Cahpter 1

GIVING INSTRUCTION TO A PATIENT

Alda Depi Arie
aldadepiari@gmail.com

1.1 Introduction
We included studies published in any language that investigated use of a virtual patient
to teach health professions learners (students, postgraduate trainees, or practitioners in a
profession directly related to human or animal health, including physicians, dentists, nurses,
pharmacists, veterinarians, and physical therapists) at any stage in training orpractice. We
defined a virtual patient as “a specific type of computer program that simulates real-life clinical
scenarios; learners emulate the roles of health care providers to obtain a history, conduct a
physical exam, and make diagnostic and therapeutic decisions.”10 This excluded other forms of
computer-based learning in which patient cases did not require the user to interactively gather
patient data, and other forms of simulation such as standardized patients, manikins, parttask
trainers, and systems requiring specialized equipment not found on a typical personal computer.
We excluded studies using computer cases for which replication would require hardware not
included with a typical personal computer (e.g., haptics input devices or virtual reality head-
mounted displays) because such cases differ from virtual patients in educational objectives and
instructional methods. We also excluded computer simulations used for procedural planning or
disease modeling, simulations that did not involve obtaining a history or exam, and computer-
mediated consultations on real patients.(Cook et al., 2010)

What quality of service do patients want and receive? ‘‘Patients want to be taken seriously
both as patients and as real people whose family and social and economic lives have been
threatened or disrupted by the medical problem and by the isolation and disorientation of
hospitalization’’ [1]. Discharge from the hospital represents a serious and complex transition in
patients’ lives. Patients and their families begin to cope with the repercussions of illness in their
daily life absent the comprehensive support of nurses and physicians. The stress and anxiety
involved only serve to intensify patients’ needs for information, education and reassurance. This
information is critical to the patient’s welfare; nineteen percent of patients have adverse events
after discharge [2]. Recent studies have substantially increased the body of knowledge and
understanding of patients’ informational and educational needs in preparation for discharge [3–
11]. Patients desire information on follow-up, home care, symptom management, pain
management and coping with potential health problems [5–7]. Patients want specific written
information and resources on follow-up and community services [6,10], pain treatment [6,11],
and life activities [6] (e.g., ‘‘What could or could not be done’’ [10]). In fact, Gustafson et al. [8]
found that information and support needs of patients outweighed care delivery needs and any
service concerns. Despite the value and demand for this information, between 27 and 80% of
patients do not receive the desired amount of information [7,9,12]. In addition to general
informational needs, clinically related educational needs are also slipping through the cracks.
Rowe et al. [13] surveyed patients following a stay of 5 days or less revealing that over 50% of
these patients failed to receive information on ‘‘side effects,’’ ‘‘recovery at home’’ or ‘‘community
health services’’. Jones et al. [14] found that 81% of patients needing assistance with basic
functional needs failed to receive home care referrals and 64% of these patients reported that
no one at the hospital had talked to them about ‘‘managing at home’ (Clark et al., 2005)

Saliva plays a key role in the maintenance of healthy oral hard and soft tissues and provides
essential lubrication1,2. Salivary gland hypofunction (SGH) is a condition in which unstimulated
or stimulated salivary flow is significantly reduced and may also result in alterations to the
chemical composition of saliva. SGH is generally defined as an unstimulated whole-saliva flow
rate of less than 0.1–0.2 ml/min and a stimulated whole-saliva flow rate of less than 0.7
ml/min1–5. Xerostomia is defined as the subjective perception of dry mouth. SGH can have
major deleterious effects on a patient’s oral health2–4. The main causes of SGH are
autoimmune diseases such as Sj€ogren’s syndrome, rheumatoid arthritis and iatrogenic
conditions including drug-related side effects or radiotherapy for head and neck cancer4–10.
Hyposalivation can contribute to several oral complaints: generalised oral discomfort, burning
mouth and tongue, traumatic oral lesions, halitosis, intolerance to acidic and spicy foods, poor
denture retention, disturbances of taste and mastication, dysgeusia, dysphasia and
dysphonia5–10. Reduced saliva flow has also been found to relate to clinical outcomes such as
dental caries, fungal infections or a lower number of teeth1,7. As patients with hyposalivation
may suffer reduced bacterial clearance and unbalanced microbial homoeostasis, it can also be
hypothesised that a reduced salivary flow rate is a risk factor for periodontal infection7.
Furthermore, it has been suggested that hyposalivation may indirectly increase the long-term
risk of plaque-induced periodontal disease through plaque accumulation when symptoms
associated with these lesions impede proper oral hygiene7,11–16. The regular and systematic
removal of dental plaque accomplished by brushing and interdental cleaning of teeth and
gingiva (oral hygiene) halts the progression of periodontal disease. Therefore, the primary
mechanism for preventing and halting the progression of periodontal disease involves personal
oral hygiene11,12. For these patients,improving adherence to oral hygiene regimes is essential,
and these must include correct brushing, use of dental tape and other oral hygiene techniques.
For this reason, there is a need for effective interventions by dental professionals to ensure that
patients follow oral hygiene instructions14–19. The objective of this study was to assess the
effectiveness of a motivational–behavioural skills protocol for plaque control in patients with
hyposalivation.(Lõpez-Jornet et al., 2014)

1.2 Communication skills instruction: An analysis of self, peer

group, student instructors and faculty assessment

Despite its unique features, VPs should be viewed by educators as an instructional aid and,
as such, are generally part of the larger curricula. The Kern model for curriculum development
(Kern, Thomas, Howard, & Bass, 1998) is a useful framework to place VPs in a proper
educational context. The
process begins when a teacher recognizes the problem as part of a general needs
assessment, for example, “poor management of chronic pain in elderly patients.” As part of this
needs assessment, the target learners, for example, residents or medical students, are
identified and goals and objectives (competencies) are set, for example, “The resident will
assess and manage chronic pain in older outpatients with chronic conditions.” At this stage of
curriculum development, the teacher explores different educational methods tailored to fill
instructional gaps and chooses appropriate instructional methods and media. At this point it is
worthwhile to make a clear distinction between instructional methods and media. Instructional
methods are educational approaches to help people learn (Cook & McDonald, 2008), whereas
instructional media are the actual vehicles that deliver this instruction (Clark, 1994). Following
this line of reasoning, the VP is not the instructional method per se, but rather case-based
learning is. Evidence shows that though the choice of an instructional method affects learning,
the choice of a media generally does not (Clark, 1994). Thus, teachers can accomplish case-
based learning
 through a variety of instructional media: text, video, and small-group discussion during a
case presentation with or without the use of VPs. The implementation of VPs as part of a
blended e-learning curriculum that consists of other instructional modalities should be followed
by an assessment of
the impact of the VP program on learning and an evaluation of the success or lack thereof of
this strategy in terms of instructional effectiveness, efficiency, and feasibility. Rationale for the
Use of VPs in Geriatrics Education According to the 2008 Institute of Medicine (IOM) report on
the workforce for geriatric patients, between the years 2005 and 2030 the number of adults age
65 years and older is expected to double from the 35 million to over 70 million. To adequately
care for the medical needs of this population, the United States will need an estimated 36,000
geriatricians (Institute of Medicine, 2008). Considering that in 2007 there were only 7,128
physicians certified in geriatric medicine and that this number is projected to increase by less
than 10% by 2030, the shortage of geriatricians will clearly not be met by merely increased
recruitment and training of geriatrics specialists. One solution proposed by the IOM is to
increase the geriatric competence of the entire health care workforce. However, a 2005 survey
of U.S. academic geriatrics program showed that one half of the responding programs had
fewer than nine full-time equivalent (FTE) geriatrics physician faculty members, the minimum
number recommended by the OM Warshaw, Bragg, Brewer, Meganathan, & Ho, 2007). (Tan et
al., 2010)

It is widely recognized that good communication skills are essential in the health care setting
[1–3]. Positive outcomes occur when clinicians are effective communicators. An increase in
patient and clinician satisfaction [4–6], patient compliance and safety [7], and quality and
quantity of information obtained through patient interview [8] has been reported. Additionally,
decreased treatment time [9], litigation [10], patient distress and anxiety [11,12] are associated
with effective clinical communication. Specific to the field of dentistry, clinicians must effectively
gather information from patients who do not always recognize the need to convey their medical
conditions. Dentists often inform patients of disease statuses that are not obvious to their
patients and educate them about oral and systemic health implications [13]. Thus, dentists must
be able to listen attentively and build rapport with their patients and impart information with the
goal of motivating patients towards treatment and behavioral change. Within the dental
literature, communication skills training programs have been described yet rigorous analysis of
teaching methodologies is somewhat lacking [1]. Hannah et al. described teaching materials
and interactive learning opportunities within a preventive dentistry course [14]. Wagner et al.
and Rowland focused on communicating with diverse patient populations and described the
communicative strengths and weaknesses of their students [15] and challenges of
communicating with patients of limited English-speaking ability [16], respectively. Recently,
Haak et al. reported the results of a randomized crosssectional study comparing a new
communication skills training program to traditional instruction [17]. This new program
incorporated role-play and observation of authentic patient interviews. Students in the test group
were shown to have better practical communicative skills than students in the traditional
learning group during simulated patient encounters. Medical school curricula have also
incorporated interactive learning opportunities into their communication skills training programs.
Small group discussion [18], observing others or oneself through video recording [19], and
interviewing simulated patients [20–22] have been reported. These strategies have been shown
to enhance students’ ability to build rapport with their patients and gather information during the
patient interview [18]. These strategies may also foster students’ self-confidence in
communicating with patients [23] and assessment of their own communicative skills [20].
Different assessment sources have been used in communications skills training. Gruppen et al.
utilized simulated patients and student self-assessment [24]. Their assessment focused on
establishing empathy, building rapport and collaboration between clinician and patient. Rudy et
al. called for faculty, peer-group and student self-assessment following interviews with simulated
patients [25]. Assessment emphasized interview structure, information flow, legitimization, and
transition statements. Student feedback was offered verbally and in writing through completion
of Likert-style rating scales and narrative comments.(Lanning et al., 2011)
Referensi

Clark, P. A., Drain, M., Gesell, S. B., Mylod, D. M., Kaldenberg, D. O., & Hamilton, J. (2005).
Patient perceptions of quality in discharge instruction. Patient Education and Counseling.
https://doi.org/10.1016/j.pec.2004.09.010
Cook, D. A., Erwin, P. J., & Triola, M. M. (2010). Computerized virtual patients in health
professions education: a systematic review and meta-analysis. In Academic medicine :
journal of the Association of American Medical Colleges.
https://doi.org/10.1097/acm.0b013e3181edfe13
Lanning, S. K., Brickhouse, T. H., Gunsolley, J. C., Ranson, S. L., & Willett, R. M. (2011).
Communication skills instruction: An analysis of self, peer-group, student instructors and
faculty assessment. Patient Education and Counseling.
https://doi.org/10.1016/j.pec.2010.06.024
Lõpez-Jornet, P., Fabio, C. A., Consuelo, R. A., & Paz, A. M. (2014). Effectiveness of a
motivational-behavioural skills protocol for oral hygiene among patients with hyposalivation.
Gerodontology. https://doi.org/10.1111/ger.12037
Tan, Z. S., Mulhausen, P. L., Smith, S. R., & Ruiz, J. G. (2010). Virtual patients in geriatric
education. Gerontology and Geriatrics Education.
https://doi.org/10.1080/02701961003795813
 BIODATA SINGKAT

Alda depi arie lahir di pulau gadang pada tahun 2001 -01
– 18 pada tahun 2004 saya masuk sekolah taman kanak –kanak di tk pertiwi Palembang,pada
tahun 2006 saya tamat tk dan lanjut masuk ke sekolah dasar di sdn 06 palembang hanya
sampai kelas 3 saja lalu saya ikut ayah pindah ke riau lanjut sd di sdn 009 tahun 2012 saya
tamat sd dan lanjut masuk ke sekolah menenga pertama di smpn 03 xiii koto Kampar tahun
2015 saya tamat smp lalu lanjut ke sekolah menengah atas di sman 2 xiii koto Kampar lalu
tamat pada tahun 2018 kemudian saya melanjutklan pendidikan saya di perguruan tinggi
universitas pahlawan tuanku tambusai dengan mengambil jurusan serjanah ilmu keperawatan.