physician responsibility. Towards developing a scientific culture: Understanding. Thinking. Description. Analysis. Objectivity. Rationality. Prudence. Respecting the other opinion. Character and behavior: Character, habits, and behavior. Positive personality traits. Self Development and personality enhancement: Self improvement. Intellectual development. Social development. Skill development. Professional development. Personal beliefs and conscience in health care decisions: respecting conscientious objection. SKILL DEVELOPMENT Communication: Concepts and theory of communication. Communication in small groups. Purposes and types of written communication. Characteristics of good writing. Special characteristics of medical/technical writing. Publishing a paper. Ethics of medical publishing. Problems in writing. Public speaking. Dealing effectively with the mass media. Negotiation skills: Nature and purpose of win-win negotiation. Negotiation strategies. Negotiation tactics. Management of a negotiation session. Difficult negotiations. Leadership Skills: Basic characteristics of effective leadership. Personal Attributes of leaders. Conceptual leadership skills. Technical leadership skills. Human skills of leaders. Diseases of leaders. Diseases of followers. Model leaders in medicine; Organizational management: Strategy, planning, and implantation. Control and evaluation. Quality assurance/quality improvement. Decision-making. Problem-solving. Crisis management. Basics of organizational management. Basics of organizational financial management. Health information management systems. | RESEARCH SKILLS (25%) Mathematical and conceptual foundations: Introduction to Epidemiology. Introduction to biostatistics. Probability theory in science. Variables and distributions. The scientific method and hypothetico-deductive inference. Epidemiological studies. Critical reading of scientific literature Descriptive statistics: Understanding computers, databases. Use of SPSS. Review of data grouping, data tabulation, and data diagrams, Descriptive statistics for numerical variables. Descriptive statistics for categorical variables. Inferential statistics: Comparison of parametric with non-parametric analysis. Inferential statistics. Inferential statistics. Numerical / continuous statistical analysis. Categorical / discrete statistical analysis. Linear correlation. Linear regression. Logistic regression. Multiple regression. Basics of survival analysis. Descriptive & inferential statistics applications: Data presentation. Writing a research report Critical appraisal of clinical research. Review mathematical and conceptual foundations. Quantitative disease measures: Measures of incidence. Prevalence. Rates & proportions. Measures of excess disease occurrence. Diagnostic tests. Screening tests. Parameters of screening tests. Time series analysis. Vital statistics and demographic methods. Study design and analysis: Sample selection. Sample size. Sources of data. Questionnaire data collection. Data management. Data analysis: summarizing and inference. Cross sectional study. Ecological study. Case control study. Follow-up / cohort study. Community randomized study. Clinical trial. Health surveys. Meta-analysis. Causal inference. Study interpretation: Measures of association: t test; F test; chi square. Measures of effect: risk ratio and odds ratio. The Odds ratio. Sources of bias & treatment of bias: selection bias, misclassification bias, confounding bias. Interaction and effect modification. Validity and precision. Critical reading of epidemiological studies |