Role Play

Role Play Gives Students Valuable Pre-Practicum Experiences

Stefanie R. Sorbet, EdD

In today’s college practicum experiences, it is sometimes quite difficult for students to find quality field or clinical placements to log hours of pre-professional experiences. Hospitals, clinics, and school districts maintain busy schedules and are not always willing to allow interns into their facilities to practice their professional skills on an ongoing basis.

Role play can be implemented by college instructors and professors as an additional way to increase practice of skills within the confines of a college classroom among peers. This can be done as practice prior to implementing the skills within partnering clinics, hospital, or school districts. In a college of education for example, role play is a time when the aspiring teacher leads a lesson or activity as the peers in the college classroom participate as students (Kazemi, Ghousseini, Cunard & Turrou, 2016). Role play within other fields may include providing therapy, health care, service, or other activity involving the college student in a typical situation that he or she may encounter within a practicum experience.

Role play is an engaging tool for professors to use in their courses and engages student interns in the delivery of a service among their peers within the college classroom. During role play, there is one lead intern who provides the service, and other peers within that college course assume the role of the patient or student. This method allows the intern to rehearse his or her planned lesson in a risk-free environment while gaining confidence in the delivery of their professional content knowledge prior to actually delivering services to involved community partners.

One instructional tactic that complements role play within the college classroom is “act outs.” Act outs are designed to further enrich the intern’s ability to deliver the skill or lesson while also addressing any challenges that may arise. The professor of the course uses 4-5 index cards with descriptions of possible challenges that may be encountered and administers these randomly to the participating peers in the classroom prior to the lead intern’s delivery of the service or lesson.

These peers must “act out” the behavior listed on the index card while the lead intern continues to provide the service. This is a time for the lead intern to experience challenges while providing the service as a means of gaining experience of situations that may arise within their profession. The peers with the act outcards continue to exhibit the behavior on the card while the lead intern addresses the behavior during his or her delivery of the service.

Act out cards could include any behaviors that the professor feels the intern needs practice managing. For students in a healthcare program, a card might say, adult is afraid of needles and does not want to get a flu shot. For students studying education, a card might say, student in first grade refuses to stay in his seat. Prior to the beginning of the lesson, the professor asks the lead intern to leave the room while the act out cards are administered to 4-5 students randomly throughout the classroom. The lead intern does not know who will exhibit a challenge nor what it will be. The professor explains to the peers that their job is to continue as instructed on the card until the service is complete or the behavior is addressed.

At the end of the lesson, the professor leads the class in a debrief and encourages all students to reflect on what transpired and discuss how things could be approached differently in a future, real-word situation.

By incorporating role-playing situations that mirror clinical settings, students can practice working with challenging behaviors in the safety of the classroom before encountering them in during their practicum in the workplace, where the stakes are much higher.

* Stefanie R. Sorbet is an assistant professor in the Elementary and Special Education Department at the University of Central Arkansas. She previously taught elementary school.

Germany Health System

Universal Health Care

 The United States should look to Germany, not Canada, for the best model.

By Jamie Daw

 A sign indicates the passage to the delivery area in the Neustadt am Rübenberge Clinic in the Clinic for Gynecology and Obstetrics in Germany.

CreditCreditHolger Hollemann/Picture-Alliance, via Associated Press

As a Canadian living and studying health policy in the United States, I’ve watched with interest as a growing list of Democratic presidential candidates — Senators Bernie Sanders, Kamala Harris, Elizabeth Warren, Kirsten Gillibrand and Cory Booker — have indicated support for a Canadian-style single-payer plan with little or no role for private insurance. Approval of such a system has become almost a litmus test for the party’s progressive base.

But rather than looking north for inspiration, American health care reformers would be better served looking east, across the Atlantic.

Germany offers a health insurance model that, like Canada’s, results in far less spending than in the United States, while achieving universal, comprehensive coverage. The difference is that Germany’s is a multipayer model, which builds more naturally on the American health insurance system.

Although it receives little attention in the United States, this model, pioneered by Chancellor Otto von Bismarck in 1883, was the first social health insurance system in the world. It has since been copied across Europe and Asia, becoming far more common than the Canadian single-payer model. This model ensures that all citizens have access to affordable health care, but it also incorporates age-old American values of choice and private competition in health insurance.

Germans are required to have health insurance, but they can choose between more than 100 private nonprofit insurers called “sickness funds.” Workers and employers share the cost of insurance through payroll taxes, while the government finances coverage for children and the unemployed. Insurance plans are not tied to employers. Services are funded through progressive taxation, so access is based on need, not ability to pay, and financial contributions are based on wealth, not health. Contributions to sickness funds are centrally pooled and then allocated to individual insurers using a per-beneficiary formula that factors in differences in health risks.

The United States has the foundation for this kind of system. Its Social Security and Medicare systems use taxation to pay for social insurance policies, and the health care exchanges created by the Affordable Care Act provide marketplaces for insurance policies.

In an American version of this system, private insurers would have to be heavily regulated to ensure that coverage was affordable and to prevent the sort of rapid increases in premiums, deductibles and cost-sharing that have occurred over the past decade. Similar to regulations for Medicare and Medicaid, insurers would be required to provide a comprehensive set of benefits with limits on patient cost-sharing, which could be means-tested or tied to other criteria, such as having a chronic disease.

In Germany, for example, insurers can charge only small out-of-pocket fees limited to 2 percent or less of household income annually. Compared with the mostly fee-for-service, single-payer arrangements in Canada or the Medicare system, enrolling Americans in managed care plans paid on a per-patient basis would offer greater incentives to increase efficiency, improve quality of care and promote coordination of care.

Under a German-style plan, states could still be given flexibility in regulating nonprofit insurers to reflect regional priorities, similar to the flexibility offered to states in managing Medicaid and the A.C.A. exchanges.

Germany, Austria, the Netherlands and other countries with similar systems vastly underspend the United States. Americans may be concerned that lower spending reflects rationing of care, but research has consistently found that not to be the case. Other high-income countries spend less on health care than the United States because they have lower prices, not because they receive less care. In Germany, sickness funds leverage market power to secure lower prices, coming together regionally to negotiate contracts with doctors and hospitals, and nationally to negotiate drug prices.

Administrative and governance costs in multipayer systems are higher than in single-payer systems — 5 percent of health spending in Germany compared with 3 percent in Canada. But there is much room to cut prices. If, for example, insurers were able, on average, to achieve hospital and physician prices at the level of Medicare, and prescription drug prices at the level of the Department of Veterans Affairs, the savings would be significant.

While recent polls indicate that a majority of Americans support so-called Medicare for all, approval diminishes when the plan is explained or clarified. The former Starbucks chief executive, Howard Schultz, who is considering running for president, called the proposal to eliminate private health insurance “not American.” A German-style multipayer road to universal coverage might receive a much warmer reception.

Americans have long valued choice and competition in their health care. The German model offers both: Patients choose private insurers that compete for enrollees, in the process driving innovation and improving quality. If the United States adopted this model, insurance companies would be more tightly regulated and required to become nonprofits, and some job losses would be likely. But they would not need to be eliminated, an idea suggested, and then retracted, by Ms. Harris in her call for Medicare for all.

The diversity of health financing arrangements globally demonstrates that there are many possible paths to achieving universal health care at an affordable cost — as Ms. Harris’s advisers acknowledged after walking back her call for the elimination of private insurance.

Advocates and policymakers should pick carefully among these paths, choosing one that strikes a balance between what is possible and what is ideal for the United States health system. While the single-payer model serves Canada well, transitioning the United States to a multipayer model like Germany’s would require a far smaller leap. And that might encourage Americans to finally make the jump.

* Jamie Daw is assistant professor of health policy and management at Columbia University’s Mailman School of Public Health.

A version of this article appears in print on Feb. 21, 2019, on Page A27 of the New York edition with the headline: A Better Path to Universal Health Care.

Educação interprofissional

Professor da Medicina defende doutorado sobre Disciplina interprofissional da UEM

No último dia 15/02/2019, o Professor Edson Roberto Arpini Miguel do Departamento de Medicina da UEM defendeu a sua tese de doutorado “Implantação e análise de disciplina interprofissional em cursos da área da saúde”, sob orientação da Profª Angélica Maria Bicudo, como requisito  do Programa de Pós-graduação em Clínica Médica – área de concentração em Ensino na Saúde da Universidade Estadual de Campinas (Unicamp).

 

Este trabalho avaliou a implantação da disciplina de Atenção em Saúde, estando o Prof. Edson envolvido desde a sua idealização. Este componente curricular é obrigatório e comum a 7 Cursos da saúde da UEM (Biomedicina, Educação Física, Enfermagem, Farmácia, Medicina, Odontologia e Psicologia) e representa um potente articulador da integração ensino-serviço- comunidade e indutor de mudanças pedagógicas nos Cursos.

Nossos parabéns ao Professor Doutor Edson pela conquista e a todos os envolvidos, docentes, preceptores e discentes da Atenção em  Saúde pelo belo trabalho!

RESUMO

As mudanças no perfil etário da população e os diagnósticos de doenças crônicas cumulativas, exigem atendimentos, estabelecendo-se demandas em relação ao ensino nas profissões da saúde buscando a integralidade do cuidado. A reorientação da formação profissional por meio de políticas públicas ofereceu a oportunidade paraa criação de componentes curriculares, para formar estudantes que exercitem práticas interprofissionais. Este trabalho faz uma análise do contexto e implicações sobre a implantação de uma disciplina interprofissional nos cursos da saúde em uma universidade pública. Após a análise descritiva da implantação da disciplina de Atenção em Saúde e suas implicações acadêmicas, foi realizado um estudo com perfil exploratório de abordagem qualitativa utilizando-se grupos focais constituídos por tutores, preceptores e estudantes. Definidas as categorias e seus descritores foi utilizado o modelo 3P para a análise de conteúdo e dos resultados. Vale destacar a resignificação do papel docente, a percepção dos estudantes frente aos desafios do ensino interprofessional e a aproximação com o serviço de saúde. Correlacionamos na discussão geral deste texto linhas de discussão junto à assistência à pessoa, à sociologia e à pedagogia. A inovação proposta pela disciplina interprofissional de Atenção em Saúde seguiu o ideário de uma agenda internacional. Os relatos de tutores, preceptores e estudantes foram um estimulo decisivo para prosseguir avançando nas demais séries dos cursos, em atividades colaborativas e práticas interprofissionais.

Palavras-chave: Ensino interprofissional, Currículo, Metodologias ativas.

Problemas brasileiros

Aluno da UEM representa o País em conferência nos EUA

Lucas Gremaschi foi selecionado, com mais 9 brasileiros, entre 7 mil candidatos para ser embaixador na Brazil Conference at Harvard & MIT 2019

 

Débora Brunes

 

O acadêmico do 5º ano de Medicina da UEM (Universidade Estadual de Maringá), Lucas Gremaschi, foi selecionado para fazer parte do Programa de Embaixadores da Brazil Conference at Harvard & MIT 2019, que será nos dias 5 e 6 de abril em Boston, nos Estados Unidos.

A conferência é um evento anual organizado pela comunidade estudantil brasileira de Harvard e pelo Instituto de Tecnologia de Massachusetts (MIT) e tem como proposta promover o debate sobre temas que envolvem o Brasil.                      

O programa, que está na quarta edição, leva os embaixadores, dois de cada região do país, com todas as despesas pagas. Além disso, oferece uma mentoria e um tour pelas duas instituições.

Segundo Gremaschi, a experiência vai além de uma projeção para sua carreira profissional. “É claro que o ganho pessoal é muito importante, mas eu vejo isso como uma oportunidade de poder fazer mais para minha cidade e pelo meu país”, afirma.

A missão dos embaixadores selecionados é multiplicar as questões, de relevância pública de suas localidades, analisadas e debatidas durante as reuniões. Esta propagação será por meio de eventos regionais, organizado por estes acadêmicos, com a supervisão e orientação da equipe da conferência.