{"id":1508,"date":"2017-03-20T11:39:59","date_gmt":"2017-03-20T15:39:59","guid":{"rendered":"http:\/\/www.neomed.edu\/medicine\/?page_id=1508"},"modified":"2021-05-04T13:27:53","modified_gmt":"2021-05-04T17:27:53","slug":"cases","status":"publish","type":"page","link":"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/cases\/","title":{"rendered":"Case Based-Learning"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row content_width=&#8221;full&#8221; page_header_style=&#8221;normal&#8221; css=&#8221;.vc_custom_1603153553087{background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}&#8221;][vc_column]<div class=\"section \">\r\n<style>.vc_custom_1603152972348{border-top-width: 5px !important;border-bottom-width: 5px !important;padding-top: 100px !important;padding-bottom: 100px !important;background: #004963 url(https:\/\/www.neomed.edu\/medicine\/wp-content\/uploads\/sites\/2\/PAL_HDR_palliative-care.jpg?id=3062) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;border-top-color: #62b5e5 !important;border-top-style: solid !important;border-bottom-color: #62b5e5 !important;border-bottom-style: solid !important;}<\/style><section class=\"wpb-content-wrapper\"><p>[vc_row content_width=&#8221;full&#8221; page_header_style=&#8221;normal&#8221; css=&#8221;.vc_custom_1603152972348{border-top-width: 5px !important;border-bottom-width: 5px !important;padding-top: 100px !important;padding-bottom: 100px !important;background: #004963 url(https:\/\/www.neomed.edu\/medicine\/wp-content\/uploads\/sites\/2\/PAL_HDR_palliative-care.jpg?id=3062) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;border-top-color: #62b5e5 !important;border-top-style: solid !important;border-bottom-color: #62b5e5 !important;border-bottom-style: solid !important;}&#8221;][vc_column][vc_row_inner][vc_column_inner][vc_column_text]<\/p>\n<h1 class=\"page-header\" style=\"text-align: center;\">Office of Palliative Care<\/h1>\n<p>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n<\/section><\/div>[\/vc_column][\/vc_row][vc_row content_width=&#8221;full&#8221; css=&#8221;.vc_custom_1488901602222{background-color: #f5f6f6 !important;}&#8221;][vc_column][vc_row_inner][vc_column_inner width=&#8221;1\/3&#8243; css=&#8221;.vc_custom_1603153558563{padding-top: 200px !important;}&#8221;]<div class=\"sub-menu\">\r\n\t<ul>\t\t<li class=\"parent 6353 \">\r\n\t\t\t<a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/\">Office of Palliative Care<\/a><\/li>\t\t<li class=\"child 6353 \">\r\n\t\t\t<a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/about\/\">About<\/a><\/li>\t\t<li class=\"child 6353 \">\r\n\t\t\t<a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/\">Building Caregiver Partnerships<\/a>\t\t\t<ul class=\"subpages \">\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/film\/\">The Film<\/a>\t\t\t\t<\/li>\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/cases\/\">Case Based-Learning<\/a>\t\t\t\t<\/li>\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/\">Discussion Guides<\/a>\t\t\t\t\t<ul class=\"subpages \">\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/safe-spaces-for-discussion\/\">Safe Spaces for Discussion<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/faculty-guide\/\">Faculty Guide<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/for-medicine-students\/\">For Medicine Students<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/surgery-orthopedic-residency-guide\/\">Surgery & Orthopedic Residency Guide<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/discussion-guides\/themed-guide\/\">Themed Guide<\/a><\/li>\t\t\t\t\t<\/ul>\t\t\t\t<\/li>\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/acgme-milestones\/\">ACGME Milestones<\/a>\t\t\t\t<\/li>\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/education-models\/\">Education Models<\/a>\t\t\t\t\t<ul class=\"subpages \">\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/education-models\/interprofessional-team-based\/\">Interprofessional Team-Based<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/education-models\/medicinehealth-professions\/\">Medicine\/Health Professions<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/education-models\/structured-clinical-encounters\/\">Structured Clinical Encounters<\/a><\/li>\t\t\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/education-models\/structured-clinical-experiences\/\">Structured Clinical Experiences<\/a><\/li>\t\t\t\t\t<\/ul>\t\t\t\t<\/li>\t\t\t\t<li class=\"child subpage 6353 \"><a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/building-caregiver-partnerships\/feedback-assessment\/\">Feedback & Assessment<\/a>\t\t\t\t<\/li>\t\t\t<\/ul><\/li>\t\t<li class=\"child 6353 \">\r\n\t\t\t<a href=\"https:\/\/www.neomed.edu\/medicine\/palliativecare\/educational-media\/\">Educational Media<\/a><\/li>\t<\/ul>\r\n<\/div>[\/vc_column_inner][vc_column_inner width=&#8221;2\/3&#8243;][vc_column_text]<\/p>\n<h2>Case Based-Learning<\/h2>\n<p>[\/vc_column_text][vc_separator color=&#8221;custom&#8221; align=&#8221;align_left&#8221; border_width=&#8221;3&#8243; accent_color=&#8221;#404040&#8243;][vc_column_text]The following cases were developed to stimulate discussion on caregiving issues that residents and providers might encounter in a variety of settings including, office, outpatient clinic, hospital and on the phone.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row content_width=&#8221;full&#8221; css=&#8221;.vc_custom_1490024591287{padding-left: 30px !important;background-color: #f5f6f6 !important;}&#8221;][vc_column width=&#8221;1\/3&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;][vc_tta_accordion active_section=&#8221;0&#8243; collapsible_all=&#8221;true&#8221; css=&#8221;.vc_custom_1490024624836{margin-top: -30px !important;padding-right: 15% !important;}&#8221;][vc_tta_section title=&#8221;I Can\u2019t Believe This is Happening!&#8221; tab_id=&#8221;1490024538934-0761a353-5c20&#8243;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This case is written from a primary care perspective with a focus on end-of-life decision making and anticipatory guidance of the patient and caregiver. \u00a0This is a short-term caregiving situation where an older couple is suddenly faced with the wife\u2019s terminal diagnosis and rapidly declining health.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Describe key issues faced by the patient, the caregiver and the physician when making health care decisions for a patient suddenly given a terminal diagnosis.<\/li>\n<li>Discuss ways to help prepare the patient and the family caregiver for the illness trajectory, management of symptoms and care required for a terminal illness.<\/li>\n<li>Identify resources and referrals that could provide support to caregivers caring for persons at end of life.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System\u2013Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #2, and<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1, and<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Mrs. Palmer is a 72-year-old Caucasian female who is diagnosed with small cell lung cancer with metastasis to the liver. Her prognosis is poor with 4-6 months to live. Prior to her diagnosis, she was without any significant health problems. The diagnosis is so sudden that Mrs. Palmer nor her husband can comprehend the gravity of the situation. They request aggressive treatment.<\/p>\n<p>Mrs. Palmer and her husband have been married for 53 years and have two sons who live out of state and a daughter who lives locally. Mrs. Palmer, who has always had a great zest for living, sings in the church choir and helps with the care of her two grandchildren while her daughter works. Mr. Palmer, age 76, has advanced COPD which is managed by medication. Mr. and Mrs. Palmer live independently in a two story home.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What are your feelings\/assumptions about this case?<\/li>\n<li>What more information do you need from the caregiver?<\/li>\n<li>What are your goals and desired outcomes for the visit? \u00a0How are they the same and how are they different from the patient and caregiver?<\/li>\n<li>What could you do to better understand the patient\u2019s and caregiver\u2019s values and underlying issues?<\/li>\n<li>What do you do today?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>Mrs. Palmer does not respond well to the chemotherapy and becomes quite ill, requiring a great deal of care.\u00a0 Mr. Palmer encourages her to fight the cancer and feels she can beat it. \u00a0While his health has markedly deteriorated, he insists that he is able to take care of her at home.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What resources are available to help Mr. Palmer care for his wife at home?<\/li>\n<li>What is your role in insuring that Mr. Palmer gets the resources he needs to care for his wife?<\/li>\n<li>How do you prepare Mrs. and Mr. Palmer for her illness trajectory, symptom management and end-of-life care?<\/li>\n<li>How do you feel about continuing aggressive treatment? \u00a0What are some alternatives? How do you communicate this to Mrs. and Mr. Palmer?<\/li>\n<li>What concerns do you have about Mr. Palmer?<\/li>\n<li>How do you incorporate other family members into the situation? \u00a0What about their feelings, goals, input into the decisions?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nMargaret Sanders, M.A., LSW; Barbara Palmisano, B.S.N., M.A.; Jennifer Drost, D.O., M.P.H.; Steven Radwany, M.D.; and Ronald Jones, M.D.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Caregiver Nightmares&#8221; tab_id=&#8221;1490024538952-c1e81bb8-64f3&#8243;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This is a case of caregiver stress and burnout. An elderly woman, in a state of acute emotional distress, calls the physician in the night.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Describe ways to defuse a highly emotional phone encounter with a stressed family caregiver.<\/li>\n<li>Identify key information that you can obtain over the phone in order to assess the urgency of a stressful caregiving situation.<\/li>\n<li>Discuss the follow-up needed to further assess and provide ongoing support to the patient and caregiver who is under great duress.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1, and<\/li>\n<li>Interpersonal and Communication Skills #2<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1, and<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>You get a call in the night from Mrs. Riche, who is in tears. She says she cannot take the stress of caring for her husband any longer. She doesn\u2019t know what to do because she promised never to put him in a nursing home. Neither she nor her daughter sleep at night and she is becoming increasingly exhausted and overwhelmed. Mr. Riche is large in stature and difficult to manage when he is confused. She has had to call the neighbor several times in the night to help get him off the floor after a fall.<\/p>\n<p>Mr. Riche is an 84-year-old African American male with diabetes, hypertension and end-stage renal disease. He has been on dialysis three times a week for the past two years. Over the course of these two years, he has become increasingly frail, falls frequently and has suffered major complications from the dialysis. He has been hospitalized several times for infections and experienced severe confusion with each hospitalization. At times he became belligerent and aggressive with the hospital staff, especially at night.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What do you say to Mrs. Riche to help calm her down and defuse the situation?<\/li>\n<li>What more information do you need to know to assess the urgency of the situation?<\/li>\n<li>What are your options at this time?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>In the morning you talk to your colleague who has seen the patient for several years. \u00a0She tells you that Mr. Riche lives with his 86-year-old wife and 55-year-old daughter who is disabled. \u00a0He was always a kind and gentle man who generously took care of his family and friends. \u00a0His wife is devoted to his care and has refused to have help in the home.\u00a0 She has been diligent about preparing his special diet and managing his medications.\u00a0 During his last office visit Mr. Riche was lucid, well-groomed and pleasant. \u00a0When the caregiving situation was discussed at that visit, Mrs. Riche stated that things were fine.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What are your recommendations to your colleague?<\/li>\n<li>Who else should be involved in the case?<\/li>\n<li>What community resources might be available to help this family?<\/li>\n<li>What are your concerns and responsibilities to the caregiver?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<b><br \/>\n<\/b><b><\/b><\/h5>\n<p class=\" \">Case Authors<b><br \/>\n<\/b>Barbara Palmisano, B.S.N., M.A.; Margaret Sanders, M.A., LSW, Steven Radwany, M.D.; and Ronald Jones, M.D.<\/p>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Guardian Angela&#8221; tab_id=&#8221;1490025166853-007f8d76-c1f9&#8243;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This case focuses on management of the conflict of interest between the patient and caregiver\u2019s best interests due to complex medical and social issues in the home.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Discuss how the family dynamics and long term familial relationships may impact patient care and caregiver responsibilities<\/li>\n<li>Discuss issues to be considered in prioritizing a management plan in caregiving situations with complex medical and social problems.<\/li>\n<li>Describe the professional responsibilities to the patient and caregiver when their best interests are in conflict.<\/li>\n<li>Identify community mental health and service resources to aid families in conflictual caregiving situations.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Betty is a 55-year-old Caucasian female with multiple medical problems. She is bed bound from advancing multiple sclerosis. She had been neglected by her husband and has multiple pressure ulcers that require constant care. \u00a0She also has osteopenia, GERD, osteomyelitis, anemia, depression and glaucoma. Betty has a heart murmur from a congenital heart condition that was surgically repaired when she was a child. Betty is paraplegic with no feeling from the waist down. She has frequently recurring urinary tract infections and developed urinary incontinence. Because of spousal neglect, the daughter, Angela, moved Betty to her own home and provides round-the-clock care. Betty is now divorced, but is frequently tearful about still having feelings for her husband. He is not allowed to visit because he sexually abused Angela as a child and she wants nothing to do with him. He is also a frequent drug user. Betty is also distraught over her ex-husband getting their son involved in drugs as well. The son does not call or visit even though he is allowed to contact his sister.<\/p>\n<p>Betty, accompanied by Angela, comes to the office for routine visit. While Betty has many medical needs she has no new complaints. Angela, pulls you aside in the hallway and states that she has been struggling more to meet her mother\u2019s needs.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What are the caregiver issues Angela is dealing with?<\/li>\n<li>What are some of Angela\u2019s most pressing issues today?<\/li>\n<li>What resources might you suggest to help Angela and Betty?<\/li>\n<li>What other team members should be involved?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>ITransportation to the many specialists for medical care is difficult and is an all-day job to accomplish. Lifting Betty to give baths is too difficult for Angela on her own, so her husband helps with that. Her daughter or husband will occasionally watch Betty while Angela goes out, but even then she is on-call to them. Nursing home respite is available to Betty to give Angela a break, but Betty refuses to go saying she is afraid it will lead to permanent placement. The tension between Betty and Angela comes to a head when she brings up wanting to call her ex-husband. This disagreement has brought out anxiety and depressive symptoms in Angela related to PTSD that was never treated during her childhood. She also wonders how long she can keep up this kind of schedule.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What feelings\/biases does this case evoke from you?<\/li>\n<li>What are your responsibilities to Betty? \u00a0What are your responsibilities to Angela? \u00a0How are these in conflict? \u00a0How could the conflict be managed?<\/li>\n<li>How might you engage the caregiver\/family and patient in identifying their own strengths and weaknesses?<\/li>\n<li>What is your plan for follow-up?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Notes to Faculty<\/h5>\n<h6>Key Learning Points<\/h6>\n<ul>\n<li>It is important for residents\/learners to recognize how complex interpersonal dynamics and family histories impact current interactions with patients and caregivers. Identifying and giving voice to these histories may improve the caregivers\u2019 ability and quality of life to continue to provide care.<\/li>\n<li>It is important to ask what the caregiver\u2019s needs are rather than making assumptions based on the provider\u2019s values and perceptions.<\/li>\n<li>Communication and establishing a trusting relationship with both the patient and\u00a0 caregiver is a critical part of the management plan.<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Teaching Tips<\/h5>\n<p>This case would make a good role play. Look for key phrases in the learner that show empathy and non-judgmental approach to problem-solving.[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nJon Thomas, Ph.D.; David Sperling, M.D.; Jenifer Drost, D.O., M.P.H.; Michael Blackie, Ph.D.; Louise Highman, LSW; Barbara Palmisano, BSN, M.A.; Margaret Sanders, M.A., LSW; and Kristen Baughman, Ph.D.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Confusion, Conflicts &amp; Cars&#8221; tab_id=&#8221;1490025654736-844aee53-051f&#8221;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This is a case where safety is a concern for both the patient, who has dementia, and his wife who is his caregiver.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Describe the unique challenges of caring for a person with dementia.<\/li>\n<li>Discuss ways to address driving concerns and other major safety issues for the patient and caregiver.<\/li>\n<li>Identify team members and community resources that could help support caregivers of persons with dementia.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<li>Interpersonal and Communication Skills #2<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Maria (age 79) and Carlos (age 80), both Hispanic, are patients at the family medicine clinic. Maria has a history of hypertension, osteoarthritis, insomnia and general anxiety. Carlos has hypertension, osteoarthritis, hyperlipidemia, atrial fibrillation and dementia. Maria has always been dependent on Carlos to care for the house and do all of the driving. She has begun to do some of the driving, but it makes her very nervous. She has worsening insomnia because Carlos does not sleep very well. He will wake up and wander around the house digging into things for no reason. Household items come up missing (remote, keys, kitchen utensils) and are seldom found. Carlos has been taking memantine HCL for some time, but it seems of little use as his dementia progresses. The house has some safety\/maintenance issues that have gone unfixed. \u00a0Carlos can no longer handle it and they have limited income to hire someone. Today they are here at their daughter\u2019s urging because Carlos has become more oppositional and difficult with Maria.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What are the issues Maria is dealing with?<\/li>\n<li>What are the issues Carlos is dealing with?<\/li>\n<li>What are some cultural issues that should be explored?<\/li>\n<li>What more information would you like to have?<\/li>\n<li>What are Maria\u2019s and Carlos\u2019 most pressing needs today?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>Carlos refuses to listen to Maria and speaks angrily to her. \u00a0She tells you she cries every day because she does not know what to do for Carlos. \u00a0She cannot do things on her own because he cannot be left alone. \u00a0This causes her to feel lonely and she misses her friends from church and the beauty salon. \u00a0She tearfully confides that she worries he may become combative and she won\u2019t be able to handle him, but refuses to consider any type of placement. \u00a0\u201cI took care of my father and I plan to take care of Carlos.\u201d \u00a0Her daughter and son-in-law are willing to help, but they both work so have limited availability. \u00a0As the interview ends, \u201cOh by the way, he has been getting lost when he drives us around. \u00a0What should I do about that?\u201d<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What resources might you suggest to help Maria and Carlos?<\/li>\n<li>What team members do you engage in this case?<\/li>\n<li>Is your approach any different if both Maria and Carlos are your patients than if only Carlos is your patient?<\/li>\n<li>How do you communicate your concerns to Maria? To her daughter?<\/li>\n<li>What is your plan for follow-up?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nJon Thomas, Ph.D.; David Sperling, M.D.; Jennifer Drost, D.O.; Barbara Palmisano, M.A.; Margaret Sanders, M.A., L.S.W.; Michael Blackie, Ph.D.; and Kristin Baughman, Ph.D.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;How Did We Come to This?&#8221; tab_id=&#8221;1490025916315-d0f6a47b-9e1b&#8221;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This case takes place in a hospital setting and has a focus on informed consent and medical decision-making. \u00a0A key issue of the case is communicating options of treatment with family members including potential consequences on the patient\u2019s quality of life.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Describe ways to communicate treatment options, along with risks and benefits to family members to obtain informed consent for a patient.<\/li>\n<li>Discuss the challenges of family conflict over health care decisions at end-of-life and ways to attempt resolution.<\/li>\n<li>Identify team members who can assist families experiencing conflict in medical decision making for loved ones with terminal illness.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<li>Interpersonal and Communication Skills #2<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Mr. Chin Lee, an 83-year-old widowed male of Chinese decent, has moderate dementia. \u00a0Medical history discloses well controlled hypertension and stable coronary artery disease. \u00a0Surgical history includes a CABG ten years prior and remote appendectomy and cholecystectomy. \u00a0He is cared for at home by his daughter, Annie, who is a nurse. \u00a0Mr. Lee is fairly functional, but requires daily supervision due to his dementia and cannot live alone. \u00a0He is communicative and recognizes his family members, but is occasionally heard speaking Chinese dialect to his dead wife. \u00a0His son, James, also lives in the area and is involved in his care as well. James and Annie have been jointly making their father\u2019s medical decisions for the past two years, but neither one has an official medical POA.<\/p>\n<p>Mr. Lee presented to the emergency room with nausea and vomiting of two days\u2019 duration. Radiologic studies suggest a bowel obstruction and a nasogastric tube is placed for decompression.\u00a0 His symptoms rapidly resolve but further workup discloses an apple core lesion of the descending colon.\u00a0 There is no evidence of spread to the liver, lungs or lymph nodes. \u00a0When the findings are discussed with his children, James strongly favors surgical removal of the cancer. \u00a0Annie seems neutral.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What would you recommend to the children?<\/li>\n<li>Would you discuss it with Mr. Lee?<\/li>\n<li>What are the cultural issues to consider?<\/li>\n<li>How specifically would you consent the procedure with the children?<\/li>\n<li>What contingencies would you discuss?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>After surgery, Mr. Lee initially does very well. \u00a0He begins taking liquids by day 4 and is ambulating with the assistance of staff and physical therapy. \u00a0At 4 AM on postoperative day 5 he becomes increasingly confused and his condition deteriorates. \u00a0He is tachycardic, tachypneic and hypoxic and is found to have a right lower lobe pneumonia which is likely due to aspiration. He requires transfer to ICU, intubation and mechanical ventilation. \u00a0He improves slowly with antibiotics and pulmonary toilet. \u00a0By postoperative day 10 he is able to be extubated. \u00a0He\u00a0is awake, but is more confused than his baseline.\u00a0 A fluoroscopic swallow study demonstrates poor oropharyngeal muscle control and obvious vocal cord penetration.\u00a0 The recommendation is made for PEG tube placement.\u00a0 In addition, you are concerned that his respiratory status may deteriorate again and want to address possible re-intubation with the family.<\/p>\n<p>Annie states that her father\u2019s condition is going down a road they didn\u2019t want to travel. \u00a0He had always said that he didn\u2019t want to \u2018be kept alive on a machine\u2019. \u00a0He was a proud and fiercely independent man prior to his dementia. \u00a0She confessed that she was a bit reluctant about consenting to the surgery, but her brother it was adamant. \u00a0Now she regrets the decision and wants to stop all further treatment. \u00a0James wants to continue an aggressive approach. \u00a0He wants him to have a PEG and remain Full Code. \u00a0He says that his father has always been a very strong man.\u00a0 He feels that Mr. Lee will be able to pull through this and thinks that Annie is \u201cgiving up on Dad too early\u201d.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>How would you discuss this with the children?<\/li>\n<li>Who makes the final decision?<\/li>\n<li>What role does Mr. Lee play in this process?<\/li>\n<li>For what contingencies do you prepare the children?<\/li>\n<li>From whom do you seek assistance?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nSteven Radwany, M.D.; John Fondran, M.D.; and Barbara Palmisano, B.S.N., M.A.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;I Know Her Best&#8221; tab_id=&#8221;1490026110770-4597eda6-db74&#8243;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This scenario takes place in the hospital and involves conflicted family dynamics and disagreements over patient values and quality of life issues.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Identify ways to assess patient values and wishes when there are no written advance directives.<b><\/b><\/li>\n<li>Describe the considerations of the caregiver when she\/he has no legal rights as decision-maker.<b><\/b><\/li>\n<li>Discuss approaches and resources that may assist in resolving family\/caregiver conflicts.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<li>Interpersonal and\u00a0Communication Skills #2<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Jackie, is a 66 year old Caucasian female who is brought into the emergency room unresponsive. \u00a0Her friend, Fran, found her unconscious on the floor and called for emergency transport. \u00a0She is immediately transferred to ICU and put on a ventilator. \u00a0She has never married and her closest relative is a sister who lives four hours away. \u00a0The sister is contacted by phone and tells you, that to the best of her knowledge, Jackie has no advance directives. \u00a0The sister insists that Jackie be full code.<\/p>\n<p>Jackie was diagnosed with lymphoma ten years ago and was treated by chemotherapy resulting in damage to her heart. \u00a0Over the years she has become functionally dependent in most of her ADLs due to her shortness of breath, chest pain and frailty. \u00a0Fran, who has lived with her for almost 30 years, is her full-time caregiver.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>How do you feel about Jackie\u2019s code status?<\/li>\n<li>What more information do you need? \u00a0Who do you get the information from?<\/li>\n<li>How do you determine what Jackie would want done?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>The next day Jackie\u2019s sister arrives with her two adult children. \u00a0They have not seen Jackie in several years, but they say they were close to her. \u00a0They state that Jackie had a fear of dying and, therefore, did not go to the doctor very often after her chemotherapy was completed.\u00a0 They seem to resent Fran and feel that she kept Jackie isolated from them. \u00a0They ask you to put Jackie on a heart transplant list and be very aggressive in her treatment.<\/p>\n<p>Fran asks to speak to you in private. \u00a0Fran tells you that she and Jackie have been partners for 35 years, but Jackie was never comfortable in disclosing their relationship to others. \u00a0She is adamant that Jackie would not want aggressive treatment. \u00a0Jackie and she have had long talks about their religious beliefs and what death might be like. \u00a0Fran tearfully tells you that Jackie was concerned that she was becoming a burden and was prepared for death. \u00a0While Fran is not ready to lose her, she will honor her wishes and have her die in peace at home.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>How does this information change your treatment plan?<\/li>\n<li>Who has the right to make the decisions on Jackie\u2019s behalf?<\/li>\n<li>Which team members would you involve to help with this case?<\/li>\n<li>What are issues\/concerns facing Fran as Jackie\u2019s caregiver?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nSteven Radwany, M.D.; John Fondran, M.D.; and Barbara Palmisano, B.S.N., M.A.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Missing Mom&#8221; tab_id=&#8221;1490026379151-3046295d-3fed&#8221;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This case highlights the impact of the loss of the caregiving role and complicated grief. \u00a0This is a long term caregiving situation where the son is the full-time care provider.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Identify risk factors and symptoms of complicated grief for caregivers.<\/li>\n<li>Describe how to communicate personal loss after the death of a patient and express condolences to family members.<\/li>\n<li>Discuss how gender biases may impact the provider\u2019s interactions with caregivers.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<li>Interpersonal and Communication Skills #2<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>\u00a0Medical Knowledge #2<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p>Dave comes to your office with complaints of depression, fatigue and lack of motivation. \u00a0He is the son and was the primary caregiver of your patient, who died six months ago from long term complications of a stroke. \u00a0You cared for her for years and despite her complicated medical problems, she always had a smile and was a delight to be with. \u00a0Dave cared for his mom in his home for 7 years. \u00a0The last three years she required 24 hour care and became increasingly dependent on her son for all activities of daily living. \u00a0They had a home health aide three days a week for her personal care, but she was very anxious when he was not in the home. \u00a0He retired early from his position as director of Habitat for Humanity. \u00a0His sister who lives out of town provided some financial assistance and visited when she could to give him a brief respite.\u00a0 Because of his mom\u2019s care needs in the past several years he was not able to come see you for his medical issues.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>How do you express your condolences to Dave?<\/li>\n<li>What is your first step in assessing Dave\u2019s symptoms?<\/li>\n<li>Is his grief normal? \u00a0What potentially complicates his grief?<\/li>\n<li>What other things do you want to know about Dave?<\/li>\n<li>What concerns do you have for his well-being?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>Dave confides that he has lost touch with many of his friends as they did not understand why he did not place his mom in a nursing home so that he could continue to live his life. \u00a0David and his mom had always had a special relationship and he felt privileged to be able to care for her. \u00a0He no longer knows what to do with his days and feels lost and without purpose. \u00a0His sister encourages him to relocate close to her in California where he can get a fresh start.\u00a0 He knows that his mom would want him to be happy. \u00a0He has always tried to live a healthy life and is reluctant to take medications.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What questions do you ask Dave about his goals and quality of life?<\/li>\n<li>How important is having a sense of purpose?<\/li>\n<li>Who would you involve in Dave\u2019s care?<\/li>\n<li>Do you react differently to Dave being a son than you would if the caregiver were a daughter?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Notes to Faculty:\u00a0Key Learning Points<\/h5>\n<ul>\n<li>Building partnerships with caregivers continues through grief and bereavement.<\/li>\n<li>While others may view the loss of the caregiving role as a relief, the caregiver may feel lost and depressed.<\/li>\n<li>It is important to recognize complicated grief and to treat it.<\/li>\n<li>Gender biases to caregiving and grief.<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nJennifer Drost, D.O., M.P.H. and Barbara Palmisano, B.S.N., M.A.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Why Can&#8217;t He Stay?&#8221; tab_id=&#8221;1490026670424-faf0784c-5276&#8243;][vc_column_text]<\/p>\n<h5>Case Background<\/h5>\n<p>This case takes place in the hospital one or two days to anticipated discharge. \u00a0The case focuses on communication and teaching the patient and caregiver for effective discharge planning.[\/vc_column_text][vc_column_text]<\/p>\n<h5>Learning Objectives<\/h5>\n<ol>\n<li>Discuss ways to approach discharge planning with the patient and caregiver who are overwhelmed with home care needs.<\/li>\n<li>Describe the teach-back method for effectively training patients and caregivers to give specific treatments.<\/li>\n<li>Identify ways to optimize patient and caregiver education and support with complicated discharge situations.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Relevant Milestones<\/h5>\n<h6>Internal Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #1<\/li>\n<li>Professionalism #3<\/li>\n<li>Interpersonal and Communication Skills #1<\/li>\n<li>Interpersonal and Communication Skills #2<\/li>\n<\/ul>\n<h6><\/h6>\n<h6>Family Medicine<\/h6>\n<ul>\n<li>Patient Care #2<\/li>\n<li>Medical Knowledge #2<\/li>\n<li>System-Based Practice #1<\/li>\n<li>System-Based Practice #4<\/li>\n<li>Professionalism #3<\/li>\n<li>Communication #1<\/li>\n<li>Communication #2<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part I<\/h5>\n<p class=\"Default\">Mr. Rankin, a 72-year-old African American male, is admitted for a foot ulcer and osteomyelitis. He has Type II Diabetes and a HbA1C of 11.3. He underwent a transmetatarsal amputation as he would not consent to a below-the-knee amputation. The surgeons were unable to debride all the infected bone. Mr. Rankin has a PICC line and will be going home on intravenous antibiotics. The surgical team spoke to Mr. Rankin about going home on IV antibiotics, Insulin and with a wound vac.<\/p>\n<p class=\"Default\">Mr. Rankin has lived with his brother in a two story home for the past ten years. Mr. Rankin feels he will need skilled help in the home as his brother is squeamish about medical care. His brother has expressed concerns that he cannot care for him and wants him to remain in the hospital until all the treatments are completed. A bit reluctantly, Mr. Rankin agrees to learn to give himself the insulin shots.<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>What are the issues important to the discharge of Mr. Rankin?<\/li>\n<li>What team members would you involve in this case and what are their respective roles?<\/li>\n<li>How do you address Mr. Rankin\u2019s concerns?<\/li>\n<li>How do you approach Mr. Rankin\u2019s brother\u2019s concerns?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>Case Part II<\/h5>\n<p>Two days before discharge Mr. Rankin is instructed to self-administer his insulin. \u00a0The day before discharge, Mr. Rankin\u2019s brother comes to the hospital to observe the antibiotic injections which are to be given through the PICC line twice a day. \u00a0He is very nervous and concerned that he may give his brother another infection. \u00a0He asks if this is really necessary and why it can\u2019t be given in a pill. \u00a0He seems overwhelmed when you discuss the wound vac and changing the dressings three times a week. \u00a0You assure him that a home health nurse will come to change the dressing. He asks \u201cwhat will happen if there is a problem and the nurse is not there? \u00a0We live an hour away from the hospital?\u201d<\/p>\n<h6>Discussion questions<\/h6>\n<ol>\n<li>How would you approach Mr. Rankin\u2019s brother about his care needs? \u00a0How do you build trust and help alleviate his fears?<\/li>\n<li>How do you explain the importance of the treatments and their long term implications for Mr. Rankin\u2019s health?<\/li>\n<li>What are some specific things you can do to help transition Mr. Rankin home?<\/li>\n<li>What kind of follow-up will Mr. Rankin need?<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h5>References<\/h5>\n<p>Case Authors<br \/>\nKatherine H. Suddarth, M.D.; Ronald Jones, M.D.; Steven Radwany, M.D.; and Jennifer Drost, D.O., M.P.H.[\/vc_column_text][\/vc_tta_section][\/vc_tta_accordion][\/vc_column][\/vc_row][vc_row content_width=&#8221;full&#8221; css=&#8221;.vc_custom_1539629530859{border-bottom-width: 5px !important;background-color: #a9b54a !important;border-bottom-color: #62b5e5 !important;border-bottom-style: solid !important;}&#8221;][vc_column][vc_row_inner][vc_column_inner]<div class=\"section darkgray\">\r\n<style><\/style><section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;darkgray&#8221;]<\/p>\n<h4>Contact<\/h4>\n<p>Margaret Sanders, M.A., LSW<br \/>\n<strong>Email:\u00a0<\/strong><a href=\"mailto:mbs@neomed.edu\">mbs@neomed.edu<\/a><\/p>\n<p>Kathleen Enoch<br \/>\n<strong>Email:<\/strong> <a href=\"mailto:kenoch@neomed.edu\" rel=\"noreferrer\">kenoch@neomed.edu<\/a><\/p>\n<p>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;darkgray&#8221;]<\/p>\n<h4>Building Caregiver Partnerships<\/h4>\n<p><em>This site contains a free compendium of educational tools and resources on issues of family caregiving for health professions faculty, providers and students.<\/em><\/p>\n<p><em>Co-sponsored with Summa Health and funded by the Arthur Vining Davis Foundations.<\/em>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243;][vc_column_text el_class=&#8221;darkgray&#8221;]<\/p>\n<h4>Office of Palliative Care<\/h4>\n<p><a href=\"https:\/\/www.neomed.edu\/medicine\/\"><i>Department of Family &amp; Community Medicine<\/i><\/a>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/section><\/div>[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row content_width=&#8221;full&#8221;][vc_column]<div class=\"section \">\r\n<style>.vc_custom_1718723061118{margin-top: 0px !important;margin-bottom: 0px !important;}.vc_custom_1718722900934{margin-bottom: 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